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Nursing home abuse takes many forms: emotional, financial, neglect, and physical assault are just a few. Nursing Homes are full of vulnerable elders who are the most susceptible to abuse. Many suffer from dementia or other disabiltiies and are unable to tell anyone aqbout the abuse they are suferring or are not aware of it.

The infographic below provides information regardnig the severity of nursing home abuse issue and warning signs of abuse. Incidents of nursing home abuse are rarely reported to the proper authorities. No matter what form it takes, nursing home abuse is wrong and needs to be stopped.

Nursing Home Abuse Infographic

Nursing Home Abuse infographic brought to you by Sokolove Law

I hope this helps you see signs of abuse if it is ocurring.
JL

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Effective pain recognition and management requires a continuous facility-wide commitment to every resident’s comfort, to identifying and addressing barriers to managing pain, and to addressing any misconceptions that residents, families, and staff may have about managing pain. As discussed previously, nursing home residents are at high risk for having pain that may affect function, impair mobility, impair mood, or disturb sleep, and diminish quality of life. The onset of acute pain may indicate a new injury or a potentially life-threatening condition or illness. It is important, therefore, that a resident’s reports of pain, or nonverbal signs suggesting pain, be evaluated.

Care plans for pain should be developed and the resident’s needs and goals as well as the cause, type, and severity of pain are needed to develop an adequate and appropriate plan of care for pain management. It is also important to consider treating the underlying cause, where possible in order to remove the cause of the pain. Understanding the underlying causes of pain is an important step in determining optimal approaches to prevent, minimize, or manage pain. Addressing those underlying causes may permit pain management with fewer analgesics, lower doses of analgesics and narcotics, or the use of medications with a lower risk of serious adverse consequences.

Certain factors may affect the recognition, assessment, and management of pain. For example, residents, staff, or practitioners may misunderstand the indications for, and benefits and risks of, opioids and other analgesics; or they may mistakenly believe that older individuals have a higher tolerance for pain than younger individuals, or that pain is an inevitable part of aging, a sign of weakness, or a way just to get attention. Other challenges to successfully evaluating and managing pain may include communication difficulties due to illness or language and cultural barriers, stoicism about pain, and cognitive impairment.

It is a challenge for the nursing staff to assess and manage pain in individuals who have cognitive impairment or communications difficulties. Some individuals with advanced cognitive impairment can accurately report pain and/or respond to questions regarding pain and others cannot. Those who cannot report pain may exhibit nonspecific signs such as grimacing, increase in confusion or restlessness or other distressed behavior. Effective pain management may decrease distressed behaviors that are related to pain. However, these nonspecific signs and symptoms may reflect other clinically significant conditions such as delirium, depression, or medication related adverse consequences, instead of, or in addition to, pain. To distinguish these various causes of similar signs and symptoms, and in order to manage pain effectively, it is important for facility nurses to evaluate the resident in detail, to confirm that the signs and symptoms are due to pain. Nursing assistants may be the first to notice a resident’s symptoms; therefore, it is important that they too are able to recognize a change in the resident and the resident’s functioning and to report the changes to a nurse for follow-up. Family members or friends may also recognize and report when the resident experiences pain and may provide information about the resident’s pain symptoms, pain history and previously attempted interventions. Other staff, e.g., dietary, activities, therapy, housekeeping, who have direct contact with the resident may also report changes in resident behavior or resident complaints of pain.

Nurses and other healthcare practitioners should look for interventions that are resident specific since the cause of pain is different for each person. Staff should try to prevent and minimize pain that is anticipated to occur due to a process or procedure. Non-pharmacological interventions should also be planned and implemented to complement the use of pharmacological interventions.

Remember – be your own advocate!

JL

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It wasn’t too many years ago that pain was often misunderstood or ignored in the Long Term Care Facility geriatric population and especially in those residents with cognitive impairment who could not verbally express the level of pain they were in. Unrelieved pain often causes residents to have behavioral changes such as resisting care, pacing, depression, negative verbalizations, facial expressions, and self-harm. It has significant consequences in the areas of function as pain causes a decrease in ability to perform activities of daily living. It leads to sleep deprivation, which can decrease pain thresholds, limit the amount of daytime energy and increase the incidence and severity of depression and mood or behavioral disturbances. Pain can cause changes in walking, skin color, vital signs, and appetite.

Now though pain management is under intense scrutiny in the CMS survey process in Long Term Care Facilities. F-tag 309 provides extensive pain management guidance and investigative protocols for Nursing Home Surveyors to follow.

Facilities must recognize and manage pain in residents in order to help each resident attain or maintain the highest practicable level of well-being for that resident. In order to accomplish that each facility must, to the extent possible, recognize when the resident is experiencing pain and identify circumstances when pain can be anticipated; evaluate the existing pain and the cause(s), and manage or prevent pain, consistent with the comprehensive assessment and plan of care developed for that resident, current clinical standards of practice, and the resident’s goals and preferences.

The guidance basically states that nursing facilities must assess and address pain in all residents, including the cognitively impaired. The guidance gives surveyors new direction to cite facilities that do not adequately manage pain with deficiencies. The guidance to surveyors at F309 helps the Nursing Home and Hospital Surveyor to determine if the facility is fulfilling these requirements in regards to pain management in the residents of that healthcare facility.

We will continue more about pain in the next installment of Pain Management in the Nursing Home. Meanwhile – Keep safe and be your own advocate in the healthcare world!

JL

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When you become aware of mistreatment of a nursing facility it is important to get your loved one the medical treatment they need and then get into ‘fact collection mode’.  In fact collection mode, you are beginning to collect information about the incident, acts of the nursing home staff and medical condition of your loved one. Doing some preliminary work before you meet with a lawyer will prove for a more effective meeting.

Don’t assume you won’t forget information regarding the incident. As time goes on, your memory will begin to fade. The following steps will help you organize your thoughts during a stressful time and to give an attorney the information he needs to work best on your behalf.

Despite the urge to block out the unpleasant facts and circumstances leading to an injury, much of the information listed below should be obtained as soon after an incident as feasible.  The following information will prove to be valuable in both assessing the facilities responsibility and potentially as evidence to be used at trial.

Photographs– Take pictures of the physical injuries themselves, the area where the incident took place and if possible, the people involved.  In cases involving particularly gruesome medical conditions (pressure sores, amputations, surgical wounds) no medical record can do justice to what your loved one experienced.  Use a real camera as opposed to a camera-phone as the photos will be better quality.

Start Writing– Write down as much information about the incident or events as you can remember. Write some more. Details can be particularly helpful in the course of litigation as many nursing homes have high rates of employee turnover that can make obtaining information difficult.  Concentrate on: names, dates, room numbers, names of facilities and medication dosages (if relevant).

Medical Chart– The medical chart from a nursing home and / or hospital is crucial to determining what a facility may have done or failed to do that resulted in injury or death.  If your loved one sustained an injury that resulted in subsequent medical care at a hospital, these records will be important as well.

Chronology– This does not need to be one’s life story.  However, if a condition developed over time or there are multiple facilities that may responsible for the injury or condition, it is important get the correct names and general dates of admission at health care facilities.  The names of doctors who provided medical can be helpful as well.

Other Relevant documents: Healthcare Power of Attorney, wills, death certificates, pre-injury photographs, autopsy reports and nursing home inspection reports all can be helpful when meeting with an attorney.  Bring them with.

There really is no such thing as providing a lawyer with too much information.  An experienced nursing home lawyer will be able to sort through the materials and determine what information is relevant to your case.  Further, a law office that regularly handles nursing home matters should be able to access much of the above information with the use of properly executed medical authorizations. 

The bottom line is that you should not let your inability to access certain information delay from meeting your meeting with an attorney as soon as you are comfortable.  Meeting with an attorney soon after an incident will provide the best opportunity to secure information relevant to your case.

Jonathan Rosenfeld represents individuals and families in cases against nursing homes and long-term care facilities.  Jonathan is the author of the Nursing Homes Abuse Blog

Admin Note: Thank You Jonathan for your great Guest post. To all my readers, if you have soemthing you would like to say or something you would like to see, please feel free to e-mail me!

JL

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