Weight Loss From Nursing Home Abuse

The Six Warning Signs, What They Mean

Weight Loss

One of the least obvious warning signs of nursing home abuse but also one of the most dangerous is sudden or severe weight loss.  Weight loss can be caused by a number of factors, including dehydration, life-threatening illness, and poor quality of food.  Undocumented weight loss in any nursing home resident should raise strong suspicions about the quality of care your loved one is receiving.

The Dangers of Weight Loss, Dehydration and Malnutrition

As you’ve probably heard, our bodies are composed primarily of water.  Water is in fact vital to life and to proper organ functioning.  And a large portion of our variable body weight is from water retention.  When the body begins losing more water than it takes in, dehydration occurs.  Dehydration causes exhaustion throughout the body.  More dangerously, dehydration causes a decrease in blood pressure and this, in turn, reduces the blood’s ability to deliver important nutrients to the body.

Weight can also be lost in nursing homes through a patient’s eating less.  When we do not eat a regular, balanced diet, the body begins to draw nutrients from its stores of body tissues.  At first the body will burn fat deposits for its needed energy, but when fat reserves fall low, the body then begins eating its own muscles, including those that beat the heart.  But even by cannibalizing itself the body only gets enough energy to barely keep basic processes going.  As the malnourished body degenerates, the chance of infection and illness increases.

Why Nursing Home Residents are Weight Loss Prone

As our bodies age, so do our senses.  The deadening of the senses of taste and smell requires special attention on the part of nursing home staff to ensure facilitated care residents are receiving and finishing their meals.  Unappetizing food can have similar results, as can medication.

Certain prescription drugs, both doctor-prescribed and staff-abused (restraints), can also diminish appetite.  Oddly enough, not eating can also weaken appetite in a vicious circle of starvation.  No matter what the cause, no person under nursing home care should be denied the attention and concern necessary to make sure meals are edible, healthy, and eaten.

Take Heavy Action against Negligent Nursing Homes

All it takes is a single voice.  Cases tried and won in the past ten years have helped bring the horrors of nursing home abuse and neglect to the public’s attention and have ensured that better care is provided to all of our mothers and fathers in facilitated care.

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6 Warning Signs of Nursing Home Abuse & Neglect

Many warning signs of nursing home abuse and neglect are overlooked or thought to be a common part of growing old.  Undue pain, abandonment, and premature death should not be part of the nursing home experience.  The following Six Warning Signs could save the life of your parent or prevent serious pain and harm:

Please Note: These six nursing home abuse warning signs are not presented in ranking order.  All six are equally serious and warrant further investigation.

If you notice any of these warning signs of nursing home abuse or neglect, please contact us immediately.

Weight Loss

(Additional information on Nursing Home Weight Loss)
Both medication and advanced age’s deadening of senses can affect appetite.  Negligent nursing homes often do not have the staff or the caring spirit needed to make sure their residents receive necessary nutrition and hydration.  Without proper nutrition, the body begins to eat itself in a serious medical condition called “cachexia.”  Additionally, susceptibility to disease increases with malnutrition as does your loved one’s suffering.

If you notice your relative in nursing home care losing weight, especially if other abuse and neglect warning signs are present, don’t wait—contact Consumer Justice Group immediately to begin an investigation. 

Bruises

(Additional information on Nursing Home Bruises)
Families of nursing home residents should demand answers when they see bruises on a loved one’s body.  Bruises (actually pools of blood from broken capillaries) heal slowly in people with poor circulation.  Bruises often occur when a nursing home resident is struck by a member of the nursing home staff or when the resident is allowed to fall.  Any bruise or cut requires both medical attention and an evaluation to determine its cause. Sometimes a bruise may support evidence of sexual abuse.

Falls

(Additional information on Nursing Home Falls)
Serious and/or frequent falls are a definite symptom of nursing home neglect.  It is the legal responsibility of a nursing home to develop a nursing care plan for each nursing home resident to help prevent falls.  Do not let what might seem like minor falls go undocumented, especially as they may lead to major medical expenses.  Nursing home falls can result in lasting injury, sometimes fatal.  Nursing home falls can and should be prevented.

If you suspect your parent or loved one shows symptoms of nursing home neglect, contact the Consumer Justice Group.  Our experienced professionals will analyze cost-free this and other telltale signs of abuse and severe neglect and find a lawyer suited to your specific case if civil action can and should be taken. 

Bedsores

(Additional information on Nursing Home Bedsores)
Bedsores are sometimes called pressure sores or decubitous ulcers.  These sores are caused by poor nutrition and prolonged pressure on the bodies of patients permitted to lie unattended for long periods of time.  Bedsores are painful.  At Stage 1, bedsores appear as painful red inflammations on the skin.  By Stage 4, a bedsore eats through skin and muscle to expose bone.  There is no reason for a properly cared for nursing home resident to suffer this neglect and abuse.

Restraints

(Additional information on Nursing Home Restraints)
Nursing homes use both physical and chemical restraints on their patients.  Physical restraints involve any method that the individual cannot remove easily and which restricts freedom of movement such as leg restraints, arm restraints, hand mitts, cuffs, wheelchair safety bars, bedrails, and lap pillows.  Abusive nursing homes also restrain your loved ones by tucking their bedsheet so tightly that they cannot move or turn those under their facilitated care into zombies by forcing them to take heavy sedatives to make them more manageable.

Staff Inattention

(Additional information on Nursing Home Staff Inattention)
Nursing homes are businesses, and one way many business owners increase profits is by cutting labor costs.  Many nursing homes are understaffed and nurses and care providers overworked.  When the staff can’t respond in a timely manner, mistakes happen.  Pills are given too often or not at all.  Patient hygiene suffers.  Signs of serious illness are overlooked.  Staff inattention and failure to respond to patients’ requests is the number one complaint filed against nursing homes.  Nursing homes residents need special care.  Do not remain quiet if you feel your loved one is not receiving the attention or not being treated with the dignity by a nursing home.  Speak up.  Contact the Consumer Justice Group to learn what action you can take to get the justice your loved ones deserve.

Advance Medical Directive

An Advance Medical Directive (commonly referred to as a “living will”) is especially vital to the care of nursing home residents to ensure their medical wishes will be honored even if they are unable to fight for themselves.  The times when we suffer overwhelming feelings of powerlessness are our scariest moments.  This is especially true for residents of nursing homes who may be unable to speak or think clearly when important medical decisions are needed.  Be prepared.  What happens to your mother or father in nursing home care after they’ve suffered a severe stroke or fallen into a coma may be decided by others unless you have an Advance Medical Directive already prepared and on file.

What’s Covered in an Advance Medical Directive?

An Advance Medical Directive is the document which cares for patients’ entire well-being and wishes while they are unable to express themselves.  While preferred forms of treatment can be included, the Advance Medical Directive is usually a restrictive, or “what not to do,” document.  Often, it outlines those procedures patients would prefer not to undergo, such as certain forms of cancer treatments or medical practices that may violate their religious beliefs.

More important for nursing home residents, an Advance Medical Directive is the document which tells doctors if and when they should “pull the plug.”  Suppose the unthinkable happened and an understaffed nursing home mixes up medication schedules causing your parent to have a cardiac arrest.  Should the hospital doctors resuscitate?  How long would your mother or father wish for a machine to feed them?  Breathe for them?  Though these subjects are always tough to talk about, these very real facts of later life need to be discussed and officially documented.  Without an Advanced Medical Directive, mom or dad’s verbal wishes are not legal evidence for deciding what kind of care they receive.

Who Gets a Copy of the Advance Medical Directive?

Any nursing home facility and hospital your loved one attends should be given a copy of the Advance Medical Directive and should keep it on file.  Additionally, primary care physicians, family members, and the person designated with Power of Attorney should all receive copies.  You should have as many relatives and friends of the family present as possible when the Advance Medical Directive is signed.  The more people who know these wishes, the better the chance the appropriate actions will be taken.  Similarly, many sons and daughters with a parent in a nursing home have a copy kept at their place of worship and keep an extra copy safely at their house in a home medical file or with other important documents in a fireproof container.

Crossing Legal t’s and Dotting State i’s

Advance Medical Directive laws vary with every state in the U.S.  It is best to obtain a copy from your local state health department office, the local agency on aging, or a hospital.  Or you can use the Consumer Justice Group’s free form – click here to open.  (Please note: This is a free service and not intended as legal advice.)  You will also need to schedule to have a notary present for notarization.  Again, it is best to gather as many relatives together as possible and to s

Assessing Nursing Home Facilities

 

It is vital for your family member that you spend a considerable amount of time researching the nursing home before you send him or her to one. Do not judge the nursing home on the basis of a guided tour or the nice furniture or attractive physical features of the facility.

Click on the topics above for tips on assessing nursing homes and to obtain information about other types of nursing care facilities.

Visit with residents

You should find at least one resident whom you can visit in the facility. This will help you in evaluating the facility without a guided tour. Walk up and down the halls and talk to bedridden residents and those who are wheelchair bound. As you talk to them, check out their grooming, skin quality, nail care and oral care. See if the residents appear upbeat or if they are depressed. If almost everyone you talk to is confused and unable to have a normal conversation, this could be cause for concern.

Assisted living facilities

Assisted living offers a wide range of services with a wide range of monthly fees. If your loved one needs assistance getting through the day, but doesn’t require the intensive supervision and medical services of a nursing home, assisted living may be a better option. Take the time and investigate state agencies which may assist with payment for assisted living facilities.

Services, staffing, and philosophy of this type of housing vary enormously. It is very important that you determine exactly what is offered in each home. Look for a place that encourages residents to be active. People who have been loners all their lives are unlikely to adapt well to congregate living, and a mentally alert person doesn’t belong in a small home with cognitively impaired people. Make sure the person is suited to assisted living.

If you disagree with certain provisions in the admission contract, see if you can modify or eliminate them. Contracts should allow for a minimum of 30 days notice if the facility desires to end the agreement. You should know who makes the decision regarding transfers when a resident’s health declines. Remember, assisted living facilities are not immune from the same problems facing nursing homes, particularly the difficulty of keeping a stable staff.

What You Can Do

Quick remedies for nursing home abuse and neglect

  • Visit frequently. Vary your visits to different times of the day and evening to assess the care provided during all times of the day, night, weekends, and holidays.
  • Talk to nurses and aides about your concerns.
  • Talk to the Director of Nurses, Social Worker and Administrator.
  • Talk to the doctor.
  • Call the ombudsman.
  • Call your state survey agency. In each state there is a division of the Department of Health which deals with oversight of nursing homes and enforcement of nursing home regulations. This agency conducts yearly surveys of each nursing home and also investigates complaints filed by family members. Find out who the state licensing agency is from your nursing home. They are required to provide this information to you when your place a resident in the nursing home.
  • If you believe the nursing home resident is a victim of any form of abuse or neglect by the nursing home you can and should file a complaint with your state Licensing and Certification division; they are required to investigate your complaint. The state Licensing and Certification division may substantiate your complaint; if they do so, the agency has the authority to issue a citation against the facility, impose a fine, and require corrective action.

Federal Regulations and Nursing Homes

 

Nursing homes that receive federal funds must comply with federal legislation that calls for a high quality of care. Though all states must comply, at a minimum, with the federal regulations, some states have adopted tougher laws.

In response to reports of widespread neglect and abuse in nursing homes in the 1980s, Congress enacted legislation in 1987requiring nursing homes participating in the Medicare and Medicaid programs to comply with certain requirements for quality of care. This law is also known as the Nursing Home Reform Act. It specifies that a nursing home “must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. …”

To participate in the Medicare and Medicaid programs, nursing homes must comply with the federal requirements for long term care facilities.

Under the regulations, the nursing home must:

  • Have sufficient nursing staff. (42 CFR §483.30)
  • Conduct initially a comprehensive and accurate assessment of each resident’s functional capacity. (42 CFR §483.20)
  • Develop a comprehensive care plan for each resident. (42 CFR §483.20)
  • Prevent the deterioration of a resident’s ability to bathe, dress, groom, transfer and ambulate, toilet, eat, and to communicate. (42 CFR §483.25)
  • Provide, if a resident is unable to carry out activities of daily living, the necessary services to maintain good nutrition, grooming, and personal oral hygiene. (42 CFR §483.25)
  • Ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities. (42 CFR §483.25)
  • Ensure that residents do not develop pressure sores and, if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing. (42 CFR §483.25)
  • Provide appropriate treatment and services to incontinent residents to restore as much normal bladder functioning as possible. (42 CFR §483.25)
  • Ensure that the resident receives adequate supervision and assistive devices to prevent accidents. (42 CFR §483.25)
  • Maintain acceptable parameters of nutritional status. (42 CFR §483.25)
  • Provide each resident with sufficient fluid intake to maintain proper hydration and health. (42 CFR §483.25)
  • Ensure that residents are free of any significant medication errors. (42 CFR §483.25)
  • Promote each resident’s quality of life. (42 CFR §483.15)
  • Maintain dignity and respect of each resident. (42 CFR §483.15)
  • Ensure that the resident has the right to choose activities, schedules, and health care. (42 CFR §483.40)
  • Provide pharmaceutical services to meet the needs of each resident. (42 CFR §483.60)
  • Be administered in a manner that enables it [the nursing home] to use its resources effectively and efficiently. (42 CFR §483.75)
  • Maintain accurate, complete, and easily accessible clinical records on each resident . (42 CFR §483.75)

Financial Abuse – Essential Factual Elements

California Civil Jury Instructions (CACI)

3100. Financial Abuse – Essential Factual Elements (Welf. & Inst. Code, � 15610.30)

[Name of plaintiff] claims that [name of defendant] violated the Elder Abuse and Dependent Adult Civil Protection Act by taking financial advantage of [him/her/[name of decedent]]. To establish this claim, [name of plaintiff] must prove all of the following are more likely to be true than not true:

1. That [name of defendant] [insert one of the following:]

[[took/hid/appropriated/retained] [name of plaintiff/ decedent]’s property;]

[[assisted in [taking/hiding/appropriating/retaining] [name of plaintiff/decedent]’s property;]

2. That [name of plaintiff/decedent] was [65 years of age or older/a dependent adult] at the time of the conduct;

3. That [name of defendant] [[took/hid/appropriated/retained]/ assisted in [taking/hiding/appropriating/retaining]] the property [for a wrongful use/[or] with the intent to defraud];

4. That [name of plaintiff/decedent] was harmed; and

5. That [name of defendant]’s conduct was a substantial factor in causing [name of plaintiff]’s harm.

[One way [name of plaintiff] can prove that [name of defendant] [[took/hid/appropriated/retained]/assisted in [taking/hiding/ appropriating/retaining]] the property for a wrongful use is by proving both of the following:

1. That [name of plaintiff/decedent] had the right to have the property [transferred/made readily available] to [him/her/ [[his/her] [conservator/trustee/representative/attorney-in-fact]]; and

2. That [name of defendant] knew or should have known that [name of plaintiff/decedent] had this right.

[Name of defendant] should have known that [name of plaintiff/ decedent] had this right if, on the basis of information received by [[name of defendant]/[name of defendant]’s authorized third arty], it would have been obvious to a reasonable person that [name of plaintiff/decedent] had the right to have the property [transferred/made readily available] to [him/her/[[his/her] [conservator/trustee/representative/attorney-in-fact]].

Directions for Use

This instruction is intended for cases brought by the victim of the abuse, or by the survivors of the victim. If the victim is the plaintiff and is seeking damages for pain and suffering, see CACI No. 3905A, Physical Pain, Mental Suffering, and Emotional Distress (Noneconomic Damage) in the Damages series. Plaintiffs who are suing for their decedent’s pain and suffering should see CACI No. 3101, Financial Abuse—Enhanced Remedies Sought Against Individual/Employee Defendant (Welf. & Inst. Code, �� 15657.5), or CACI No. 3102, Financial Abuse—Enhanced Remedies Sought—Employer Defendant (Welf. & Inst. Code, �� 15657.5, 15610.30). The instructions in this series are not intended to cover every circumstance in which a plaintiff can bring a cause of action under the Elder Abuse and Dependent Adult Civil Protection Act.

If the plaintiff is also seeking tort damages against the employer under a theory of vicarious liability, see instructions in the Vicarious Responsibility series (CACI No. 3700 et seq.).

Add the bracketed portion if the plaintiff is seeking to prove wrongful use by showing that defendant acted in bad faith as defined by the statute. This is not the exclusive manner of proving wrongful conduct under the statute. (See Welf. & Inst. Code, � 15610.30(b).)

Sources and Authority

Welfare and Institutions Code section 15610.07 provides:

“Abuse of an elder or a dependent adult” means either of the following:

(a) Physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment with resulting physical harm or pain or mental suffering.

(b) The deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering.

Welfare and Institutions Code section 15610.30 provides:

(a) “Financial abuse” of an elder or dependent adult occurs when a person or entity does any of the following:

(1) Takes, secretes, appropriates, or retains real or personal property of an elder or dependent adult to a wrongful use or with intent to defraud, or both.

(2) Assists in taking, secreting, appropriating, or retaining real or personal property of an elder or dependent adult to a wrongful use or with intent to defraud, or both.

(b) A person or entity shall be deemed to have taken, secreted, appropriated, or retained property for a wrongful use if, among other things, the person or entity takes, secretes, appropriates or retains possession of property in bad faith.

(1) A person or entity shall be deemed to have acted in bad faith if the person or entity knew or should have known that the elder or dependent adult had the right to have the property transferred or made readily available to the elder or dependent adult or to his or her representative.

(2) For purposes of this section, a person or entity should have known of a right specified in paragraph (1) if, on the basis of the information received by the person or entity or the person or entity’s authorized third party, or both, it is obvious to a reasonable person that the elder or dependent adult has a right specified in paragraph (1).

(c) For purposes of this section, “representative” means a person or entity that is either of the following:

(1) A conservator, trustee, or other representative of the estate of an elder or dependent adult.

(2) An attorney-in-fact of an elder or dependent adult who acts within the authority of the power of attorney.

Welfare and Institutions Code section 15657.5 provides:

(a) Where it is proven by a preponderance of the evidence that a defendant is liable for financial abuse, as defined n Section 15610.30, in addition to all other remedies otherwise provided by law, the court shall award to the plaintiff reasonable attorney’s fees and costs. The term “costs” includes, but is not limited to, reasonable fees for the services of a conservator, if any, devoted to the litigation of a claim brought under this article.

(b) Where it is proven by a preponderance of the evidence that a defendant is liable for financial abuse, as defined in Section 15610.30, and where it is proven by clear and convincing evidence that the defendant has been guilty of recklessness, oppression, fraud, or malice in the commission of the abuse, in addition to reasonable attorney’s fees and costs set forth in subdivision (a), and all other remedies otherwise provided by law, the following shall apply:

(1) The limitations imposed by Section 377.34 of the Code of Civil Procedure on the damages recoverable shall not apply.

(2) The standards set forth in subdivision (b) of Section 3294 of the Civil Code regarding the imposition of punitive damages on an employer based upon the acts of an employee shall be satisfied before any damages or attorney’s fees permitted under this section may be imposed against an employer.

(c) Nothing in this section affects the award of punitive damages under Section 3294 of the Civil Code.

Welfare and Institutions Code section 15610.27 provides: ” ‘Elder’ means any person residing in this state, 65 years of age or older.”

Welfare and Institutions Code section 15610.23 provides:

(a) “Dependent adult” means any person between the ages of 18 and 64 years who resides in this state and who has physical or mental limitations that restrict his or her ability to carry out normal activities or to protect his or her rights, including, but not limited to, persons who have physical or developmental disabilities, or whose physical or mental abilities have diminished because of age.

(b) “Dependent adult” includes any person between the ages of 18 and 64 years who is admitted as an inpatient to a

24-hour health facility, as defined in Sections 1250, 1250.2, and 1250.3 of the Health and Safety Code.

“The purpose of the [Elder Abuse Act] is essentially to protect a particularly vulnerable portion of the population from gross mistreatment in the form of abuse and custodial neglect.” (Delaney v. Baker (1999) 20 Cal.4th 23, 33 [82 Cal.Rptr.2d 610, 971 P.2d 986].)