Nursing Home Abuse Causes

Nursing Home Abuse: Why Does It Exist?

Elderly residents of nursing homes are often frail and vulnerable. Dependent on their caretakers for their food, housing and health needs, they deserve the best care possible. However, many nursing homes are failing our seniors (see Recognizing Elder Abuse).

Many studies have been done on the causes of neglect and nursing home abuse. This section provides a brief overview of the problems of the elderly in our nursing homes.

Nursing Home Abuse Due to Inadequate Staffing

Inadequate staffing is a major cause of nursing home abuse. A series of reports for members of the U.S. House of Representatives revealed that many nursing homes do not have enough staff to meet the levels recommended by federal officials (3.45 nursing hours per patient daily) and nursing home experts (4 nursing hours per patient). Annual inspections also show that too many nursing homes do not even meet minimal legal staffing requirements (3.2 nursing hours in California, as an example). (SeeNursing Home Staffing in 13th District of California).

Residents of those nursing homes falling below minimal staffing standards are much more likely to develop bedsores and experience excessive weight loss than those in other nursing homes. This is because enough staff must be available so that all residents who cannot eat by themselves receive help. Also, unless immobile elderly residents are repositioned frequently, they may develop bedsores. To add to the problem, understaffing contributes to low morale and frustration among employees, decreasing their ability to deal with residents patiently and respectfully.

Poorly Trained, Low–Paid Employees May Lead to Nursing Home Neglect

Nursing home employees may receive minimal training in working with disabled patients and in documenting their conditions. Form records may be used that are filled out quickly and do not address the realities of the patient’s condition. This leads to confusion, neglect of patients, and sometimes to nursing home abuse.

The pay for nurse’s aides and orderlies is often low. Because dealing with the physical needs of the elderly can be hard work, job burnout and stress are common. The result can be loss of concern for patients. Also, a high job turnover rate means that staff members are not likely to develop strong relationships with patients.

Nursing Home Abuse As Inadequate Medical and Nursing Care

A senior who enters a nursing home usually loses the treating physician who knows his or her medical condition best. Doctors within the facility know little about the new resident, may suffer a heavy work load, and are pressed for time. Under federal law, nursing home doctors are only required to see a resident once every 30 days for the first 90 days after admittance, and then only every 60 days (42 CFR §483.40(c)(1)). In California, doctors must see patients only every 30 days (22 Cal Code Regs §72307).

The physician may have a close relationship with the facility, but little relationship with the patient, creating a potential conflict of interest. Consider the following scenario (California Elder Law: An Advocates Guide, Volume 2, §12.5). Suppose a nursing home patient is immobile and needs frequent toileting. The facility is understaffed. The physician orders sedatives to calm the patient and a Foley catheter, an inserted tube that draws urine from the bladder. The staff benefits since the now overmedicated patient may be helped to the bathroom less frequently. However, the patient’s needs are overlooked (see Recognizing Elder Abuse: Elder Neglect). Federal law requires that an incontinent patient receive appropriate treatment and be subject to catheterization only when the procedure is clinically necessary (42 CFR §483.25(d)). The convenience of the nursing home is not a good reason for the procedure.

Avoiding Nursing Home Abuse; Finding a Better Nursing Home

Although most nursing homes have some care violations, not every nursing home is inadequate. See Choosing Care: Signs of a Good Nursing Home to find out how to recognize a good facility. See Avoiding Nursing Home Abuse for tips on how to get quality care for your elderly loved one.

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Problems that May Lead to Nursing Home Abuse:

• Inadequate staffing
• Low-paid employees
• Lack of good training
• Heavy work load for doctors and staff

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