A Reporting Primer

Hold My Hand

   In the previous post we talked about the distinctions between unacceptable quality of care issues in residential facilities and criminal abuse or neglect. With regard to elder abuse, regardless of where it takes place, or whether it is or is not criminal, here is an excellent site that offers resources for elders, families and friends: 

http://www.helpguide.org/mental/elder_abuse_physical_emotional_sexual_neglect.htm

    In addition, I promised to offer state-by-state, information and instructions for reporting abuse and neglect, particularly in residential care. The following link offers this information and may be downloaded as in portable document format: 

http://www.americanbar.org/content/dam/aba/migrated/aging/docs/MandatoryReportingProvisionsChart.authcheckdam.pdf

The moral arc of the universe bends at the elbow of justice.  -Martin Luther King, Jr.

       As we discussed last week, If you suspect a family member, friend or neighbor is suffering neglect or abuse in residential care, report it immediately to supervisory staff in the facility, to medical personnel, to the management of the facility. If there are indications the neglect and/or abuse rises to generally accepted definitions of criminal behavior, go a step further. Report the matter to law enforcement and government agencies, keeping in mind timeliness is critical. With government agencies, use telephone reporting, e-mail or electronic forms advisedly. By this I mean, even detailed electronic messages with attachments may not receive the attention they deserve.

  If this is a criminal matter, reporting effectively and immediately may very well be a question of life or death for the patient. Memorialize all conversations you have in writing. In this telecommunications era, many of us have lost touch with the local post office. This is a time to certify correspondence and mail it, return receipt requested. Keep hard copies of everything you send and receive, including mail receipts. Purchase some inexpensive file folders or a ring binder, a hole punch and an inexpensive photo album. Organize your documentation and evidence, to have it immediately accessible.

     Finally, follow through promptly, if possible, in person. Do not be intimidated; you are interested in getting at the truth and arriving at an outcome for someone who needs your help. Personally I am not merely persistent, I'm tenacious, like a bulldog with a bone. Whether it is your nature to confront problems head-on, or not, this is the time not to be swayed. This is the time to persevere.

Justice, A Single Word

All the great things are simple, and many can be expressed in a single word: freedom, justice, honor, duty, mercy, hope.

Winston Churchill

So you are in long-term care or you have a family member (or very close friend)  in one of the following types of care facilities: 

Nursing Home

Hospital Long-Term Care Unit

Home for the Aged

County Medical Care Facility

Adult Foster Care 

Assisted Living Facility

     Whether or not you placed the patient in the facility, the patient appears to decline dramatically and unexpectedly. You suspect something is wrong, or the patient tells you something is wrong. You may be this person's only advocate, while you are in a tailspin. In addition time is not on your side. Report immediately. Begin the reporting process with supervisory and management personnel of the facility. Memorialize meetings with written correspondence. 

      Speak with everyone else closely involved. Speak with medical personnel and the patient's medical providers. Step up the frequency of visits and the visibility of guests, even if you must enlist the help of other friends and family. Make the times and dates of visits unpredictable. Visitors should maintain journals and carry cameras. Don't hesitate to talk to neighboring residents, their friends and family about the level of care Look at the patient. This is very important. No-one wants to demean or intrude on a patient's privacy, but injuries, bruising, and sores may be hidden under gowns, pajamas, robes, socks and shoes. Someone of the same sex, who is close to the patient must check the patient frequently. Weight loss is concerning, so see that the patient is regularly weighed and does not show signs of dehydration.

 Ask yourself and others close to the patient, whether management or supervisory staff can and will readily correct the issues. Look for classic signs of neglect or abuse, while deciding whether there is criminality involved. There is a language to learn, and there are steps to be taken, the sooner the better. Here are some legal guidelines regarding criminal issues, together with examples:

a) What is criminal neglect?

Is the patient experiencing any of the following: a) suspicious or questionable injuries or death; b) unexpected and serious weight loss; c) severe dehydration; d) painful bed or pressure sores.

b) What is criminal assault and/or battery?

As disgraceful as it is, employees of residential care and skilled nursing facilities assault and batter residents every day.You may have to ask the right questions, because a fearful patient may endure abuse, rather than reveal it. If a patient is fearful, anxious, or talks about being hurt or bullied, listen carefully and observe. If there is widespread or serious bruising, bruising at unlikely sites, sprains or broken bones, or signs of over-medication, criminal acts may have occurred. Employees of nursing homes and residential health care facilities may not: a) threaten or strike patients; b) use unauthorized physical or chemical restraints. 

c) Mental abuse is abuse!

Certain levels of bullying, reprisal and threats rise to the level of criminal behavior or preface criminal acts. Mental abuse is as unacceptable as physical abuse.

d) What constitutes criminal financial exploitation? 

Nursing home and residential health care employees may not: a) wrongly remove funds from a resident's person, checking or savings account; b) accept or obtain a "loan" or "gift" from a resident; c) use a resident's personal information illegally to obtain credit cards (i.e., commits identity theft.) 

e) Define criminal sexual conduct.

No employee of a residential healthcare facility or nursing home may engage in unlawful sexual conduct with a patient (that is to say, sexual contact was non-consensual.) That distinction aside, any sexual contact between an employee and a patient/resident, consensual or not, should be a firing offense.

     If you are not satisfied with responses, or with the timeliness of responses, you may have to know how and where to report in your state and county. In a subsequent post we'll talk about reporting in Colorado and state-by-state.

An Ounce of Prevention

   

Fast Times at Sunny Vale

Before agreeing to place yourself or any patient in a residential care facility, there are important questions to ask. It is not always obvious or easy to ask the right questions, because marketing personnel are extremely skillful at 'selling' you on a facility, its amenities and standards of care. A decision maker must focus on facts, not fiction. Is the corporate mission posted? Are there community standards posted? If so, don't take them at face value. The name, Sunny Vale Assisted Care and a lovely motto, such as "A Restorative Community," are meaningless. Was there a cute day care facility, where pre-school children were abused in your community? Didn't it have a sweet name, like Button Tree Farm?  We're always so polite in speaking with sales people and managers; remember, this is not a social occasion, any more than it was a social occasion, when we chose our children's day care facilities.

     Consult consumer ratings and publications, local, as well as national. Know the staff-to-patient and the supervisor-to-staff ratios for a specific facility. How does the outside of the building (not the landscaping or building facade) look? Is trash, garbage and bio-hazardous waste properly contained? Does it appear to be removed on an appropriate schedule, or is it overflowing -- is the containment area clean? Walking the premises inside, how does the facility look and smell. There should be no lingering or pervasive smell of urine, feces, or other unpleasant smells in hallways, rooms or waiting areas. Is the facility well lighted, night and day? Is it attractive and well-maintained in appearance? Is there video surveillance? Where, and are the cameras both maintained and used? Who manages and dispenses medications, and is the dispensary well-staffed and secure? 

     Ask management for the facts of recruitment, training standards and vetting of staff. Do staff members rely on a day of orientation, or are training workshops and demonstrations substantive. Are they ongoing and how often is continuing education offered? What about emergency preparedness for management, supervisors and other staff? What are the benchmarks for quality of care in the facility, and how well are they being met. How are benchmarks measured? -How often and by whom? Ask to speak with other residents or their family members concerning the quality of care, meals, recreational opportunities -- don't hesitate to be nosy.

      Here is a patient bill of rights. If you are going into long-term care, have a close friend or family member entering care, know the following: 

1. No patient may be denied appropriate care on the basis of race, religion, national origin, sex, age, handicap, marital status, sexual preference, or source of payment. 
2. Any patient may inspect and obtain a copy of his or her medical records, upon demand. No third party may receive a a copy of the patient's medical records without the patient's express authorization, except as required by law or third party contract.
3. Every patient or resident is entitled to privacy, to any extent feasible, in treatment and caring for personal needs. Care for personal needs will be delivered with consideration, respect, and full recognition of the patient's individuality and dignity. 
4. A patient or resident is is entitled to adequate, appropriate, care. The patient has the right to full information about his/her medical condition, proposed treatment and prospects for recovery, unless medically contraindicated by the physician in the medical record. 
5. A patient or resident is entitled to examine and receive an explanation of his/her bill. Also, he/she is entitled to know who is responsible for, and who is providing, his/her care.
6. A patient or resident has the right to associate and have private communication with his/her physician, attorney or any other person. A patient has the right to send and receive personal mail unopened, unless medically contraindicated.
7. No patient's or resident's civil and religious liberties shall be infringed. The facility shall encourage and assist in the exercise of patients' civil and religious rights.
8. Every patient or resident is entitled to be free from mental and physical abuse. Every patient shall be free from physical and chemical restraints, unless authorized by his/her physician, or necessitated by emergency to protect the patient.
9. A patient or resident has the right to retain and use personal clothing and possessions, space permitting. At the request of a patient, a nursing home shall provide for safekeeping of personal property and funds. However, the nursing home shall not be required to provide for the safekeeping of property which would impose an unreasonable burden on the nursing home.
10. The nursing home must provide the patient with meals which meet the recommended dietary allowances for the patient's age and sex. The menu may be modified according to special dietary needs.
11. A nursing home, its owner, administrator, employee, or representative shall not discharge, harass, retaliate or discriminate against a patient because a patient has exercised rights protected by law. (Reporting violations of the above rights or quality of care issues is protected by law.)

     Whether you are helping a loved one enter independent living, assisted living or nursing care, you are his or her best hope in ensuring these rights are protected. It is important to know your own rights and those of others. 

     Be vigilant on behalf of your loved one. Be present. Be in touch frequently. Even people in independent settings are vulnerable.In the next post, we'll make a distinction between unacceptable conditions and criminal negligence or abuse in long-term care. Meanwhile prevention begins with each of us.

Longevity For Better or Worse

Longevity

   Longevity, excellent fortune in some cultures, is so for elders who are reasonably well, active, financially independent, creatively involved and/or pursuing work they love.  You are in good company, if the Old Folks Home and the Nursing Home evoke ugly specters from America's past. We've progressed from the almshouse to the old folks home or nursing home, to care which is meant to encourage the highest level of independence, dignity of choice and quality of life we can achieve. Overcoming history, however, is a painfully gradual process, rife with errors and failures. Enter the Assisted Living Facility. Even with the advent of assisted care, Medicaid has come under fire for having a tendency to keep people in nursing homes.

 Assisted living facilities (ALFs) gained tremendous popularity in the 1990s, as part of the continuum of care for people who did not require skilled, around-the-clock nursing care, but were not able to live independently. The idea was to provide supervision and help with activities of everyday life (including, for some, personal care, as well as the supervision/dispensing of medications by trained staff.) Assisted living was widely promoted as a philosophy of care and service intended to honor "independence and dignity." It sounded like a fine idea to keep nursing homes from being society's dumping grounds.

    If you have not watched the PBS documentary, "Living and Dying in Assisted Care," do so. Better yet, ProPublica has published a four-part series. I provide links here: 

http://www.propublica.org/article/emeritus-1-the-emerald-city

http://www.propublica.org/article/emeritus-2-theyre-not-treating-mom-well
http://www.propublica.org/article/emeritus-3-a-sinking-ship
http://www.propublica.org/article/emeritus-4-close-the-back-door

    
     This is greed's horror story, real and pervasive. One thing is crystal clear; economically disadvantaged Americans, who cannot readily move from one facility to another are worse off than their prosperous counterparts. The same is true for those whose families are neither knowledgeable nor vigilant.    Many well-meaning family members believe they can fulfill or share among them, the role of caregiver, regardless of what the role will entail. It is a daunting business, and soon becomes extremely burdensome. From experience and observation, there is a third category, families who, simply, place their elderly into the hands of others, relieved to be shut of the problem. These folks just walk away, visiting rarely, if at all.
     For millions of elderly each year, "Assisted Living" becomes assisted dying. Abused, neglected, despondent, over- and wrongly medicated people fade, wither and die. Although it was first published in 2008, here is a condensed version of what consumers need to know about Assisted Living:
http://newoldage.blogs.nytimes.com/2008/10/20/10-things-to-know-about-assisted-living/?_r=0
        My desire is to write an informative blog one that stressed stress the importance of issues of aging and elder law for everyone. It isn't simply that we're all going to be older some day; it is that we all have older people in our lives, people we love, whose concerns are our concerns.
       In another post we'll talk about about a plan of action for elders already in assisted living facilities, their intimate friends/family. To begin, here is a state-by-state mandatory reporting link from The American Bar Association:
http://www.americanbar.org/content/dam/aba/migrated/aging/docs/MandatoryReportingProvisionsChart.authcheckdam.pdf