• Suspect nursing home abuse or neglect?
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PET_scan-normal_brain-alzheimers_disease_brainWe often read news stories about nursing home abuse and dementia patients, but are elders who suffer from Alzheimer’s disease and other forms of dementia at greater risk of elder abuse? According to a fact sheet from the University of California, Irvine’s Center of Excellence on Elder Abuse and Neglect, advocates generally agree that seniors who suffer from dementia “are thought to be at greater risk of abuse and neglect than those of the general elderly population.” What else should you know about dementia and its connection to nursing home abuse?

Growing Number of Americans with Dementia

As the fact sheet notes, the total number of elderly Americans is expected to grow substantially in the coming decades. As the total population of America’s seniors grows, the total population of elders with dementia will also increase. Currently, around 5.3 million seniors in our country have Alzheimer’s disease. Of those people, a little over 5 million are aged 65 or older, while about 200,000 people under the age of 65 suffer from this disease. By 2030, however, the Center predicts that approximately 7.7 million elders will have Alzheimer’s disease. Any by year 2050, that number will grow to around 16 million older adults with Alzheimer’s.

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file3451272140532How often does the California Department of Public Health fine nursing homes and assisted-living facilities for elderly patient injuries and deaths? When facilities do receive significant fines as a result of nursing home abuse or neglect, are those fines sufficient to protect other residents in the future? According to a recent article in the Los Angeles Daily News, the California Department of Public Health issued a $75,000 fine for a Southern California nursing home due to neglect resulting in a patient’s death.

Fatal Injuries Caused By Nursing Home Neglect in Canoga Park

As the article explains, Topanga Terrace, a nursing home in Canoga Park, was issued a $75,000 fine “after staff there failed to monitor a resident who kept removing his own breathing tube, resulting in death.” The patient needed a tracheostomy tube in order to breathe following a surgery in 2013. In addition to the use of the tracheostomy tube, the patient also “suffered from multiple illnesses including dementia, chronic respiratory failure, and tuberculosis.” Despite his medical needs, however, the facility did not have a treatment plan that included methods to prevent or deter the patient from removing his breathing tube.

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William_Albert_Ackman_signatureFor more than a year, mandatory arbitration agreements have been illegal in California nursing homes. Instead, patients at facilities in San Diego can only be asked to sign voluntary binding arbitration agreements. Over the last year, the Centers for Medicare and Medicaid Services (CMS) has been working on a federal rule that would prohibit forced arbitration agreements in nursing homes across the country, permitting facilities instead to have only voluntary binding arbitration agreements (like those in California). Yet according to a recent article in The New York Times, even voluntary binding arbitration agreements can put a nursing home resident in a vulnerable position in relation to a facility. Should we be talking about banning all arbitration agreements if we want to ensure patients get justice when nursing home abuse happens?

No Legal Recourse for Harmed Patients in Arbitration?

As the article in The New York Times explains, federal rules concerning forced arbitration agreements in nursing homes will soon be finalized. However, are those protections sufficient to ensure that nursing homes are held accountable when nursing home abuse or neglect occurs? As a brief reminder, arbitration agreements—both those that are “forced” or required for a patient to enter a nursing home, as well as those that a patient agrees to voluntarily upon entering a facility—require patients and their families to settle legal issues “through private arbitration rather than through lawsuits.”

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file000356994816Allegations of Elder Neglect and Abuse Resulting in Patient Deaths

According to a recent report from The San Diego Union-Tribune, concerns about elder abuse and preventable injuries in assisted-living facilities in Southern California still loom large. A 2013 special report from The San Diego Union-Tribune highlighted the dangers of nursing home neglect in assisted-living facilities across the state, emphasizing that regulators needed to do more to address serious allegations including but not limited to:

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800px-Woman_readingOver the past several months, California residents have been hearing news about nursing homes in our state and throughout the country evicting patients for whom it is more difficult to provide care. For example, an article in Modern Healthcare emphasized that nursing home patients who are “targeted for eviction are frequently poor and suffering from dementia.” Numerous lawsuits have been filed in relation to such evictions, and a recent press release from the California Advocates for Nursing Home Reform (CANHR) suggests that elder safety advocates may be gaining ground.

Modesto Elder Care Center Cited for Evicting ‘Long-Term’ Residents

According to the press release, Avalon Care Center, a Modesto-area nursing home, has been cited for illegal patient eviction practices. The press release notes that the California Department of Public Health (DPH) recently levied “a whopping 29 citations” against the care center in Modesto “for engaging in a reprehensible and systematic illegal eviction program to force out undesirable ‘long-term’ residents.” Why did the facility evict these residents? It was not actually for some of the same reasons noted in the Modern Healthcare article mentioned above.

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Vr_(14798594120)A recent article in Reuters Health reported that one out of every five nursing home residents that suffers verbal or physical nursing home abuse is not enduring that abuse at the hands of one of the staff members at a facility. Rather, about 20% of all verbal and physical nursing home abuse cases involve violence committed by another resident. While these cases may result from serious issues of nursing home neglect and understaffing (and the general failure to properly monitor patients in a facility), a recent article from NPR and KQED News, a new virtual reality device is helping seniors in nursing homes and assisted-living facilities to remain calmer and to, perhaps, live fuller lives.

Can such technology help to prevent elder abuse when it is perpetrated by other residents?

Virtual Reality Improving the Lives of Seniors

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DSC_0041While it might sound unlikely, perpetrators of nursing home abuse are not always those employed as caregivers for the elderly. According to a recent article in HealthDay, many elderly residents at nursing homes suffer injuries at the hands of other patients. The article cites a recent study that determined “one in five nursing home residents had been involved in an incident with a fellow resident within the past month.” In a majority of cases, those “incidents” were only verbal altercations and did not involve physical violence. However, as the article explains, “some seniors were involved in physical scuffles, and some experienced inappropriate sexual behavior.”

It is difficult enough to feel like you have conducted sufficient background research into the caregivers at a nursing home or assisted-living facility before feeling comfortable with your elderly loved one receiving care at such a place. But how can you determine whether some instances of elder abuse actually were caused by patients living within the facility?

Elder Mistreatment Not Openly Discussed

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handsIn order to stop nursing home abuse or to remove California seniors from assisted-living facilities where they have suffered serious injuries as a result of elder neglect, we need to know that this kind of abuse is occurring. However, according to a recent report in California Healthline, the silence surrounding elder abuse is one of the biggest barriers to helping seniors who have been victims of nursing home abuse and neglect. The report emphasizes that, when it comes to elder abuse, “one of the hardest parts about prosecuting and curbing it is that the victims are often too embarrassed or scared to speak up.” The California Healthline report cites an article in the Modesto Bee that clarifies that problem of silence in relation to nursing home abuse in California.

Victims Do Not Always Want to Report Abuse

In Modesto, CA alone, the Modesto Police have investigated 30 cases of elder abuse this year. According to the article, there are “dozens more throughout Stanislaus County,” and those numbers do not even begin to take into account the number of cases that have been reported in San Diego County or in other parts of the state.

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file1251238100316June is Elder Abuse Awareness Month, and on June 15th, organizations across the globe will recognize World Elder Abuse Awareness Day, according to a press release from the United Nations. While we might not initially think about the ways in which California seniors who have been victims of elder abuse are connected to other older adults in other parts of the world, the World Health Organization (WHO) emphasizes that we need to think both locally and globally when it comes to preventing violence against the elderly.

During Elder Abuse Awareness Month, what can we do in California to help prevent nursing home abuse and neglect in a way that will reflect upon prevention initiatives in other parts of the world?

United Nations Resolution to End Violence Against the Elderly

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file000790132663If an elderly California resident is declared incompetent and placed under a conservatorship (also known in many places as a guardianship), can that senior actually be at greater risk of elder abuse? According to a recent article in Forbes Magazine, conservatorships and guardianships are “ideally a protection for older adults.” However, as the article explains, a conservatorship “is a drastic measure often prompted by warring relatives, nursing homes that want to get paid, or a ‘friend’ who gains the trust of an older adult in order to take advantage of him or her.” While these typically are worst-case-scenario examples, it is important to think carefully about the potential links between conservatorships and nursing home abuse in Southern California.

What is a Conservatorship?

The California Courts make clear that a conservatorship involves an adult (the “conservatee”) who either “cannot care for himself or herself or manage his or her own finances” and a responsible person or entity (the “conservator”) to care for that adult. The Court’s website explains that general conservatorships, like the scenario described above, often involve an elderly person.