New York Nursing Home Abuse Lawyer Blog

A recent study conducted by the Journal of the American Medical Directors Association (JAMDA) indicates that surveyors routinely failed to detect quality care issues with respect to the assistance provided by nursing home staff members at mealtime. As we have discussed many times on this blog, malnutrition and dehydration are two of the most common and most important issues facing nursing home residents.

According to the JAMDA website, "Guidelines written for government surveyors who assess nursing home (NH) compliance with federal standards contain instructions to observe the quality of mealtime assistance. However, these instructions are vague and no protocol is provided for surveyors to record observational data. This study compared government survey staff observations of mealtime assistance quality to observations by research staff using a standardized protocol that met basic standards for accurate behavioral measurement."

The study found that nutritional care (or lack thereof) is a significant problem in long-term care facilities, and noted that it is underdetected in the survey process. The researchers that conducted the study call for surveyor training on this issue that fosters more accurate and consistent observation of feeding assistance issues and a "standardized protocol to organize and guide" surveyor observations.

Lacy Reid, a 45 year-old assisted living employee residing in Nassau County, has been charged with Felony Reckless Endangerment for failing to come to the aid of his ailing mother. His mother allegedly fell in her kitchen on Tuesday night and remained on the floor until Thursday. Mr. Reid, who lives with his mother, stepped over her on his way to work Wednesday and Thursday.

When the authorities were finally called, officers found Mary Reid face down in the foyer by the front door. She was dehydrated and malnourished, and she suffered a heart attack while being transported to the Emergency Room.

Website Resources:

Cops: Freeport man left ill mother on floor for 2 days, Newsday, Zachary R. Dowdy, August 14, 2009.

Dehydration, or inadequate hydration, is a serious problem facing nursing home residents. Dehydration means that an individual is losing more fluid than his or her body is taking in. Although it would seem that keeping a resident hydrated in a nursing home setting would be simple enough, it is one of the most common diagnoses when nursing home residents are discharged from a nursing home to a hospital.

Dehydration can occur if residents are on certain types of medication and/or if a resident has diarrhea. In addition, some nursing home residents become refuse to eat or drink. However, in these situations, it is incumbent upon the nursing home staff to be more vigilant in monitoring the resident's hydration. Unfortunately, dehydration is often the result of nursing home neglect and/or understaffing. Dehydration can lead to:

1) Infection;
2) Confusion;
3) Weakness;
4) Bedsores;
5) Pneumonia; and
6) Death.

Signs of dehydration include dry mouth, grey or ashen skin, confusion, dark or amber urine, low urine output, fever, delirium, and infection. We cannot stress enough how important it is for families of nursing home residents to be a constant presence where a loved one is a resident. By doing so, the family members can observe and react appropriately if signs or symptoms of neglect or abuse arise.

At Gallivan & Gallivan, we represent individuals who have suffered from dehydration or malnutrition as a result of nursing home neglect or abuse. If you or a loved one has been the victim of elder abuse or neglect, please contact us to discuss the matter further.

Website Resources:

Dehydration, Mayo Clinic, Mayo Clinic Staff.

Malnutrition & Dehydration in Nursing Homes, Nursing Home Abuse Resource Center.

Two Orange County nursing homes have been fined for care (or lack therof) that resulted in the wrongful death of two residents. At Alamitos West, an 82 year-old resident died from dehydration after the nursing home failed to provide sufficient fluids. Investigators found that intake and output records were blank and/or illegible over the course of the resident's admission.

Staff at Huntington Valley Nursing Home failed to resuscitate a resident because they mistakenly believed that a Do Not Resuscitate order was on file. In fact, the resident's chart indicated that the family specifically requested that CPR be administered if necessary. By the time paramedics arrived, the resident had passed away.

As a result of these incidents, Alamitos West was fined $100,000 and Huntington Valley was fined $80,000.

Website Resources:

2 Orange County nursing homes fined for patient deaths, Los Angeles Times, Rong-Gong Lin II, June 11, 2009

According to the New York Times article below, in a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent. Experts estimate that two million Americans suffer from pressure ulcers each year, usually through some combination of immobility, poor nutrition, dehydration and incontinence. This relatively new research suggests that the battle against bedsores requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians.

This should not be a surprise to anyone familiar with the nursing home environment. It is vitally important for residents at risk for pressure ulcers to receive appropriate care and attention from all employees listed above. A lapse in one area for even a short period of time can lead to the development and progression of an otherwise preventable pressure ulcer.

Website Resources:

Fighting Bedsores With a Team Approach, Amanda Schaffer, New York Times, February 19, 2008.

The article below gives an insightful overview of some of most common causes of serious injury and/or death in the nursing home setting that are completely preventable:

1) Malnutrition;
2) Dehydration; and
3) Infected Pressure Sores.

The article cites data from the U.S. Centers for Disease Control and Prevention that was analyzed by the Detroit Free Press. The data indicates that nearly 14,000 deaths in nursing home patients between 1999 and 2002 were caused by malnutrition, dehydration, and/or infected pressure sores. The author of the article, Andrea Billups, also recounts some specific instances of neglect and abuse in facilities nationwide. Understaffing at nursing homes is named as one of the causes of such neglect. Although it was published in 2006, its findings are certainly still relevant and worth reading.

Website Resources:

Deadly Neglect: The shocking truth about what's going on in America's nursing homes, Andrea Billups, Reader's Digest, December 2006.