Some residents in "bad homes" are treated with respect and dignity. Any staff member can tell you why.
The residents who have families who know how to hold management accountable for substandard care are treated the way the system was designed to work under government regulations.
Many families fear retaliation if they become bossy or too demanding. As a staff nurse and patient advocate I see just the opposite. Management fears a family who takes notes on conditions or photograph inadequate care.
The family who can file a valid complaint or document evidence to substantiate a lawsuit greatly intimidates management and staff toward ensuring quality care. Loss of profits scare the nursing home industry. Large settlements and lawsuits are a very real threat to the facilities, not state inspections.
This is why facilities so often offer poor care, because consumers have such great difficulty proving what they see and hear. There is a well know cliche in the medical profession:
Many nursing homes use this to their advantage every day.
For example: You find your loved one covered in feces over and over again. You complain on deaf ears. Or are told they are doing the best they can, but they are short of staff. You file a complaint with the state department of health and have the complaint "unsubstantiated".
What went wrong?
Nurses don't chart incidents such as what you evidenced. In fact, we can be fired for such documentation which would be necessary for the state to confirm the existence of a deficiency. Most staff working in nursing homes are employed under an "at will status". This means we can be fired for any or no reason.
So, I intend to empower you with the ability to ensure your loved one is receiving quality care guaranteed to all nursing home residents.
Sometimes a resident may receive better care just because you are reading the chart. Why? Staff may scrutinize their own performance and documentation practices to make sure they are not liable for not providing an acceptable standard of care should something go wrong.
Ask questions if you don't understand what you read. If you get a "gut feeling" that something is amiss, ask for a copy of that part of the medical record. Again, it is important to know your rights. The amount of time and expense for copying the records may vary from state to state, but the legal guardian has the right to copied records upon request.
Take the copied records to an independent outside source for review and interpretation. Remember staff are often times intimidated by management to document to prevent the nursing home from liability. Nurses are sometimes threatened with termination if they do not follow instructions and chart what they are told.
Don't expect to see mistakes or accidents to jump out at you. We are trained to chart the facts only, but we do it in a manner so we don't send any red flags up to a plaintiff's attorney.
Don't expect to read "incident report filed" or "medication error made". These are Big NO NO's!!
If you do notice a big flurry of documentation (especially vital signs without a concurrent illness) and close monitoring, but you were never informed of an incident, become suspicious.
First inspect your loved one from head to toe. Then begin to document your own
observations if you suspect an incident occured. (This will be discussed in more
detail later).
Now you have a good start at legitimate proof of poor care even though the incident probably does not exist in the medical record. Another reason I make this suggestion is now the nursing home is made aware you have informed an outside source of your problem.
Remember documentation is the key to accountability. If problems are ongoing, start a paper trail of evidence to lead your attorney towards a successful lawsuit or authorities to substantiate a complaint against the nursing home. Always keep in mind, the nursing home has been charting to defend their actions and many times have had their attorneys advising them how to chart from the very beginning. You must have proper documentation which will be upheld in a court to contradict them.
I probably don't have to tell you this is no easy battle!
Again, look at your Resident Rights and your state rules and regulations that govern the nursing homes in your state to determine how the council is to function.
I strongly recommend you copy the minutes from the council meetings and their concerns
or requests to your local ombudsman also. This places outside pressure on management
to respond timely.
Immediately start the documentation process. Take photographs or video tape of your loved one, especially if they are still coherent and can describe what happened and who abused them. Sadly, some abuse is life threatening causing the resident to become unable to testify at a later stage.
Write down everything you see and hear in a journal. Keep dates and time references very accurate. Talk to staff and ask them what they think happened. Then document this information without them being aware. If possible have a witness with you to hear what the staff have to say. Many times staff can be caught off guard before management has "the talk" with them.
In other words, act like your own private investigator.
Contact the police department and request an investigation. This may be a first for them, but insist! You need a timely independent investigation to contradict what the nursing home may or may not chart.
Be prepared to lead the investigation in many instances. In some small towns everybody is related. Have your questions prepared for the police to ask staff.
Contact your local ombudsman at the same time but do not be surprised for a delay due
to their caseload or inexperience. Finally, after you have secured a copy of the
police report,
My next article will focus in more detail on how to direct a police investigation in suspected nursing home abuse.
In summary:
Education is the key to empowerment.
Documentation is the key to accountability.
If it wasn't charted, you have to prove it ever happened!
Start a paper trail as soon as problems go unresolved.
Any particular problems or concerns contact me at:
sketter@bonwell.com
This advice does not pertain to all nursing homes. Thankfully there are some good ones.
There are also many conscientious caregivers working long hard hours and being grossly
underpaid. My advice is strictly for families who are not having legitimate
concerns validated.