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Senior Citizen's Guide

Nursing Home Abuse and Neglect

"According to the best available estimates, between 1 and 2 million Americans age 65 or older have been injured, exploited or otherwise mistreated by someone on whom they depended for care or protection."

– Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America, National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect, 2003, as reported by the National Center on Elder Abuse

"In FFY 2006, we opened 3,113 cases, and closed 2,881 cases, representing 6,394 complaints … more than 120,000 men and women … make their homes in long-term care facilities in this State."

– 2007 Annual Report, New Jersey Office of the Ombudsman for the Institutionalized Elderly

The statistics are appalling, especially for those of us who have entrusted the care of our elderly parents or spouses to those who work in nursing homes and other long-term care facilities. The idea of abuse or neglect haunts all of us who have made this uncomfortable, and often, guilt-ridden, placement decision.

You, too, struggled with the idea of releasing the care of your loved one to strangers. Yet, finally, you knew that the time had come, so you thoroughly researched all your options and found the place that seemed to offer the highest quality of care. You visit regularly (and at different times of the day), have forged relationships with the staff and administration, and attended every Care Plan meeting. You frequent the cafeteria and attend social events. But you're not there 24/7, and sometimes you have lingering doubts of "What if…"

It's important to know that your loved one's rights are protected by both federal and state laws. In 1987, the federal government passed the Nursing Home Reform Act, also known as the Omnibus Reconciliation Act (OBRA), which sets forth the standards for these facilities in administering care and treatment to their residents. These federal regulations are incorporated into New Jersey's Nursing Home Residents' Bill of Rights, which requires the facilities to promote and protect the rights of each resident, and to recognize and respect each individual's needs and differences.

Specifically, the legislation affords those living in a long-term care facility the right to live in a clean, safe place that acknowledges each person's dignity and individuality. With this goal in mind, the regulations address issues such as facility staffing and maintenance. Nutrition and hydration are important factors, too. Quality of life issues, such as personal hygiene, socializing and activities of daily living, are considered, and the regulations also discuss the issues of privacy, improper use of restraints and abuse.

By way of example, the regulations provide that patients with pressure ulcers must be turned, repositioned, given the appropriate mattress, receive treatments etc. Many times, nursing homes will contend that the pressure sores are unavoidable given the resident's other medical conditions and declining health. No pressure sores are unavoidable unless and until the nursing home can show that it took every step necessary to prevent the development of the pressure sore or the worsening of an existing pressure sore. The complete Bill of Rights is available from the New Jersey Office of the Public Advocate (

Although OBRA does not regulate assisted living facilities, New Jersey has specific regulations that address issues including residents' rights, the services to be given, and the evaluation process for admittance. Keep in mind, an assisted living facility is not a nursing home. They provide less care and therefore, placement into assisted living should only be those who are appropriate for this type of facility. Cases against assisted living facilities are often based on the fact that the resident is improperly placed and, in reality, belongs in a nursing home. Making the decision about where to place a loved one is not easy, but considering the differences in regulations, a nursing home facility may be the best choice.

Elder abuse can be defined as doing – or not doing – something that results in the risk of harming, or actually harming, an older person. The abuse can be physical, emotional or sexual, or it may result from neglect or exploitation. There is always someone who is responsible. Elderly residents experiencing abuse or neglect in long-term care facilities may be embarrassed, afraid or unable to speak up or seek help. Therefore, it's important for you to visit as often as possible and to be on the alert for any signs of abuse or neglect.

Signs of Abuse or Neglect:

One of the most prevalent concerns in all long-term care facilities is the risk of falls. Falls are the top cause of injury in elderly people and often lead to bone fractures and trauma causing heart attacks and an inability to walk. To that end, both nursing and assisted living facilities are required by law to complete fall risk assessments for every resident to determine the type of care he or she requires.

If, at any time, you suspect that your loved one has been abused or neglected, or has felt that his or her rights have been violated, report it immediately to the facility's staff and administration. Be sure to follow through in getting answers and ensuring that there is satisfactory resolution. If you're not satisfied, you may decide to take legal action. A typical nursing home lawsuit contains multiple reasons for filing. The violation of the Nursing Home Residents' Bill of Rights is, in most cases, only a small part of a lawsuit. There may also be claims against individual nurses, aides, management personnel and physicians for medical negligence and abuse. Also, there may be contractual claims for breach of contract of the resident's agreement with the facility.

Most importantly, know that your loved one is entitled to live safely and comfortably, and without harm or fear. Every moment of life is precious. Long-term care facilities must treat their residents with dignity and respect, and must provide services to ensure that each resident enjoys the highest possible quality of life.

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