2. Has the resident demonstrated an unexplained dramatic change in condition?  The nursing home is required by law to maintain the resident’s highest quality of life and condition that is practicable.  Unless there is a plausible medical explanation, therefore, the resident should not be experiencing dramatic changes in condition.  If there is a medical explanation, the nursing home staff has a duty to notify the family and explain.  In most instances, a change in condition will require that a physician be notified as well.  If the resident has a dramatic change in condition that is unexplained, this raises a concen for abuse or neglect.

3. Is the resident uncharacteristically sedate, lethargic or unresponsive?  While anti-psychotic medications are often used to ease anxiety or agitation on the part of nursing home residents, they should not be used as “chemical restraints.”  More and more, there is a tendency for nursing home staff and attending physicians to overuse anti-psychotic medications in order to control or subdue difficult residents, rather than addressing the root cause of the difficulty such as a resident’s fear of the new environment, isolation and loneliness or other medical problems.  Where a resident who was previously active and communicative becomes sedate, lethargic or unresponsive, it raises a concern for overmedication.

4.  Has the resident experienced a signficant loss of weight?  A nursing home is required to provide a resident with a diet and supplements adequate to meet the resident’s nutritional needs.  If the resident has difficulty swallowing or has individualized dietary needs, the nursing home must provide the necessary specialized diet or therapy with eating.  If a resident refuses to eat certain types of food, the facility must provide alternatives and nutritional supplements, such as milkshakes, to ensure that the resident’s needs are met.  If there is a concern about a resident’s lack of eating or nutrition, the resident’s weight should be checked regularly to ensure there is no unhealthy weight loss (or gain).  If the resident loses a significant amount of weight over a relatively brief period of time, this raises a concern for abuse or neglect.

5.  Has the resident suffered serious skin breakdown?  The law specifies that a nursing home must prevent skin breakdown in the form of pressure ulcers, unless skin breakdown is unavoidable.  Pressure ulcers occur because a resident is left in one position (either lying or sitting) too long, causing pressure to build to the point where the skin begins to break down.  For residents who require regular assistance with toileting, this problem is compounded when they are left for extended periods of time lying in urine or feces.  Pressure ulcers begin as discolored, reddended skin, but can quickly worsen to open wounds with blackened, decaying flesh and a discernable odor.  If a resident experiences a significant wound of this type without plausible explanation, it raises a concern for abuse or neglect.

For more information about accidents, falls and elopement, read the full article.

A recent article in the NY Times discusses life and medical care for an elder following a fall.

http://www.nytimes.com/2008/11/08/us/08falls.html?_r=1&pagewanted=2