Nursing home abuse is on the rise in the United States. America is an aging population. According to the National Center on Elder Abuse, “Life expectancy has risen from 68 years in the mid-20th century to the current average of about 81 years for women and 76 years for men…In 2018 there were 29.1 million older women in the United States, compared with 23.3 million older men….It is expected that by 2030 there will be a 50% increase in the number of elders over the age of 65 who require nursing home care.”
This rapidly increasing demographic is accompanied by some horrible and unimaginable national elder abuse statistics in the nursing home and skilled nursing facilities provided by the NCEA: “A recent systematic review that collected self-reports of abuse by residents found high levels of institutional abuse. By type, prevalence estimates reported: psychological abuse (33.4%), physical (14.1%), financial (13.8%), neglect (11.6%), and sexual abuse (1.9%).”
South Carolina attorney Grady Jordan is a passionate advocate for victims and their loved ones of skilled nursing facility abuse and neglect. In a recent interview, Grady offered his thoughts on this growing problem.
What is nursing home abuse regarding the law?
Under South Carolina law a family member of a deceased patient or someone who has a power of attorney for a current living patient would have the rights to bring civil litigation against a nursing home facility, which would include the staff as well as the providers, nurse practitioner, PA’s, or the physician that provide the care. Often the providers are contracted by separate companies into the skilled nursing facilities to see patients and write orders. So if there is a problem with a patient in a skilled nursing facility then the family member can bring an action against the nursing home itself as well as against the company that contracts or brings in the professional staff.
If loved ones and family are suspicious of abuse or neglect what should they look for?
Signs that the patient is not being bathed properly, soiled diapers, they look like they are not getting proper nutrition, oftentimes they are dehydrated and end up getting UTI’s that causes them to go to the ER and those often cause the patient to become septic and infection spreads into their system, not just in the bladder or urinary tract. Another common problem is bed sores. These occur on the patient’s sacrum or their heels as those develop rather quickly. Those on the sacrum or rear end can become infected with feces and the patient can die.
What do you advise them to do if they notice these things?
I tell everyone to take lots of pictures of anything they think is a problem so that later if you have a bad bed sore, for example, you’ve got images and you don’t have to try and explain how bad it looked and the image is unbelievably helpful.
How do you rely on medical documentation for these cases?
If a client suspects abuse or neglect which they usually know because the patient has been sent to the emergency room and been in the hospital for weeks the family realizes there is a problem. We get the records from the hospital where they were admitted and treated, or we get their death certificate. We get the facility records and we review them and have them reviewed by a nurse that specializes in reviewing nursing home cases. Then, if we think we have sufficient evidence of abuse from a medical standard we provide that information to a medical doctor for purposes of the abuse, and sometimes we may also get an opinion from an expert nurse as to the lack of care from the facility staff.
Is this a common occurrence in your experience?
It is common in skilled nursing facilities because they are short-staffed and many of those providing care have limited experience, or they are not certified and accredited to do the job. The facilities are chronically understaffed and not, in my opinion, well supervised and the paperwork may have been checked off, but that doesn’t mean what was supposed to have been done was done.
Do these failures or abuse in care get reported to any official agencies?
It gets reported and Medicare gets statistics. It does often get reported to DHEC in South Carolina which is the Department of Health and Environmental Control. If there is a fall in a facility they are supposed to report to DHEC and then they keep statistics on it. You can log onto the Medicare website and review the history of a facility and sort of getting an idea of any problems they may have had. It would be difficult for a layperson to do that, but I don’t care because my purpose as a litigator is to make the nursing home pay to help them understand that is NOT a good thing. What happens with the facility and Medicare I don’t care about. I care about the victim and their family members who have been traumatized by abuse or neglect.
Are most of these physical injuries, or is it neglect, or a combination?
It is neglect physically. You know it may be they have signs of something is going and the nursing staff is just slow to alert the physicians that there is a problem because the doctors don’t make rounds on these patients that often and they rely on the nursing heavily on the nursing staff to monitor so if they find a problem to alert the doctor so he/she can get involved. There are certain rules as to how often doctors are to see these patients, but it’s not near often as some of us would imagine. That’s why it’s called “skilled nursing” and if the nurses don’t inform the doctors that is where the problem can get out of hand. A bladder infection can turn into sepsis infecting the entire body in days if not properly diagnosed and treated with antibiotics.
Can you provide an example of this?
I have a current case where there was a UTI and the patient had a fever for several days and the nurses did not notify the doctor and the person ended up in the hospital with sepsis and died. And that’s just from a bladder infection. So many of these things are easily prevented. These bedsores are a huge problem. The nursing staff is supposed to rotate these patients on a certain schedule, especially those who are confined to bed and unable to get up on their own. They may report that they moved the patient and maybe not have done it, or they may not have properly checked the bedsores and applied the medicine, gauze, or dressing, or keeping it open. If a person is incontinent and the bedsore is near their sacrum feces can get into the wound and it gets infected. Sometimes their sore gets infected and they get a separate infection in their urinary tract and when they get to the hospital they are just a disaster and the ER ends up admitting these patients and tries to get them back to where they need to be if they can. It’s a huge problem.
Speak to the empathy you and your firm experience when it comes to these loved ones?
You know these families are often very reluctant to get involved in the legal system. They don’t want to sue or go to court, but sometimes the abuse is so bad that they just become so disgusted that they reach out to a lawyer for help and at that point, we are dealing with a family member(s) who has already been traumatized by what’s happened to their loved one and at the same time they want to get some kind of relief from the court system because of what happened. So, we end up helping them by reviewing their records and explaining what happened. Sometimes family members don’t even realize how bad it was. As part of that process, they end up reliving the abuse their family member suffered. Sometimes they find out it is far more abusive than they ever realized which adds more trauma and guilt upon the surviving family members. Even though they may have visited their loved one daily and ask if everything is ok and the victim says it is and they discover after the death what happened and feel horrible.
And the legal process brings even more trauma, doesn’t it?
Yes, they go through the legal system and file the complaint, we just work hard with them to keep them and hold their hand in the process so they can get through this, and then at some point, they will have to give a deposition where they testify as to what happened. They have to listen to experts testify as to what happened to the victim. It’s a learning process and it’s also traumatic, but they want some closure. They can’t make what happened to go away but they want to make sure that the facility does not do it to someone else.
Do these cases often result in the removal of people involved in the abuse or neglect?
We recently finished a case where the nurse practitioner that did not provide any care and admitted it was turned in by the professional who helped us an expert and her license authority is investigating her and my understanding is that she will no longer be able to practice. The second one was the “licensed wound care nurse,” who was only a licensed practical care nurse and they are not allowed to be wound care nurses in South Carolina because only a registered nurse can assess a patient. She would go get RN’s down the hall to sign off on her paperwork and her assessment of these pressure wounds. She is now being investigated by her licensing board for what she did.
What advice would you give to people searching for a skilled nursing facility for a loved one?
They need to visit the facility and try to get an idea of the quality of care. They can go online and search DHEC’s and Medicare’s websites to investigate the history of the facility. They should ask about staffing ratios and who provides the physician care, is it a contract doctor, how often do they see patients, etc. They need to come to the facility very often, be very involved and ask a lot of questions and not feel as if they can’t do that, or the facility will think they are bothersome. They are going to continually ask their family member (the patient) are they doing this for you, is everything ok, are you having any problems? If for some reason a problem develops one of the things that usually get to the family is the facility says, “Well you didn’t visit much so you didn’t care.” If you visit a lot then no one can say that because you were engaged in their well-being. And that is pathetic that a facility would say that to a family who’s lost a loved one due to negligent care.
Is this a national problem?
I don’t think people fully comprehend what is going on in many of our nursing homes and how bad the care can be. It depends on the facility, the staff they had at the time. They are just chronically understaffed and the staff on hand can’t do what they need to. Many have poorly trained personnel who are CNA’s and Medtech’s who have little to no certifications and they are doing things that should be done at a higher skill level. It’s not so much the mobile patients but it’s the bed-ridden patients and those that have mental issues who are dependent upon the staff to help them. Those that are confined to bed have a higher risk of abuse and it’s more difficult for the staff so it’s easier to not do much.
Isn’t this also emotional abuse?
Sometimes patients fall and falls aren’t always preventable. Facilities can’t strap people in and it’s a difficult thing. However, often patients will fall and get hurt but the staff doesn’t tell the family because they don’t want the family to know. Falls must be reported, but they aren’t always reported.
Let’s discuss compensation for the victims’ families?
We’ve been picky about the cases we take in. We normally do death cases or persons that have become seriously ill as a result due to the lack of care. We are just wrapping up a case that involved a patient getting a UTI infection that went unreported and treated and it cost Medicare $65,000. This is pathetic and it’s just stupid that it got this far when it didn’t have to.
Are these awards considered punitive damages?
You can get punitive damages in addition to the actual damages. Actual damages are the costs incurred for going to the hospital and having to fix whatever the problem was. You can get pain and suffering damages for the patient for what they experienced. And you can get punitive damages if you meet certain statutory requirements like gross negligence. The cases we take would be ripe for these damages.
The family can be compensated, but sometimes when there is a death they say well they are dead and my loved one is not going to get the money but the family wants that nursing home to pay. They want it to cost them something for what they did or did not do. And a lot of these people are reluctant to file a lawsuit, it’s something they never wanted to do, they are not litigious by nature, but they are so disgusted with the care provided that sometimes they just feel like it is the right thing to do and they are not only doing it for their loved one, but hopefully so in the future, another family won’t experience what they have had to endure.
Grady Jordan was the lead attorney on a recent nursing home abuse case handled by Smith Jordan. The case settled for $1,465,000, after extensive litigation where the blatant abuse of the provider
and the nursing staff was shown. The case involved a sacral pressure wound that was not even cared for by the professional staff. It caused not only severe pain to the patient, but became severely infected and ultimately resulted in the death of the patient. The problems that resulted from the pressure wound could have been avoided with proper care and monitoring.
Grady Jordan, JD, University of South Carolina School of Law, 1992
MS, Industrial Management: Clemson University, 1984
BA, Modern Languages (French): Clemson University, 1981
Smith Jordan PA
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