Neglect: Is it Abuse?

Elder abuse legislation has been expanded by CMS for the first time in 15 years.

Recently, the Centers of Medicare and Medicaid Services (CMS) made a substantial upgrade to existing nursing home legislation, the first upgrade of its kind in nearly 15 years. One important change that has been made has to do with the very definition of elderly abuse.

According to the new legislation, the term “abuse” covers the following definition:

[T]he willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being.Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology. Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm.

(Emphasis has been added.)

CMS added and expanded upon other definitions of “abuse”, “adverse event”, “exploitation”, “mistreatment”, “neglect”, and “sexual abuse”.

Neglect = Abuse

What does all of this mean for nursing homes and their residents?

It means that CMS officially recognizes neglect as abuse. It increases the rights of nursing home residents because they have additional protections. As a relatively vulnerable group, elderly people deserve to be protected from nursing homes, and this is long over due.

If you have a loved one that has suffered from some kind of neglect at a nursing home and you have questions regarding their situation, please contact me here.

To begin, it is important to outline a few kinds of neglect:

Personal hygiene neglect occurs when nurses or nurse aides do not provide adequate assistance with laundry, cleaning, bathing, brushing their teeth, or other forms of hygienic practices.  When it comes to older people who are not able to care for themselves, hygiene can be a matter of life and death.  For example, leaving them in soiled linens can lead to urinary tract infections (“UTIs”) or infected bedsores.

Basic needs neglect occurs when a nursing home neglects to provide reasonable food, water, or a safe and clean environment.   This can lead to serious, even deadly, dehydration or malnutrition, skin breakdowns due to poor nutrition, falls, or serious illness.

Medical neglect occurs when a nursing home fails to provide adequate attention to a resident’s medical needs, such as failing to prevent or adequately treat medical issues like bedsores, urinary tract infections, infections, pneumonia, and the like.

Emotional or social neglect occurs when nursing home staff repeatedly ignores, abandons, or acts rudely or dismissively to a resident, often because the staff is overstressed from inadequate staffing and being overworked.  Often this is seen in conjunction with abuse, poor care, or other forms of neglect, at a facility that is being run to put corporate profits over resident safety.

The most recent update to legislation officially defines these categories of neglect as elder abuse.

Other Changes from CMS

There are a few other important changes that were outlined by CMS. One important change is regarding resident rights and freedom from abuse, neglect, and exploitation. In regards to resident rights:

Medicare retained all existing residents’ rights in substance, but “updated” it to “improve logical order and readability, clarify aspects of the regulation where necessary, and updating provisions to include advances such as electronic communications.”

By adding additional protections for the elderly, we are guaranteeing them the right to age with dignity, which is a human right.

Additionally, the new rule adds a provision about not employing caregivers who have been found guilty of abuse and neglect, as well as, requiring facilities to investigate and report all allegations of abuse and neglect. The rule states the following:

(a) The facility must—

(3) Not employ or otherwise engage individuals who—

(i) Have been found guilty of abuse, neglect, exploitation, misappropriation of property, or mistreatment by a court of law;

(ii) Have had a finding entered into the State nurse aide registry concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of their property; or

(iii) Have a disciplinary action in effect against his or her professional license by a state licensure body as a result of a finding of abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property.

Recognizing Critical Signs of Neglect

Regardless of legislation, it is always important to know the sign of elderly neglect:

• Bedsores (also called pressure ulcers);
• poor hygiene;
• sudden, unusual, or unexpected weight loss;
• Injuries from nursing home falls;
• Dehydration;
• Malnutrition;
• Changes in behavior or emotional state, such as becoming withdrawn, confused, or disoriented;
• Changes in personal hygiene or appearance efforts, such as not getting dressed, out of bed, or other changes in routine;
• Unsafe room or facility conditions, such as poor lighting, slippery floors, unsafe mobility equipment, or unsafe furniture in the nursing home resident’s room;
• Staff refusing to let family members or friends visit the resident;
• Resident being kept in an overmedicated state.

If you recognize any of the above mentioned signs, it is important that you stay alert. You should be aware that intervention should be made immediately in order to prevent serious injury or even death.

If you have questions regarding the upgrades in legislation or a potential case, please feel free to comment below or contact me here. You can also visit my informational page regarding elderly neglect here. Remember neglect is abuse!