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Recognizing Neglect and Abuse in Nursing Homes by Irene Repczuk-D’Alessio Advocating for good care in a nursing home presents many challenges. The primary challenge is knowing how to detect any signs of deterioration in the health and well being of your elderly relative. This will help you to protect your loved one from harm or prevent further mental or physical deteriora tion. The second challenge is to have the courage to voice concerns to staff in a consistent and effective manner. Abuse or neglect often go unreported be cause residents or families fear that complaining will lead to worse care or retaliation against the resident. The most effective way to prevent neglect and abuse is to know all aspects of care required by the resident and to visit frequently. Frequent visits, at different times of the day, night, weekends and holidays, provide an opportunity to become familiar with the staff and with the routine of care: hygiene, nutrition, physical therapy, bed care, medical and nursing care, and recreation. This familiarity makes it easier to recognize problems with care-giving practices and how they impact the residents’ condi tion, mood, energy level, and functional level. Two of the most common forms of neglect that require monitoring are malnutrition and dehy dration. Malnutrition and dehydration are difficult to recognize. If you suspect your elder is not eating, do not always rely on reports of staff, but visit at mealtimes. Possible signs of malnutrition are cracks around the mouth, skin breakdown, pale lips or mouth, wounds that take long to heal, or confusion. To check for dehydration, look for skin tone and dryness in the mouth and lips. You can also pinch the skin on the forehead. If the pinched skin does not bounce back quickly, dehydration may be the cause. A checklist of things to look for follows: • Lack of assistance with eating and drinking. • Resident has poor appetite; is not eating or drink ing • Loose dentures or poor oral hygiene • Persons with swallowing problems are fed too quickly, or food is the wrong consistency. • Food is not palatable or the wrong temperature • Water or fluids are not offered to residents dur ing the day • Noticeable weight loss If you suspect a problem, have the doctor run blood tests to determine malnutrition or dehy dration. Both can cause diseases that are life threat ening, such as kidney failure, skin breakdown, con fusion, dementia, and a weakened immune system. Poor appetite can be an indicator of overmedication or adverse effects of medication. You can and should speak to the doctor about your concerns. If you disagree with the diet, speak to the dietician and offer suggestions for meals your relative enjoys. Another problem to look for is skin break down or pressure sores. Common causes for these are incorrect body positioning, prolonged bed rest, lack of attention to changing of disposable diapers, and failure to turn a bed-ridden resident. They are direct sign of lack of care and are preventable if proper care is provided. Failure to monitor the onset of skin breakdown can lead to infection. If you sus pect a problem, speak to the charge nurse and the Director of Nursing. In some nursing homes, disregard for per sonal care needs is also a problem. Frequent visits can help you determine whether there is proper at tention to bathing, grooming, and dental hygiene. Lack of response to toileting needs can lead to in continence, infections, or skin breakdown. Check whether staff responds to call bells or cries for help quickly. Many elderly people require assistance with walking. If this is neglected, it can lead to lack of mobility and you should check whether adequate at tention is given to motion exercises. Prolonged bed rest can also lead to lack of mobility as well as pneu monia, skin breakdown, and poor quality of life. Your inspection of the quality of care in the nursing home should also include a review of staff attention to health and safety matters. Remember that falls can cause fractures and that there are many reasons elderly people fall. Some causes of falls in clude dehydration, dizziness, medications, restraints, problems with mobility or gait, and stroke. Wounds that do not heal indicate that there is a significant problem and may signal that appropriate medical care is not being provided or that there is lack of access to physicians. Also pay scrupulous attention to medication administration. Errors in time or dos age are extremely common. If you are dissatisfied with the care, you have a right to choose your own physician. “НАШЕ ЖИТТЯ”, ЛИСТОПАД 2004 19
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