Nursing Home Abuse Questions

How many people are in nursing homes? Across the U.S., there are around 1.4 million people living in nursing homes.  This includes the following breakdown of age:

• 7.8% are 95 years old or older.
• 33.8% are 85-94 years old.
• 26.4% are 75-84 years old.
• 16.5% are 65-74 years old.
• 15.5% are younger than 65.

There are approximately 15,600 nursing homes in the U.S. The population of residents in these facilities is estimated to be around 1.6 million. Most facilities average 500 to 1,300 beds, with an average capacity of 106 certified beds.

When run correctly and when residents enjoy excellent, respectful care, nursing homes can be good for elderly people.  However, poorly run facilities and those with abusive or neglectful caregivers can result in harm to older adults.

The care delivery model of traditional nursing homes may leave much to be desired in terms of resident safety.  Residents can face increased risks to their physical health and psychological well-being due to factors like infections and apathetic or untrained staff.

Some serious yet preventable conditions common to nursing home residents include:

• Secondary infections
• Pneumonia
• Respiratory infection
• Kidney infection
• Urinary tract infection
• Heart failure
• Hip fractures
• Pulmonary edema
• Bacterial skin infections
• Injuries due to falls

The skyrocketing cost of nursing home residency also poses risks for elderly people.  Rather than having the quality of care increase with cost, residents may not receive a reasonable standard of care, potentially putting their well-being at risk.

Studies have also found nursing home residents suffer a substantially higher rate of mental and emotional problems, including depression and anxiety.  They are also much more likely to commit suicide than elderly people who do not live in a residential care facility.

Although living in a residential care facility may never be good for certain elderly people, nursing home residents have a right to several things that can make the experience more tolerable.  They include:

• Retain their privacy and individual freedoms
• Stay with their spouse or partner
• Live in a facility without foul odors
• Live with dignity
• Receive the care and treatment they need
• Live with a sense of security

Simply having the freedom to pick out their own clothing and determine how they spend their days can hold significant meaning for elderly people.  Unfortunately, they do not retain these options in some nursing homes.

To ensure the best outcome for a loved one in a nursing home, family members can attempt to ensure that the facility scores well in the following key metrics:

• Staff-to-Resident Ratio: The higher the ratio of staff to residents, the better the experience will be for those who live there.  A lower ratio can lead to stressed or overwhelmed staff, which increases the risk of caregiver burnout.  Stress and burnout are two risk factors for abuse and neglect.
• Staff Training and Competency: The higher the facility’s standards for staff training and competency, the better the residents’ chances of receiving an acceptable level of care.  That is because untrained staff may make mistakes that cause injuries and erode residents’ sense of safety and well-being.
• Staff Turnover Rates: If the facility staff turns over quickly, residents may face an increased risk of nursing home injuries and abuse.  New employees may also lack the training necessary to deliver safe, respectful care.
• Quality of Life Focus: Facilities with a quality of life focus respect the resident’s wishes whenever possible, rather than approaching their care based on staff convenience.

Other factors that are important to older adults include:

• Having their own room
• Meal programs that serve tasty, nutritious food
• Opportunities to socialize at their discretion
• Access to activities and services on-site

When it is time to select a nursing home, make an informed choice. Select a facility near family, doctors, favorite shopping, and other important places. Check your state’s elder affair agencies for facility ratings, reports, and violations. There should be a low resident-to-staff ratio. Often, abuse and neglect are the product of overworked and understaffed employees.

If your loved one lives in a nursing home, stay in close contact. Notice any sudden changes in appearance or demeanor. Your attention and involvement could protect an elderly relative from a dangerous situation.

If you live too far to visit often, call at least once a week. Mail cards and letters, and check with your loved one to make sure they were received. If your loved one has a computer or phone, use Facetime or Skype for a virtual visit. It is also a wise idea to speak often with the director of nursing and your loved one’s regular caregivers.

Unfortunately, families sometimes have no choice but to put an elderly loved one in a nursing home.  If the unthinkable happens and your loved one suffers abuse or neglect, you may not know what steps to take.

A nursing home abuse lawyer can help you navigate the complex legal issues and obtain the resources the victim needs to recover from their injuries.  A lawyer will identify the parties who caused the victim’s injuries and pursue legal action to hold them accountable.  Your lawyer will also help you recover the financial compensation you need to get the victim to safety and obtain comprehensive medical treatment and care.

Abuse is a broad umbrella term that refers to specific forms of abuse, neglect and exploitation. Here is the application of each in an elderly care facility setting:

• Abuse refers to any act, threat, or omission by a nursing home employee or resident that may cause harm to an elder’s physical or mental health.
• Neglect is the failure to act or intentional omission committed by a caregiver. This includes the failure, regardless of intention, to provide care, supervision, and service to maintain an elder’s physical and mental health. Failure to protect an elder from abuse, neglect, or exploitation by others is also considered neglect.
• Exploitation often refers to financial abuse, but it also includes the misuse of a power of attorney or guardianship duties, stealing assets, and failing to use an elder’s income and assets to support the elder and provide necessities.

The few studies that have focused on care facilities suggest that abuse in nursing homes is severely under-reported. What we do know is that estimate suggest one in 10 Americans over age 60 have experienced some form of elder abuse. That could mean up to five million older adults are abused each year.

Although no formal or official definition determines who an elder adult is, this type of abuse typically occurs in adults age 60 and above. It is more common for women to be abused than men, although this challenge affects both sexes. Abuse is most common among those who rely on the assistance of someone else for their care.

Elders who are physically weak or frail, those with dementia, those with disabilities, and those with impaired communication abilities are most likely to fall victim to abuse or neglect.

The largest population facing the risk of elder abuse, however, are those older adults living in a nursing home or residential care facility.

Studies suggest that only one in 14 cases of elder abuse are reported. That means that an alarming number of older adults are being abused each year without getting the help they deserve.

In around 60 percent of elder abuse cases, the person doing the abuse is a family member. Abusers are both men and women, and are often the spouse or adult children of the victim. In many other cases, the abuser is a caregiver, such as a nursing home staff member or nurse.

Your loved one might not be able to communicate with you due to fear or inability, so it’s up to you and outstanding medical professionals to look for signs of abuse, neglect, and exploitation. Here are some of the most common warning signs of elder abuse in a nursing care facility:

• Unexplained cuts, bruises, wounds, and welts
• Bedsores
• Poor hygiene and soiled clothing
• Repeated falls and injuries
• Sunken cheeks and/or eyes
• Trouble eating and sleeping
• Sudden weight loss
• Hair loss
• Refusal to talk openly, especially in front of nursing home employees

Establishing a strong causal connection to certain behaviors and elder abuse is difficult, if not impossible. Yet, researchers have spent a great deal of effort identifying risk factors of elder abuse. These are characteristics about the victim, the abuser, the relationship, location, and social norms, that are similar across many cases of nursing home abuse and neglect.

• Victim risk factors. There is strong evidence that the presence of a disability or functional dependence, poor physical health, cognitive impairment, poor mental health, and a low socioeconomic status are risk factors for elder abuse. Other potential victim risk factors include gender, age, financial dependence, and race.
• Abuser risk factors. Overwhelming evidence supports that those who abuse elders might have a mental illness, might have a substance abuse problem, or suffer from abuser dependency.
• Relationship factors. The relationship between the abuser and victim doesn’t factor into nursing home abuse as strongly as other situations, but a relationship between the victim and the abuser might be a risk factor. This is especially true when resident-on-resident abuse occurs in a nursing home. Facilities are also liable for this kind of abuse if they know it is happening and don’t stop it.
• Societal factors. Research on societal factors of elder abuse is heavily contested, but some support the idea that negative stereotypes about aging and cultural norms play a large role in elder abuse.

Having knowledge about the causes and risk factors of elder abuse in a nursing home will let you better monitor the care of your loved one.

If you become aware that an elderly person is in immediate or life-threatening danger, call 911 immediately.

If you know or even suspect that someone is suffering abuse from a caregiver, nursing home, or another party, you have options for making a report. Consider contacting one of the following resources:

• Local law enforcement authorities
• Local adult protective services (APL)
• Local long-term care ombudsman
• Other eldercare resources

Although you do not have to provide your name or any personal information, be prepared to answer questions about the situation. The individual or agency you contact may want to know basic information such as:

• Whether you believe the victim is being abused or neglected
• Any health conditions or medical problems the victim has
• Details regarding the nature of the suspected abuse
• Family contacts or support resources available to the victim

If the victim is a nursing home resident, you could notify a facility administrator. However, before doing so, consider talking to the police or APL first. In some cases, the abuser may take retaliatory action against the elderly victim. You may also want to consider talking to an elder or nursing home abuse lawyer to learn more about your options.

If you are an older adult who is being abused, tell someone. You can call the authorities or if you prefer, confide in someone you trust such as:

• Your doctor or another medical care provider
• A trusted friend or family member
• Your clergyperson or spiritual leader
• Someone you know in the community

Based on the circumstances of the suspected abuse and who you reported to, a qualified responder will likely be sent to interview the victim. If the interviewer determines that abuse may be occurring, they may contact family members or refer appropriate resources.

If the victim is not forthcoming or unable to communicate effectively with the interviewer, they may not be able to take any action. In that case, it may be up to you to take further action to protect the victim.

Next steps to consider include:

• Removing the victim from the situation and moving them to a safe location
• Reaching out to elder abuse or care resources to learn more about your options

If you cannot get the cooperation and assistance you need from local resources or agencies, talking to a legal professional may be the most effective way to get the victim help.

If your state mandates reporting, most medical care providers have an obligation to report suspected elder abuse. If they fail to report potential abuse, they can be liable for any injuries and damages the victim may later suffer.

However, whether your state requires mandated reporting or not, any person who becomes aware of possible abuse has a moral obligation to report the situation.

If your loved one is still in charge of his or her financial affairs, warn them about solicitations for money from email or telephone con artists. Be on the alert for caregivers who ask to borrow money or try to change your loved one’s will. For seniors with memory or cognitive issues, they should be informed about their finances but have an appointed family member, trusted friend, or attorney manage their money.

Even with competent care and safe surroundings, seniors fall. Certain medications, like blood thinners, cause bruising to the skin that can look alarming. These are typical issues related to aging. However, repeated falls or unexplained bumps and bruises could be a sign of abuse or neglect. A reputable nursing home has nothing to hide and will tell you if your loved one falls or gets injured accidentally.

Bedsores are ulcers that develop when an individual is immobile and spends most of their time sitting or lying down. They can form when residents are in wheelchairs, bedridden, or in any position that puts pressure on the skin and cuts off blood supply, and they can develop in as little as three to four hours.

How fast bedsores develop can depend on a few factors like kind of position a person is in and how much pressure is put on the skin, but a resident typically needs to be turned or repositioned every two hours to prevent developing bedsores. Padding can also be used to lessen the pressure on the skin.

Proper nutrition through vitamins, minerals, and protein helps prevent and heal bedsores, which is why it’s vital for facilities to provide residents with necessary nourishment.

If bedsores do develop, they can be treated through proper skin care and medication and can often heal in a matter of days for a healthy individual.

Individuals with diabetes, circulation issues, malnutrition and an inability to sense pain are at higher risk to develop bedsores. Facilities need to accommodate at-risk residents and provide adequate care by taking preventive measures.

Some of the most common treatment options for bedsores include:

• Repositioning: Bedsores form due to extended pressure on an area of the body. Frequent repositioning can take pressure off the part of the body where the bedsore formed, allowing it to heal.
• Support Structures: Caregivers may use pads and cushions to aid in repositioning the body to relieve pressure from the affected area.
• Dressing and Cleaning Wounds: Regular cleaning and frequent dressing changes are important to prevent infection and aid in wound healing.
• Debridement: Debridement refers to the removal of dead, infected, or otherwise damaged tissue from the wound. Cleaning the wound with water may help with debridement, though in some cases doctors may cut away the damaged tissue.

If a wound is unresponsive to treatment, the affected area may need surgery to heal properly. This may entail placing skin or muscle over the affected skin, especially if the area is particularly boney to give an extra cushion.

Surgery is often seen as a last result for elderly patients due to the risk of infection and lengthy recovery period. A doctor will typically only recommend surgery if other treatment options have been ineffective. Talk with your doctor if you have any concerns.

Elder psychological abuse is the verbal or non-verbal infliction of emotional or mental anguish. Typically, the abuser repeats a pattern of behavior over time with the goal of controlling the victim through fear.

Psychological abusers prey upon the many vulnerabilities of older adults to invoke the fear of violence, feelings of deprivation, indignity, isolation, shame, and powerlessness.

Deep emotional and mental damage can result, often with the victim requiring long-term treatment. Psychological abuse often opens the door for other types of elder abuse, particularly financial exploitation and sexual abuse.

Elder psychological abuse can take countless forms. Sometimes an abuser will employ multiple techniques to achieve a more profound response, particularly if they have an ulterior motive for emotionally or mentally abusing the victim.

Some of the most common examples are bullying, threatening, harassing, intimidating, and coercing the victim. Other examples of psychological abuse in nursing homes include:

• Denying (or threatening to deny) the victim the right to have visitors
• Threatening the victim with physical harm unless they obey
• Humiliating the victim by calling them names, etc.
• Treating the victim like an infant or child
• Threatening to deny the victim food, water, or other basic needs
• Isolating the victim in their room

Unfortunately, elder psychological abuse is type of abuse can be difficult to detect. If you have a loved one living in a nursing home or residential care facility, watch for signs such as the following (that are not associated with the victim’s current condition):

• Fearfulness
• Withdrawal
• Helplessness
• Insomnia
• Anxiety
• Depression
• Apathy
• Inhibited speech
• Resignation
• Passivity
• Paranoia
• Confusion

It may be easier to spot warning signs of emotional abuse if the abuser is present. These may include:

• Refusal or unwillingness to make eye contact with them
• Closed body language, huddling or self-hugging
• Sudden unwillingness to speak or answer questions

Other potential warning signs of psychological abuse are sudden, unexplained personality changes and excessive fearfulness when visitors prepare to depart.

The Most Common Signs of Emotional Abuse Are:

• Depression
• Anxiety
• Withdrawal from people and activities
• Fearful or cowering behavior
• Reluctance to speak or make eye contact
• Changes in eating or sleeping that are unrelated to health condition or medication
• Low self-esteem and self-worth
• Attempts to harm self or others
• Any attempt by the facility to prevent the resident from phone calls or visits

Emotional abuse can be verbal, like shouting, scolding, or insulting the victim. It can also be nonverbal, such as denying a patient social interaction. Abusers may threaten physical violence to control, humiliate, or demean the victim. Some abusers torment their victims by placing necessary items – i.e. glasses, walker, or hearing aid – out of reach.

Other examples of emotional abuse are:

• False accusations against the victim
• Interference with favorite activities or hobbies
• Disrupting sleep or meals
• Making the victim wait for food, water, or medication

Emotional abuse is the third leading type of abuse or neglect in nursing homes. In a 2012 survey conducted by the National Council on Elder Abuse, more than 50 percent of nursing home staff admitted to committing physical or emotional abuse or neglect. If untreated, emotional abuse creates depression, anxiety, and other mental health issues. The emotional stress can worsen physical ailments such as heart disease or hypertension (high blood pressure).

Yes, if it is determined that the victim suffered mental, physical or financial harm, the abuser could be held responsible in a civil lawsuit. Sometimes the state or county files criminal charges. An abuse victim or family member may seek compensation regardless of the presence or absence of criminal charges.

Elder emotional abuse can occur anywhere that older adults receive care and services from others. In-home caregivers can perpetuate abuse and neglect, even those who are related to the victim.

Often, however, older adults sustain psychological abuse in nursing homes and residential care facilities. According to the National Institute on Aging, women are more likely than men to be the victims of abuse, but abuse can happen to anyone, anywhere.

In the nursing home or residential care environment, psychological abuse can occur for a variety of reasons. In some cases, this abuse occurs due to caregiver stress, overwork, and other factors that exert long-term mental and emotional pressure. Staff stretched too thin may neglect the basic needs of residents, causing mental and emotional distress.

In other cases, however, the abuse is intentional. In many cases, the abuser uses psychological manipulation to coerce the victim to sign over their assets or give the abuser control of the victim’s finances.

Abusers often choose victims who:

• Rarely have visitors or outside contact
• Lack the ability to communicate effectively
• Suffer from dementia or cognitive impairments
• Have more assets or higher wealth

If your loved one faces physical harm, you understand how important it is to get them to safety. Psychological abuse can also cause significant damage and lasting emotional scars.

Unfortunately, family members may hesitate to take action or delay seeking help. The safest course of action is to move the victim to safety, out of reach of the abuser. This is especially important if you do not know who has perpetuated the abuse or if it is still going on.

Physical and financial abuse of an elder are criminal offenses. Unfortunately, not all states have criminalized elder psychological abuse. However, you can hold the abuser accountable for their actions and liable for the victim’s injuries and damages. A nursing home abuse lawyer can assist you, protecting your legal rights and fighting to recover compensation.

You may have the right to recover compensation for:

• The victim’s medical and psychological care
• Relocation expenses
• Financial damages
• Pain and suffering

No settlement can undo the damage caused by elder psychological abuse. However, financial compensation can provide the treatment and care the victim needs for psychological evaluation, treatment, and therapy.

The remedies imposed if a nursing home is found noncompliant with federal requirements depend on the infraction itself and the nursing home’s general history.

Every nursing home that accepts Medicare and Medicaid payments is subject to federal regulations under the Nursing Home Reform Act of 1987. The reform law was adopted to ensure that each resident receives quality care free of neglect, abuse, and mistreatment.

The law not only requires federal oversight of nursing homes but also for states to regularly inspect nursing homes for violations. Criteria the state use when it inspects houses include whether a deficiency is an isolated incident and whether a deficiency causes immediate harm to a resident.

According to federal nursing home regulations, nursing homes must:

• Conduct comprehensive, accurate assessments of each individual’s functional capacity
• Provide the necessary assistance needed for a resident to carry out regular daily activities, such as good hygiene, grooming, and healthy nutrition
• Prevent a resident’s ability to bathe, groom, dress, groom, move around, use the bathroom, eat, and communicate from deteriorating
• Ensure residents receive proper treatment and supportive devices to maintain their vision and hearing
• Work to prevent residents from developing bed sores and pressure sores by prevention infection and encouraging mobility
• Have an adequate amount of trained nursing staff
• Develop a comprehensive care plan for each resident, which must involve the resident
• Ensure residents receive adequate supervision to prevent slips and falls in nursing homes
• Help residents avoid dehydration and malnutrition
• Ensure that residents receive adequate medical attention and medication, limiting medical mistakes

Additionally, nursing homes are required to treat every resident with dignity, courtesy, and respect and to keep records about their progress and any regressions.

Any nursing home that fails to comply with federal regulations set forth by the Centers for Medicare and Medicaid (CMS) can be subject to sanctions.

CMS and state agencies can punish any nursing home that fails to meet compliance, as well as those that regularly perform poorly during inspections. Sanctions are based on the seriousness of offenses and may include:

• Appointing temporary managers for facilities
• Hosting training and other workshops for staff members
• Creating directed plans of correction
• Imposing a sliding scale of fines
• Removing homes from Medicare and Medicaid

Under federal guidelines, homes in violation can be terminated from Medicare and Medicaid if they fail to remedy issues within six months. Being removed from the program means that nursing homes can no longer accept patients who pay with Medicare and Medicaid.

Being able to put a camera in a loved one’s room depends on a few factors. It’s perfectly legal to place a camera in your loved one’s room if the facility is given notice and a sign is set in the room to make caretakers aware of the recording device. The facility cannot remove a resident because of the request.

Additionally, the resident or guardian is responsible for the cost of the device, installation, and maintenance. If the resident has a roommate, you must obtain their written content to a place a monitoring device in the room. The camera may not be in plain sight, but a facility can request the camera be visible.

It’s ill-advised to install a camera without notifying the facility, but if they are not willing to fulfill your request, you should consult with a nursing home abuse lawyer before doing anything else. Placing a recording device can be tricky depending on your state and HIPAA laws.

Placing an audio recorder in a nursing home is subject to similar laws as putting a camera in a home. It greatly depends on the state and HIPAA laws. Some states operate under single-party consent laws where only one party is required to consent to the audio recording. But this can also depend on the type of facility and HIPAA laws.

As of June 1, 2018, all nursing homes and assisted living facilities in Florida are required by law to have backup generators or another alternative energy source so they can maintain temperatures if their facilities lose power during an emergency.

The new law comes following a series of preventable deaths at a nursing home where residents were left to sit in a sweltering facility after a 2017 hurricane knocked out its power, rendering its air conditioning system inoperable.

According to the Centers for Disease Control and Prevention (CDC), when Hurricane Irma made landfall in Florida in September of 2017, the storm flooded coastal cities, devastated communities, left millions without power and led to the deaths of 123 residents.

Nearly 10 percent of these deaths occurred at The Rehabilitation Center at Hollywood Hills in Hollywood, FL. After the nursing home lost its air conditioning system due to a power outage caused by the storm, residents spent three days in oppressive heat that climbed up to 99 degrees.

Residents remained at the nursing home despite federal rules that require the home to either fix the problem or relocate residents once temperatures rise above 81 degrees. Nursing staff only began evacuating the home after residents began to die. The deaths were ruled homicides because the nursing home failed to provide proper care, which includes keeping the residents under its care cool and hydrated.

These preventable deaths led Florida legislators to create laws requiring nursing homes and assisted living facilities to have backup generators.

Nursing care facilities rely on heating and air conditioning systems to maintain comfortable temperatures for residents. When power outages occur during storms, hurricanes, and ice storms, residents are at risk of contracting illnesses or dying when the facility does not maintain safe temperatures. If a nursing home doesn’t take the correct steps after a power outage, they can face criminal charges.

Excessive heat poses a severe risk to elderly residents in nursing homes. Some of the common conditions and complications that an elder might suffer when exposed to extreme heat are:

• Heat stroke is the most dangerous condition to elders who have been exposed to excessive heat. Death may befall elders that don’t receive immediate medical attention for heat stroke. Those afflicted will have a high body temperature and might exhibit symptoms that include hot, red, damp or dry skin, a fast pulse, a headache, dizziness, nausea, and confusion. Those who suffer from heat stroke might also pass out and lose consciousness.
• Heat exhaustion is often the stage before heat stroke. It includes many of the same symptoms with the exception of fever. Clammy skin, heavy sweating, muscle cramps, and weakness are common warning signs of heat exhaustion.
• Heat rash leads to red marks and bumps on an elder’s body as a result of pores trapping sweat under the skin. Florida’s humidity, for example, contributes to heat rash and commonly affects seniors who are exposed to unsafe temperatures. If heat rash goes untreated, it might lead to painful pustules and infection.

People who have the coronavirus report a variety of symptoms.  Some people experience a mild illness, while others report more sudden, extreme symptoms.

According to the Centers for Disease Control and Prevention (CDC), the most common symptoms include:

• Fever
• Cough
• Chest pain
• Shortness of breath
• Chills
• Headache
• Muscle pain

These symptoms generally appear between two and 14 days after exposure to the coronavirus.  Not everyone who has the coronavirus will have these symptoms.  Some people have only a few, and others have no symptoms at all.

People who have the coronavirus should monitor their symptoms closely.  General symptoms can worsen gradually or suddenly, and may require medical attention.  The CDC urges anyone with the following symptoms to get medical attention immediately:

• Difficulty breathing
• Persistent chest pain or pressure
• Confusion
• Inability to rouse
• Blue tint to face or lips

These symptoms are serious.  If you or someone in your household has these symptoms, you should call 911 or go to your nearest emergency room (ER) right away.  Inform the operator or person at the ER that you believe the patient has COVID-19.  If possible, wear a face covering.

There is currently no official treatment for the coronavirus COVID-19.  Like other viruses, the symptoms of coronavirus will go away on their own.  The duration of the illness depends on the individual and whether he or she has other medical conditions.  Doctors may prescribe fever reducer or pain reliever to help manage symptoms.  Most people are able to manage symptoms and heal at home.  Doctors recommend getting plenty of rest and drinking lots of fluids to stay hydrated.

Researchers are working to develop a vaccine or treatment option for the coronavirus.  They are working on a treatment option similar to Tamiflu, which reduces the duration of the flu.  A similar treatment option for the coronavirus could help reduce the severity and duration of the illness.

Being in quarantine means that you are separated from people who have been exposed to the coronavirus, but have not shown symptoms within the standard incubation period.  For COVID-19, the incubation period is 14 days.  According to the CDC, after 14 days, if there are no remaining symptoms, you should not be a risk for spreading the virus to others.

Healthcare experts call nursing homes a “perfect storm,” “breeding ground” and “hotspot” for coronavirus.  That is because the virus continues to spread rapidly in nursing homes causing thousands of illnesses and deaths among residents and staff members.

We know that the coronavirus spreads primarily through respiratory droplets.  That is, when someone coughs or sneezes – those droplets of bodily fluid that leave the body.  But the coronavirus can also spread through touching surfaces that have germs on them.  The spread of coronavirus in nursing homes is thought to be rampant because of several factors, such as:

• Nursing homes house a lot of people in a relatively confined area.
• Nursing home staff and residents share many of the same spaces, including dining, public areas and activity areas.
• Many nursing home residents have underlying medical conditions that make them more vulnerable to diseases, particularly viral infections.
• Staff members are vulnerable because they work directly with residents and may be exposed to bodily fluids, including respiratory droplets.
• Staff members continue to work after contracting the illness. People who are asymptomatic can still spread the disease.

Many nursing homes are not following infection control guidelines to prevent the spread of the coronavirus.  Furthermore, because many people who have the virus do not have symptoms, the coronavirus may be in nursing homes without staff or resident knowledge.  This contributes to outbreaks because staff do not know that infection control measures need to be initiated.

CDC guidelines state that not everyone needs to be tested for coronavirus.  If your loved one living in a nursing home has symptoms of coronavirus, you can talk to their primary healthcare provider about whether they need to be tested.  Their healthcare provider and the facility will work together to determine if testing is needed.

The CDC has recommended that all non-essential visits to nursing homes be temporarily suspended.  Visitors who are asymptomatic are a known cause of spread in nursing homes.  The CDC recommends that no visitors be allowed in nursing homes except in very certain situations.  Those situations include end-of-life care and compassionate care.  Even in these situations, visitors must be screened for a fever and symptoms of coronavirus.  Visitors who have a fever or symptoms should not be allowed to enter the nursing home.

Not being able to visit your loved ones is definitely challenging.  Fortunately, technology allows us some alternatives to physical visits.  Many nursing homes are providing residents with access to tablets or iPads in order to interact with loved ones.  Programs like Skype, FaceTime and Zoom allow families to video chat with loved ones in real time.

In addition to video chatting, many facilities are offering visits between glass.  You can see and interact with your loved one with glass (usually a window) between you.  You communicate with them over the phone.  This is a good option for children, who may want to show nursing home residents art, projects, etc.

For some families, the best option to prevent coronavirus infection is bringing a nursing home resident home.  If someone in your home is capable of caring for them, and there is no risk of infection, then bringing your loved one home may be a good option to keep them away from others who may be infected.  You should discuss this possibility with your loved one’s healthcare provider.

As COVID-19 nursing home outbreaks became more frequent, the CDC implemented new guidelines and key strategies for nursing homes and other long-term care facilities.  The key strategies for preventing the spread of coronavirus include:

Prevent COVID-19 from entering the nursing home:

• Restrict all visitors (exceptions for end-of-life care).
• Restrict volunteers, non-essential service providers (barbers, etc.) and non-essential healthcare providers.
• Actively screen anyone who enters the building for fever and respiratory symptoms.
• Cancel all field trips outside of the nursing home.

Identify infections early:

• Actively screen all residents for fever and symptoms of coronavirus.
• If a resident has a fever or symptoms, he or she should be isolated away from other residents.
• Facilities should follow the CDC’s transmission-based precautions.
• Facilities must notify the local or state Health Department within 24 hours if:
  • A resident has a severe respiratory infection that requires hospitalization
  • A resident dies due to a severe respiratory infection
  • Three or more residents (clusters) have respiratory infection
  • Individuals have suspected or confirmed cases of COVID-19

Prevent the spread of COVID-19:

• Cancel group activities.
• Suspend communal dining.
• Enforce social distancing among residents.
• Make sure residents wear a face covering when they are outside of their room or around other residents.
• Make sure all healthcare providers wear a face covering while in the nursing home.
• If there is a positive diagnosis of COVID-19, restrict residents in the affected unit/wing to their rooms.
• When caring for residents who are positive for COVID-19, healthcare providers and staff should wear PPE, including an N95 respirator, gown, gloves and eye protection.

Assess supply of PPE and optimize supply:

• Assess current supply of PPE, including masks, gowns and gloves.
• If you have a shortage of PPE, or anticipate a shortage, contact your local or state Health Department.
• Consider using face masks, respirators and eye protection more than once, or extend their use for certain activities.

Identify and manage severe illness:

• Facilities should designate an area to care for residents who have COVID-19, or they suspect have it. Separate these residents from others.
• Monitor all residents who have signs of illness. Document oxygen saturation, temperature and blood pressure at least three times per day.

If you suspect that a nursing home is not following CDC guidelines, you should report your concerns.  You can contact your local long-term care Ombudsman or Health Department.  You can also contact a nursing home abuse lawyer, who can advise you of your legal rights and options to protect your loved one.

Nursing homes must take reasonable steps to protect residents from the coronavirus.  That includes following normal infection control guidelines, as well as new guidelines from the CDC and CMS.  Nursing homes who fail to follow these guidelines and stop the spread of the coronavirus may certainly be subject to lawsuits for negligence and wrongful death.