A nursing home is a facility that provides organized, structured nursing care and services to its residents. Nursing homes located in Texas cannot operate without a license.  Agencies must apply for and be granted licenses with the Texas Health and Human Services Department in order than they can be monitored with regard to compliance regarding levels of care, safety, and maintenance of the nursing facilities where residents will live.  Regulation insures Texans are receiving a proper level of care after being admitted to a nursing home.

Federal funding affects bed allocation. There are private pay facilities and Medicaid/Medicare-certified which receive revenue from federal agencies.  Nursing home providers must allocate a certain number of beds for Medicaid patients in order to receive reimbursement for eligible Medicaid patients.  Medicaid requirements establish number of beds required at facility, contracting procedures for high-occupancy bed addition, bed waiver requests, and bed allocation and rules to receive Medicaid reimbursement.  Allocation of beds gives nursing home owners or operators the opportunity to contract with Medicaid whereby: 1)  beds are allocated to the nursing facility and remain there unless the Department of Health and Human Services transfers or assigns the beds; and 2) the allocation of beds remains at the nursing facility even when the licenses operator ceases operations or sells it.

Resident abuse and neglect must be reported.   Recent news of neglect causing death to a resident, and residents being beaten to death are grave causes for concern when having to leave your loved one at a nursing home; even more dangerous if the standards seem to be driven down due to Medicare/Medicaid funding. Nursing home ratings information in Houston, Texas are valuable tools for people who are in the position of having to move their loved ones to a skilled nursing care facility. Out of 151 facilities in Houston, only 6 have received top performance ratings in U.S. News & World Report.  That is a very poor statistic.

What Signs of Abuse Look Like.

Bodily Injury – Physical abuse may reveal itself through: 1) unexplained bruises or injuries, or recurrence of the same type of injury, or abrasions; 2) signs of restraint on wrists and ankles such as bruising, cuts or abrasions, using restraints for long periods of time can cause patients to suffer from lower muscle tone, reduced bone mass, and muscle disorders; 3) malnutrition, dehydration and sudden or severe weight loss; and 4) when staff will not leave family alone with resident for fear they may tell of abuse.

Neglect – Physical neglect is a type of abuse that may or may not be intentional, perhaps as a result of not enough staff or supplies at a nursing home.  Resident’s cleanliness, availability of food, clothing and surrounding sanitary environment that diminish human dignity are signs to look for and overlap with physical abuse of malnutrition and dehydration.

Verbal or Emotional Abuse can present itself in many different ways such as agitation, nervousness, fear, or sadness. Acts of emotional abuse can be intentional, but they can also be unintentional when the abuser is overly stressed and unknowingly lashing out or harming the elderly person. Emotional abuse can be both verbal and nonverbal in nature. Verbal abuse is characterized by verbal harassment, yelling, or emotional manipulation that the abuser inflicts on the elderly. In nursing homes, abusive caregivers must be reported immediately. Non-verbal abuse can make elderly patients feel isolated, helpless, and afraid. After witnessing this abuse once, you may not notice that abuse is occurring, but the repetitive nature of this type of abuse can cause serious psychological and emotional damage to a nursing home resident. Nonverbal forms of abuse include: 1) silent treatment; 2) threatening to cause physical harm; 3) ignoring resident and keeping them from socializing; 4) restricting food, water and using the bathroom; 5) treating them as if they were children; and 6) hiding or taking away personal items.

Exploitation Abuse occurs when someone improperly or illegally uses or steals a resident’s funds, assets, or property.

Sexual Abuse could reveal itself through 1) a new case of sexually transmitted diseases (STDs); 2) difficulty walking, sitting or complaints of pelvic injury; 3) bruises, irritation, bleeding or pain on inner thighs and genital areas; 4) bloody, torn or stained clothing items; 5) agitation and withdrawal from socializing; 6) PTSD symptoms and panic attacks; 7) unusual sexual or inappropriate behaviors toward abuse suspect; and 8) attempts at suicide.

The largest percentage of elder sexual abuse, around 70.7% of cases, occurred within nursing homes.

Who is Responsible for Negligence and Abuse?

The nursing home facility can be held liable for any personal injury or neglect causing harm to a resident or patient in their care.  This negligence may have occurred by their part through 1) negligent hiring, 2) understaffing, 3) breach of regulatory obligations to guidelines, 4) insufficient employee training, or 5) errors in treatment or medication dispensing.  Liability is the state of being responsible for something, especially by law, vicariously liability is a legal doctrine assigning liability for the injury to a person even if they did not cause the injury directly but had a legal relationship with the negligent person who caused the injury.  This means that a nursing home employer can be held responsible for the negligent or abusive acts of its employees during the course of their work and through the scope of their job descriptions.

Due to the nature and varying levels of care given at nursing homes, there are often contracted workers who have direct access to residents that may cause purposeful harm or harm through negligence to a resident.  Those parties, through their contracts with the nursing home, may share the liability for any neglect, abuse or injury to a resident.

Seeking Help and Support.

Call 1-800-458-9858 if you suspect any form of abuse or neglect in a nursing home to elders or disabled persons who are residents or www.txabusehotline.org.  The Department of Family and Protective Services needs to be contacted immediately if you  believe a provider is allowing abuse, neglect or exploitation of a resident, or someone receiving services from a nursing home. Seeking out legal counsel if you believe you have cause due to personal injury of your loved one may be prudent to outline the possibilities of a law suit or damages to remedy any physical harm, or pain and suffering caused at the nursing home.