Nursing home abuse is on the rise in the United States. America has 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 provides 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, or they look like they are not getting proper nutrition. Oftentimes nursing home patients become dehydrated or end up getting Urinary Tract Infections (UTI’s) that cause them to be transferred to the hospital. There are times when a patient with a UTI can develop a systemic infection that is referred to as “sepsis.” Another common problem with nursing home patients is bed sores. These occur on the patient’s sacrum or their heels and they can develop rather quickly. Those on the sacrum or buttocks can become infected with feces resulting in a serious infection or even death.
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. 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. You can just show the pictures. Images can be unbelievably helpful.
How do you rely on medical documentation for these cases?
If a prospective client suspects abuse or neglect we will request records from the skilled nursing facility as well as the hospital. We get the records from the hospital where they were admitted and treated. We get the facility records and we review them and may also have them reviewed by a medical professional.
Is this a common occurrence in your experience?
Neglect can be 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. Many skilled nursing facilities are chronically understaffed and not always well supervised. The paperwork may have been checked off, but that doesn’t mean what was supposed to have been done was actually done.
Do these failures or abuse in care get reported to any official agencies?
Certain problems, like falls, are reported. Those reports go to DHEC in South Carolina which is the Department of Health and Environmental Control. So, if there is a fall in a facility the law requires a report be made 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 get an idea of any problems they may have had. Whether the facility reports problems is not something that I depend on in nursing home litigation.
Are most of these physical injuries, or is it neglect, or a combination?
It is physical neglect. It may be that a patient has signs of something going on and the nursing staff is just slow to alert the physicians that there is a problem. The doctors don’t make rounds on these patients like in a hospital and they rely heavily on the nursing staff to monitor the patient. That’s why it’s called “skilled nursing” care. But, 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?
A good example would be a 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 also a huge problem. The nursing staff is supposed to rotate the 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. If a person is incontinent and the bedsore is near their sacrum, feces can get into the wound and it can result in an infection.
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. We are very conscious of the stress this can cause our clients and we handle these matters in a very professional manner.
And the legal process brings even more trauma, doesn’t it?
Yes, but we work with our clients to limit the trauma as best we can. We hold their hand in the process so they can get through the litigation. At some point, the client has to give a deposition where they testify as to their knowledge of what happened. They also are involved in the questioning of experts who 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 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. This type conduct can lead to an investigation by a professional’s licensing authority. There are also instances where a nurse does more than she is licensed to do. For example in South Carolina only a licensed registered nurse can provide wound care. I’ve seen where licensed practical nurses are called “licensed wound care nurses.” This may be the practice in the facility, but it is not allowed by the nursing board and can result in a problem with a nurse’s license.
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 the doctors see the patients? Once the loved one is a patient, the family needs to visit the facility very often, be very involved and ask a lot of questions and not feel as if they can’t do that. They should continually ask their family member (the patient) questions about their care. Are they doing this for you? How often are you getting a bath? Are you taking your medicine on time? Is everything ok? Are you having any problems? If for some reason a problem develops one of the things that usually gets to the family is when 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. Of course, there are facilities that do provide good quality care. It depends on the facility’s commitment and the quality of their staff. Unfortunately, many facilities are just chronically understaffed and the staff on hand can’t do what they need to. Many have poorly trained personnel or personnel who have little to no certifications that are doing care tasks that should be done by a higher level professional. 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.
Should patients fall in a nursing home?
Sometimes patients fall and falls aren’t always preventable. Facilities can’t strap people into their bed or their wheelchair. 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 to DHEC and they should be reported to the family, but the reality is that they often are not.
Let’s discuss compensation for the victims’ families?
We’ve been selective about the cases we take in. We normally do death cases or cases where the person became seriously ill. 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 for the hospital care, that wouldn’t have been necessary had the nursing home provided good treatment.
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 treat whatever the problem was. The law does allow for 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 there is never enough that the legal system can do to compensate the family. 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 also so that 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