Elder Abuse & Neglect Law Blog

Seniors for Sale

Justin P. Walsh — Wed, 17 Feb 2010 16:35:51 -0800

The Seattle Times recently ran a three part story about the neglect of seniors at Adult Family Homes. One particular aspect of this case is something I had encountered in my own practice. In fact, the very story in the article involved my client.

When seniors or other disabled people are discharged from the hospital, its usually in a hurry. The vulnerable don't necessarily have the time to research a facility before they are placed in one. Instead, they rely on referral services to help make that decision for them.

The way the system works, is the referral service will place a vulnerable person in a facility, then accept the first month's rent at that facility as payment for their services. This wouldn't be a problem if every facility recommended by the referral service was up to snuff. Unfortunately, this isn't always the case. As noted in the article, there is no check on the referral service.

These services can refer you to places that can't meet the needs of your loved one, are unlicensed, or even employ people with revoked medical credentials.

If you think you may have to go into a nursing home, adult family home, or other facility, do the research on the front end. Unfortunately, you can't rely on people, even if within a hospital, to do that research for you.

Help Finally Getting to Haiti Nursing Homes

Justin P. Walsh — Fri, 22 Jan 2010 13:51:02 -0800

The Associated Press is telling the harrowing tale of some of Haiti's most vulnerable. In the recent earthquake endured by the impoverished country, residents of one nursing home were left to fend for themselves:

On the grounds of the Municipal home for the elderly Thursday, old people lay listlessly in beds out in the open with sheets smeared with excrement, surrounded by hundreds of people living in makeshift tents. One man wore just a T-shirt, his private parts exposed. A woman, just skin and bones, held her head. A body lay in the debris of the nearby nursing home.

The aid that is starting to trickle in isn't getting to the nations most vulnerable nearly fast enough:

On the grounds of the Municipal home for the elderly Thursday, old people lay listlessly in beds out in the open with sheets smeared with excrement, surrounded by hundreds of people living in makeshift tents. One man wore just a T-shirt, his private parts exposed. A woman, just skin and bones, held her head. A body lay in the debris of the nearby nursing home.

The quick end to lives in these nursing homes only highlights what a lack of proper nutrition and hydration can do to an elderly person's body, with people passing from a lack of food of just 3 days.

I often decry the conditions at for-profit nursing homes. But I have to admit that the situation in Haiti is far worse. If you can, please donate a couple of dollars to the American Red Cross. You can do so by texting the word GIVE to 24357 (2HELP). You may give up to 5 $5 donations using that method.

Financial Abuse Costs Seniors $2.6 Billion Per Year

Kevin Coluccio — Wed, 06 Jan 2010 16:39:34 -0800

Because I handle claims of Elder Abuse quite frequently, I like to stay abreast of developments in the communities in which I practice. The Senior Focus is a paper that published the latest issues facing Senior Citizens. They recently reported that financial abuse of senior citizens costs vulnerable adults up to $2.6 billion a year.

The report, by the National Committee for Prevention of Elder Abuse, states that the abuse is often where you least expect it, from those taking care of the elderly. The Committee states the abuse is "most often perpetrated by family members and caregivers."

If you feel you may have been the target of elder financial abuse, you need to take action. Be wary of someone wanting you to place all of your financial assets with them as a trustworthy source if things go wrong. There are ways to structure your assets so that they can be used for your benefit without putting all your trust in one person. Additionally, if you do need to execute a power of attorney, place that power in more than one person. If you have two people who you trust, the second person can act as a check if the first begins to abuse their power over you.

In addition, the article lays out other forms such abuse can take: marketing and repair scams, brokers, salespersons, loan officials. If something seems too good to be true, it usually is, and you should enlist the assistance of a friend, relative, or even an attorney to help you evaluate the deal.

A common scam perpetrated not only on the eldery, but on anyone, involves "phishing". Phishing does involve fishing for your personal information through either the phone or the internet. If someone is asking you for your social security number or bank number, get their name and telephone number. After you have verified that they are who they say they are, you can call them back or visit in person. As a general rule, anyone that would call you and ask for such information is someone who shouldn't be getting that information in the first place -- if you're the one who called them, you probably already know the number you are calling is the right one.

$2.6 billion may seem like a drop in the bucket compared to things like defense spending and the annual budget, but the number should be $0. Learning the signs to watch for is the first step.

Woman dies: Found outside of assisted living facility

Justin P. Walsh — Fri, 11 Dec 2009 13:34:21 -0800

King 5 is reporting that last night a 95-year-old woman was found dead outside of the Assisted Living Facility where she was a resident. Within a few hours of last seeing the woman, the Facility called police who initiated a search. She was found at the garden of a neighboring facility.

Wesley Care's CEO, Kevin Anderson, says this has never happened in the 26 years the facility has offered care and they are cooperating fully with authorities.

"We grieve with the family deeply over this tragic incident," he said. "We are extremely sorry that the incident happened. (Jensen's) family has our deepest sympathies."

Anderson told KING 5 News Jensen did not have a history of wandering away from the Center. The police report said staff told officers that earlier that evening, Jensen was found in another wing of the care center and had to be escorted back to her room.

If your loved one has a history of wandering, it is important the facility take action to prevent it. in this case, there is a question as to how alert they should have been given her recent evidence of confusion. However, in other facilities, the failure to care for the special needs of your loved ones is easily preventable.

My prayers go out to her family.

Medicare Site a Wealth of Knowledge for Elder Care

Kevin Coluccio — Thu, 19 Nov 2009 09:11:13 -0800

Medicare's website provides an excellent resource for those making the tough decision of whether and where to place a loved one in a nursing home. The Official U.S. Government Site for People with Medicare, www.medicare.gov provides useful and detailed information. If you are struggling with the decision, the site provides alternatives to a Nursing home for you and your family to consider.

Other useful information on the site includes:

A nursing home rating system;
An easy way to find medical equipment suppliers;
A comparative tool for nursing homes;
Medical nutrition therapy; and
Caregiver stories.

If selecting a nursing home is, indeed, the option you have chosen, follow the steps set forth on the website and take both the time and care to consider where you will being placing your loved one. This is an important decision, so take great care in obtaining as much information as possible. Look at ratings, heath inspection results, staff data, and quality measures.

Once you have narrowed your list of homes to a few, take the time to visit the homes, wander the hallways and to observe the nature of the care and the appearance of the residents. If possible, talk to families who have their loved ones at the home. Visit a few times, as each visit may provide you with new information. Some of the less reputable homes put on a facade for a sales visit. Only by coming in armed with information and taking the time to conduct a thorough investigation on your own can you break down that wall and see if the home is right for your loved one.

Facility Fails to Notify Doc of Festering Open Wound

Justin P. Walsh — Fri, 06 Nov 2009 13:50:13 -0800

Charles Bradley was 93 years old and a resident at Everett Care and Rehabilitation. I use the word "was" because Charles Bradley is no longer with us. He died as a result of neglect at the facility:

In court documents, attorneys for Bradley's family claim staff at the nursing home left a wound on the elderly man untreated for months. That injury, apparently the result of an undiagnosed penile cancer, purportedly contributed to his death.

The saddest part here...the staff noticed it. They noticed it and told their supervisor, who simply didn't tell the doctor. Over the course of months, Charles' penis essentially fell apart.

The saddest part? The nursing director investigated the situation and found no impropriety. The state disagreed: "There was no evidence the facility had contracted their social services department or the resident's family."

This begs two questions.

1) What on Earth will it take for a nursing director to find impropriety during an investigation? If you can't find it when there's a festering wound on a resident's genitalia, a wound that you noticed daily as you changed the resident's adult diapers, then what exactly will it take?

2) When is the state going to realize that the reform needed has to come through hitting these egregious errors with stiff penalties. I know I sound like a broken record here, but true reform will only come when the costs of compliance are less than the costs of non-compliance. Resident's are simply debits and credits in the accounting books to these facilities.

Certificates of Merit Unconstitutional in Washington

Justin P. Walsh — Thu, 17 Sep 2009 10:46:46 -0800

Often times, a claim for elder neglect also involves a claim for violating the standards of medical care. For instance, failure to properly treat a pressure sore usually involves the elder neglect of simply not treating it, but also the failure to adhere to standards of pressure sore treatment and prevention in the medical community. For the medical side of the claim, a claimant had to jump through hoops in order to sue the wrongful party. This meant that, without the benefit of any discovery, a claimant still had to get a doctor to agree that someone else acted below the standard of care.

The Washington Supreme Court today invalidated the requirement of a certificate of merit. Because the opinion says so much about what justice is, what justice requires, and how we should treat impediments to justice, I have included it after the jump.

I cannot stress how much of a win this is for patients rights. Medical negligence claims are one of the hardest to prove because it involves judgement of a doctor, often in complex situations. Many times, if a hospital or doctor knows they screwed up, they will impede your pre-trial discovery, hindering your ability to obtain a certificate of merit. The striking down of the certificate of merit requirement removes this procedural roadblock and allows the case to move forward on an even keel with all other negligence claims. It removes a procedural hurdle that was a bar to so many negligence claims, regardless of whether the provider violated the standard of care. This will allow people to have their day in court -- to be heard.

“The very essence of civil liberty certainly consists in the right of every individual to claim the protection of the laws, whenever he receives an injury. One of the first duties of government is to afford that protection.”Marbury v. Madison, 5 U.S. (1 Cranch) 137, 163, 2 L. Ed. 60 (1803). The people have a right of access to courts; indeed, it is “the bedrock foundation upon which rest all the people’s rights and obligations.”John Doe v. Puget Sound Blood Ctr., 117 Wn.2d 772, 780, 819 P.2d 370 (1991). This right of access to courts “includes the right of discovery authorized by the civil rules.” Id. As we have said before, “[i]t is common legal knowledge that extensive discovery is necessary to effectively pursue either a plaintiff’s claim or a defendant’s defense.” Id. at 782.

Requiring medical malpractice plaintiffs to submit a certificate prior to discovery hinders their right of access to courts. Through the discovery process, plaintiffs uncover the evidence necessary to pursue their claims. Id. Obtaining the evidence necessary to obtain a certificate of merit may not be possible prior to discovery, when health care workers can be interviewed and procedural manuals reviewed. Requiring plaintiffs to submit evidence supporting their claims prior to the discovery process violates the plaintiffs’ right of access to courts. It is the duty of the courts to administer justice by protecting the legal rights and enforcing the legal obligations of the people. Id. at 780. Accordingly, we must strike down this law.

. . .

Wenatchee Valley Medical Center argues that medical malpractice proceedings are “special proceedings” because the legislature has set out statutory requirements for filing medical malpractice cases. This argument is unsustainable because it places no limits on the ability of the legislature to determine procedural rules. Under this standard, the legislature could reclassify any common law action as a special proceeding by passing statutes regulating its procedures, thereby eroding this court’s power to determine its own court rules.

A more appropriate definition of special proceedings would include only those proceedings created or completely transformed by the legislature. This would include actions unknown to common law (such as attachment, mandamus, or certiorari), as well as those where the legislature has exercised its police power and entirely changed the remedies available (such as the workers’ compensation system). Other states have adopted similar standards within their civil codes, typically defining an ordinary action as one based in common law and a special proceeding as any other action. See, e.g., Tide Water Associated Oil Co. v. Superior Court, 43 Cal. 2d 815, 822, 279 P.2d 35 (1955); Dow v. Lillie, 26 N.D. 512, 520, 144 N.W. 1082 (1914). This standard protects the separation of powers because it preserves this court’s abilities to set its own court rules for traditional actions but allows the legislature to set rules for newly created proceedings.

Medical malpractice claims are fundamentally negligence claims, rooted in the common law tradition.See, e.g., Wright v. Cent. Du Page Hosp. Ass’n, 63 Ill. 2d 313, 327, 347 N.E.2d 736 (1976). While the legislature has made some changes to medical malpractice claims, it has not extinguished the common law action and replaced it with a statutory remedy. Cf. Lane v. Dep’t of Labor & Indus., 21 Wn.2d 420, 428, 151 P.2d 440 (1944) (holding that the workers’ compensation act “took away from the workman his common-law right of action for negligence” and “[i]n its place it provided for industrial insurance,” thereby “creating the right of the workman to compensation” from the workers’ compensation fund). Therefore, under the standard described above, medical malpractice suits do not qualify as special proceedings and are not exempt from the civil rules under CR 81(a).

. . .

This requirement directly conflicts with CR 11, which states that attorneys do not have to verify pleadings in medical malpractice actions, as well as CR 8, which details our system of notice pleading. First, RCW 7.70.150 conflicts with CR 11 because it requires the attorney to submit additional verification of the pleadings — a requirement that CR 11 explicitly limits to “dissolution of marriage, separation, declarations concerning the validity of a marriage, custody, and [related modifications].” CR 11(a). Second, RCW 7.70.150 conflicts with CR 8 and our system of notice pleading, which requires only “a short and plain statement of the claim” and a demand for relief in order to file a lawsuit. CR 8(a). Under notice pleading, plaintiffs use the discovery process to uncover the evidence necessary to pursue their claims. Doe, 117 Wn.2d at 782. The certificate of merit requirement essentially requires plaintiffs to submit evidence supporting their claims before they even have an opportunity to conduct discovery and obtain such evidence. For that reason, the certificate of merit requirement fundamentally conflicts with the civil rules regarding notice pleading — one of the primary components of our justice system.

. . .

We hold that RCW 7.70.150 is procedural because it addresses how to file a claim to enforce a right provided by law. See, e.g., Hiatt, 68 Ohio St. 3d at 238 (”Since the conflict involves the form and content of the complaint to initiate a medical malpractice case, it is a procedural matter.”). The statute does not address the primary rights of either party; it deals only with the procedures to effectuate those rights. Therefore, it is a procedural law and will not prevail over the conflicting court rules.

Illinois Nursing Home Hid Fall of Resident

Justin P. Walsh — Fri, 28 Aug 2009 10:13:39 -0800

In a sad story, Ruston Health Care in Williamsburg, Illinois has been sued for trauma to one of its residents. The mentally disabled man was supposed to have his bed guard rails raised. The rails are there for a very specific reason, to keep the resident from falling out of bed.

Tragically, the staff at the nursing home failed to follow the instructions for the man's care, leaving the rail down. The man fell out of bed, striking his head hard enough to cause swelling the size of an orange. He also had blood in his urine. Visible blood in the urine (gross or acute hematoria, depending on the amount of blood -- acute being more severe) after trauma, such as a fall, can be a sign of damage to the upper or lower urinary tract. This can mean trouble with the kidneys, bladder, or urethra.

Basically, this was no small fall.

The sad part is, the nursing home failed to act in the best interests of the patient by not disclosing the fall to hospital staff after blood was in his urine. Its bad enough that they put him in danger in the first place. But by failing to disclose the fall, they put him in danger of wasted time in trying to diagnosis the cause of the blood in his urine, as it can be caused by many non-trauma related issues.

Its these simple things that the homes know they should do, but don't, that make me the most frustrated. How do you get a nursing home to stop understaffing? How do you get them to hire people qualified enough to follow the patient's care plan? Simple, you make them pay. Everything in a for profit business comes down to money. If it costs less to break the rules than to follow them, the for profit company will usually break the rules. But by making it hurt every time they endanger a patients life, these companies will start to realize that their bottom line is better off if they follow the rules.

Of course, this can't be the only tactic used to reform this deplorable behavior, this putting of profit over people.

Its important that each of us, whether in the legal or medical community, get involved with other avenues that can help with reform. There are boards and commissions that deal with nursing homes, you can stay in contact with your local Health and Human Services Department to see what you can do to help.

Residents and their families can help to, by staying involved with the Resident and Family Councils at these places, documenting what they see and working with DSHS to improve the conditions for our loved ones.

I know I often sound like a broken record, but this is how we fix things -- by working together.

Many thanks to Levin and Perconti for bringing this story to my attention.

Dead by Mistake

Justin P. Walsh — Mon, 10 Aug 2009 14:51:18 -0800

I often get asked by friends and family why I do what I do. You have to admit, its a big investment. Not only are you devoting 3 years of your time to law school and upwards of $100,000, you’re also slightly pigeon-holing yourself into a profession. I’m sure that can be said for just about any other profession, but with law, medicine, and I’m sure a few others, you lose that ability to bounce freely between careers. As you move through time, your practice generally becomes more focused and honed.

Simply put, I do it for the victims of negligence. The Seattle Post-Intelligencer ran an article entitled Dead By Mistake. The article explains the myriad of deaths that occur in the health care system simply by virtue of someone making a mistake. Now, I make mistakes, you make mistakes – everyone makes mistakes. Most of the time my mistakes are merely grammatical or spelling errors. It tends to happen when you type a lot. I’m sure one day I’ll make a mistake that cause harm to a client by causing trouble within their case. Unfortunately, for doctors, a mistake can often have tragic consequences.

“So what?,” you may say. “Everyone is entitled to make mistakes.” Sure, but that doesn’t mean that a person isn’t held accountable for their mistakes. The same powers that shout “PERSONAL RESPONSIBILITY!” over and over when it comes to a reason why they shouldn’t lend a hand to a homeless man largely fall silent when the same topic is applied to professionals. You hear arguments that to hold these people accountable for their mistakes places a burden on the health care system.

Yes, I’ll admit, it does place a burden on the health care system. A burden of change. A burden to not allow simple mistakes to be made. A burden to innovate so that people don’t die at their hands when the death was entirely preventable. Unfortunately, the only way to press change, it seems, is to make the alternative hurt. If a hospital has to pay for its mistakes, it will invoke change when it becomes cheaper to go through the change than it does to continue paying claims. Hospitals are no different than Ford, making its cold calculated decision of gas tank deaths in the Ford Pinto. The only difference is, there’s not a video-clip with which we can be appalled.

Be appalled.

Guilty Verdict in Kent Assisted Living Rape

Kevin Coluccio — Thu, 16 Jul 2009 14:22:35 -0800

Joseph Thurura, A 32-year old former assisted living employee has been found guilty of rape by Judge Richard McDermott in King County Superior Court. The rape occurred while the victim, Jaime - a 45-year-old woman who is blind and mute, was living at Integrated Living Services, an assisted living facility in Kent, Washington.

The Seattle Post-Intelligencer reports:

Unable to identify her assailant, police took DNA samples from 11 men who had been in a position to have sexual contact with the woman. Prosecutors asserted that Thurura proved a 99.99 percent match to DNA recovered from fetal tissue.

McDermott's ruling means Thurura faces 6 ½ to 8 ½ years in prison. He is scheduled to be sentenced August 14 at the Norm Maleng Regional Justice Center in Kent.

An investigation showed that the facility had done criminal background checks, and the staff was informed as to signs of elder abuse. Unfortunately, the discovery of those signs did not translate into a check for rape until Jaime was found to be pregnant.

If your loved one is in a nursing home, be aware of the signs of abuse. Bruising, scratching, or behavior outside the norm for them could be indicators of a traumatic event. Seeing them early may help to prevent abuse or stop it early on.

$1,500,000 verdict for resident fall

Justin P. Walsh — Thu, 16 Jul 2009 10:31:41 -0800

New York Nurse Home Abuse Lawyer Blog recent reported on a $1,500,000 verdict for a nursing home resident fall.

In July 2004, an Erie County jury awarded plaintiffs, Thomas S. Kolbert and the Estate of Victoria Poielski, $1,500,000 in damages in a lawsuit brought under the New York Public Health Law for nursing home negligence. The plaintiffs alleged that Ms. Poielski, an 80 year-old resident suffering from dementia, fell while unattended in her bathroom and suffered a fractured right elbow.

Apparently, the resident was left alone on the toilet for a three hour period. When no staff member came to her assistance, she tried to move from the toilet to her wheelchair and suffered a fall. Pressure sores (bedsores, decubiti) also developed on her heels after the fall.

While the verdict itself is not surprising, I still find that the post offers something important to talk about -- Nursing homes focusing on profits to such an extent that it places the residents of their homes in real danger.

In most businesses, when you want to cut down on overhead, one of the things you look towards is cutting staff. I can't tell you how many companies I've worked for where, as soon as you feel some financial tension, line level workers are cut, units consolidated, and so on and so forth.

But when you are talking about helping the elderly, the sick, those who can't care for themselves, cutting staff (or not hiring enough staff) placed people at peril. This poor woman was sitting on the toilet for THREE HOURS waiting for someone to help her back to her bed. It was either stay there and wonder if someone would ever come to help her, or try to make her way back. Though unsteady, she attempted it, resulting in her fall.

Unfortunately, I have seen story on top of story of residents using their call lights and having to wait hours for assistance. Often it involves going to or coming from the bathroom, a basic human need. The failure to respond often results in falls, fractures, or soiling themselves. Those things can further lead to infections and decubitis ulcers (pressure sore wounds). Its sad to say that with just a few more staff, most nursing homes would be able to adequately respond to those lights and a plethora of injuries could be avoided.

3rd Circuit Recognizes Civil Rights Action for Abuse

Justin P. Walsh — Thu, 09 Jul 2009 13:17:08 -0800

It's rare that I see a blog post or a shift in the law that catches me off guard. Its even rarer that such a thing also reaffirms my belief that we will be able to get these companies to change their ways. Joseph Lamy recently posted about a landmark decision out of the United States Court of Appeals for the Third Circuit. The case, Grammer v. John J. Kane Regional Centers, recognizes that an action for rights abuses was created under the Federal Nursing Home Reform Amendments (FNHRA).

While Grammer's recognition of a civil rights action at a circuit level is monumental, the recognition that this is a civil rights action is not new. Turns out the Eastern District of New York decided the same thing last year.

For all these reasons, I conclude that plaintiffs are part of the class for whose particular benefit the NHRA was enacted, and that the NHRA creates a federal right that plaintiffs may enforce under § 1983. Accordingly, plaintiffs meet the first Blessing factor, as limited by Gonzaga. Moreover, there does not appear to be any dispute that the statute meets the remaining two Blessing factors-that the statute is not “vague and amorphous” and that it imposes binding obligations on the state. The statute mandates a clearly-defined process to be followed by the state before an individual with mental illness may be admitted to a nursing home and if an individual has a significant change in condition while in the facility. See 42 U.S.C. §§ 1396r(e)(7)(A)(i), (e)(7)(B)(i), (e)(7)(C)(iii); 42 C.F.R. §§ 483.104, 483.106, 483.112, 483.126, 483.128, 483.132. The PASRR regulations are precise, unambiguous, and mandatory.

Joseph S. v. Hogan, 561 F. Supp. 2d 280 (E.D.N.Y. 2008).

It looks like a framework is starting to emerge for the recognition of § 1983 cases, with recognition in the second and third circuits.

The Dangers of Dehydration

Kevin Coluccio — Thu, 02 Jul 2009 00:31:39 -0800

Dehydration is one of the more prevalent problems seen in nursing homes. Patients that are confined to their bed have little to no control over their fluid intake. A bed-ridden patient is essentially limited to the water they have within their reach. When the pitcher runs dry and doesn't get replaced, the fluid intake can suffer. If a resident's fluid intake and output isn't monitored, the resident runs the risk of developing a myriad of problems.

Thomas Gallivan at New York Nursing Home Abuse Lawyer Blog explains how dehydration leads to other problems:

Although it would seem that keeping a resident hydrated in a nursing home setting would be simple enough, it is one of the most common diagnoses when nursing home residents are discharged from a nursing home to a hospital.

Dehydration can occur if residents are on certain types of medication and/or if a resident has diarrhea. In addition, some nursing home residents become refuse to eat or drink. However, in these situations, it is incumbent upon the nursing home staff to be more vigilant in monitoring the resident's hydration. Unfortunately, dehydration is often the result of nursing home neglect and/or understaffing. Dehydration can lead to:

1) Infection;
2) Confusion;
3) Weakness;
4) Bedsores;
5) Pneumonia; and
6) Death.

Signs of dehydration include dry mouth, grey or ashen skin, confusion, dark or amber urine, low urine output, fever, delirium, and infection. We cannot stress enough how important it is for families of nursing home residents to be a constant presence where a loved one is a resident. By doing so, the family members can observe and react appropriately if signs or symptoms of neglect or abuse arise.

I can't tell you how many times I've seen reports from nursing homes where residents were dehydrated, yet consistently left without water within their reach. These same people, though clearly showing the signs of dehydration, weren't monitored as to the fluid intake and output. Its these simple things that or so simple to do that get lost in budget cuts. We never see the dehydration in isolation. We see it combined with a myriad of other problems, just as described above. If you have a loved one in a nursing home, please follow Tom's advice and keep an eye on these things that the staff may be missing.

Family Councils Improve Quality of Care

Justin P. Walsh — Sat, 13 Jun 2009 22:48:36 -0800

California seems to be on the forefront of legislation aimed at improving the lives of nursing home residents. The legislature recently approved AB 1457, which provides transparency in the shell game of nursing home ownership and operation.

California also has legislation in place which improves on the idea of Resident Councils by creating Family Councils. Resident Councils can have any number of residents as members, and are usually facilitated by the facility. The downside of a Resident Council is that there is no check on the accountability of the system. A problem may get reported to a Resident Council but not acted on. A Family Council allows two extra prongs of accountability. First, the Family Council involves not just residents, but family members external to the nursing home. These family members can push back without worry of the inherent power dynamic that is involved in an elder care relationship. Second, the concerns of the Family Council must be addressed by law. According to Walton Barber, the law in California provides improved protections not available in other states:

California law allows the creation of "family councils" by relative of a nursing home resident to help influence the quality of care given to a resident. Not merely gripe sessions, these councils can facilitate communications between families and residents with the nursing home staff and caregivers, and also offer peer support for friends and relatives of the resident, and help prevent substandard care.

A nursing home may not prohibit the formation of a family council, and must allow the council to meet on the grounds of the facility at least once a month. In addition the home must designate a staff member who is responsible for assisting the council, and to respond to all written requests made by the council.

Maybe its time to look at these types of protections in Washington. Below is a short video on Family Councils.

"The Unspeakable" - A heart wrenching story of elder neglect.

Justin P. Walsh — Sat, 13 Jun 2009 22:07:06 -0800

Juicy Nurse is a blog devoted to giving nurses an outlet for their stories, whether they be sad, happy, or just plain hilarious. Unfortunately, the following story is all too common:

Several months ago I stayed at work until almost midnight "cleaning up" a man that came from a nursing home and may, very well, die of nursing home neglect. This man was unable to communicate much at all because he had suffered a devastating stroke in the past leaving him unable to care for himself. As if this was not sad enough, he presented to me with the UNSPEAKABLE!

This man had a rash that covered his entire back, buttocks, groin and legs. This "rash" turned out to be burns from urine and feces that burned his skin only because he sat in it for several hours without being changed. He had ulcers, open and infected, on his ears caused from the oxygen tubing that stayed in the same position for so long that it actually wore through his skin and caused ulcers that became infected. His scrotum was the size of a volleyball and his penis was swollen and oozing. The Foley catheter that he had in his penis had remained there so long without being changed that bacteria had actually eaten a path in between his penis, scrotum and bladder. He had a tube for feeding (G-Tube) that was ulcerated and oozing with a dressing on it that had not been changed in weeks. He could barely breathe when he got to me. We did everything we could to support his oxygen level, just to find that he had a piece of pita bread lodged in the back of his throat......about the size of a hockey puck! When we were able to finally pull it out the smell was so foul that I actually began to dry heave in a nearby trash can. This smell was only a bit comparable to the smell that you can only imagine was coming out of his penis.

I was SO disgusted when this man fell on my list of things to do for the day. Clearly not because I was upset to care for him but only because it broke my heart EVERY TIME I walked into the room. He did nothing but stare at me. He locked his eyes with mine in a way that assured me that he could understand everything that I was telling him.

I immediately called social services, his family, and the department for children and family services. I cleaned this man from head to toe, with the assistance of many others. I stayed with him until midnight, not because I was busy, or overworked or covering for another nurse, but because what happened to him took away all of his pride and dignity. This man deserved a voice.....an advocate.

We took pictures and filled out paperwork and cried with family and talked about it in the break room and lost a little sleep here and there.........but ultimately, what happened to him was UNSPEAKABLE! Abuse at its finest, most disgusting and most difficult to prosecute!

This case is so sad and will NEVER leave my mind. I don't know what ended up happening to this man. I assume that infection probably took over his body and that he has probably passed on, but I don't know for sure. This is the case of many patients that we see and treat in the hospital. They impact our lives and we never forget them. We impact their lives, i assume, and then we only hope that things get better for them.

I thought of this man 2 weeks later when I admitted a mentally challenge female from a nursing home with severe bruising to both of her inner thighs, her chest and her upper arms. I did for her as I did for him, as I will do for the next one.

When will the unspeakable stop? How do those of us that deal with it all of time, move on?

All we can do is give these people a voice.

It is refreshing to me that people can come from such varied backgrounds and all have the same passion for these problems of neglect and abuse. The nurses, the investigators, and even the attorneys all see the same things and want the same changes to occur. We all want to fix the underlying problems in the system that will allow our most vulnerable to suffer. We will change things. We will give them a voice.