Nursing home facts

  • Today, about 1.5 million Americans live in our nation’s 17,000 nursing homes.
  • More than 90 percent of America’s nursing home residents are over 65.
    88 percent of America’s nursing home residents are white.
  • Three out of four nursing home residents are women.
  • The typical nursing home resident is a woman in her 80’s, who shows mild forms of memory loss and dementia. Although physically healthy for her age, she needs help with about 4 of 5 activities of daily living (eating, dressing, bathing, transferring, toileting). Over her lifetime, she’s saved for retirement, but the average cost of nursing home care is too expensive. She is, therefore, unable to afford the care she needs after six months and will be forced to rely on Medicaid.
  • Two out of every three nursing home residents rely on Medicaid.
    Every 8 seconds, an American baby boomer (those born between 1946 and 1964) turns 50.
  • By 2030, one in every five Americans will be a senior citizen.
    Americans 85 and older are the faster growing segment of the national population. From 1960-1994, that group increased by more than 274 percent.
  • Americans 85 and older are the heaviest users of long-term health care services.
  • Longevity is expected to rise for all ages.
  • More than 15 percent of Pennsylvania’s residents are 65 or older.
  • Two out of every five Americans will need long-term care at some point in their lives.
  • In 1996, the average cost of a stay in a nursing home was $41,000 per year.
  • Only one in four Americans can afford private nursing home care for one year.
  • The average stay in 1995 for a nursing home resident was 2.3 years.
  • On average, 8 out of 10 beds in certified nursing homes in America are occupied.
  • In Pennsylvania, more than 90 percent of beds in certified nursing homes were occupied by March 2000.
  • In 1995, America’s nursing homes were 87 percent full.
  • Most nursing homes (66 percent) are operated for profit and more than half are operated as part of a chain. This has resulted in fewer, but larger, nursing homes.
  • More than half of American nursing homes (54 percent) are below the suggested minimum staffing level for nurse’s aides. Nurse’s aides are the lowest paid and least trained of all nursing home staff, but they most often feed and bathe patients.
  • Nearly one in every four nursing homes (23 percent) are below the suggested minimum staffing level for total licensed staff.
  • Nearly one third of nursing homes (31 percent) are below the suggested minimum staffing level for registered nurses. The minimum staffing level for registered nurses is only 12 minutes per day per patient.
  • Registered nurses in Medicare/Medicaid-certified nursing homes spend an average of 42 minutes a day with each patient. Licensed practical nurses spend the same amount of time per patient per day. Certified nursing assistants spend an average of 2 hours and 6 minutes per day with each patient. This results in 3½ hours of direct and indirect care from all sources per resident in a 24-hour period.
  • Low staffing levels in America’s nursing homes contribute to an increase in severe bedsores , malnutrition, and dehydration, which lead to increased hospitalization.

Sources :

American Health Care Association, Facts and Trends ; Health Care Financing Administration, 1996; U.S. Census Bureau 1996; Modern Health, March 10, 1997; the United States Senate Special Committee on Aging News Release dated July 27, 2000; 1999 Census Estimates of the Older Population; U.S. Department of Health and Human Services 1997: An Overview of Nursing Homes and Their Current Residents: Data from the 1995 National Nursing Home Survey; U.S. Department of Health and Human Services: Your Guide to Choosing a Nursing Home; American Health Care Association’s Online Survey, Certification and Reporting Data (March 2000); Malnutrition and Dehydration in Nursing Homes: Key Issues in Prevention and Treatment (National Citizens’ Coalition for Nursing Home Reform, June 2000).

Sexual abuse of nursing home residents

Unfortunately, elderly nursing home residents are easy prey for sexual predators because they are often weak and defenseless. They may also fall victim to sexual abuse because they had a stroke or other medical condition that caused them to lose their speech or motor skills. When a nursing home resident is weak and unable to resist or unable to speak, the likelihood of becoming a victim of sexual abuse increases. The most recent statistics from the United States Administration on Aging reveal that there were 548 complaints of sexual abuse in nursing homes between October 1, 1995 and September 30, 1996.

Sexual abuse is any form of nonconsensual sexual contact, including unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually-explicit photographing, and sexual harassment. It would include situations where the nursing home resident was forced, coerced, tricked, or manipulated into unwanted sexual contact and where the nursing home resident is too ill, frail, or mentally incapacitated to give consent. A nursing home resident can be sexually abused by a nursing home staff member, another resident, a stranger, or a family member in a variety of situations, including :

Sexual abuse by a nursing home staff member

Sexual abuse of a nursing home resident by a staff member often occurs because the nursing home fails to conduct background investigations of potential employees. Many staff members, particularly nurse’s aides, are minimum-wage employees who go from one job to the next. Nurse’s aides also have the most contact with nursing home residents and are responsible for a variety of tasks, including helping residents bathe, dress, and toilet, which may create the opportunity for sexual abuse. Some of these aides may have been terminated from previous jobs because they abused a nursing home resident at another facility and some may have criminal records.

When a nursing home fails to properly screen an employee who has a history of sexual abuse and that employee sexually abuses a resident, the nursing home can be liable for negligence . Sexual abuse by a staff member can also occur because the nursing home fails to properly supervise employees. This may result from understaffing or poor training. When a nursing home fails to properly supervise employees or properly train employees on how to spot sexual abuse and sexual abuse occurs, the nursing home can be liable for negligence.

Sexual abuse by another resident

Oftentimes, nursing homes are co-ed. In such settings, normal male-female relationships are bound to develop. Unfortunately, however, co-ed settings in nursing homes can give rise to the sexual abuse of one resident by another. Those residents who are weak and unable to resist or unable to speak may be an easy target for sexual abuse by another resident who knows of the potential victim’s mental or physical challenges. Sexual abuse by another resident may occur because the nursing home fails to properly supervise residents. This can result from understaffing or poor training. When a nursing home fails to properly supervise residents and properly train employees on how to spot sexual abuse by residents and sexual abuse occurs, the nursing home may be liable for negligence.

Sexual abuse by a stranger

Sexual abuse by a stranger often occurs because the nursing home lacks adequate security which allows strangers to enter the facility. Strangers can also enter the facility when nursing home employees step outside to take a break or smoke and negligently fail to lock the door when they re-enter. If a nursing home resident is sexually abused by a stranger who gains access to the facility under these circumstances, the nursing home may be liable for negligence.

Sexual abuse by a family member

When a person is placed in a nursing home, the resident’s spouse may miss the relationship the two shared when they were at home. When the resident’s mental or physical condition prohibits consensual sexual relations between spouses, the sexual act may rise to the level of sexual abuse. In these situations, nursing home staff members may fail to report the incident because of the legal relationship between the couple, therefore, and permit the abuse to continue. Under these circumstances, the nursing home may be liable for negligence.

Physical Abuse

Under the law, nursing home residents have the right to be free from physical abuse. This right, however, is often violated by nursing home staff members. Physical abuse is the intentional use of physical force that may result in bodily injury or pain. The injuries that a nursing home resident may suffer as a result of physical abuse can be very serious because most older people are fragile. For example, many older people have brittle bones that can break easily. An elderly person’s skin is also more susceptible to bruises, cuts, and tears because aging causes the skin to lose elasticity.

The following are examples of the types of physical abuse that can be inflicted by nursing home staff members on elderly nursing home residents :

  • Striking or beating the resident with an object or with a hand
  • Pushing or shoving the resident
  • Shaking, slapping, kicking, or pinching the resident burning the resident
  • Force feeding the resident
  • Using chemical or physical restraints that are unnecessary
  • Mishandling the resident during ambulation (for example, throwing the resident into bed, or pushing the resident in an attempt to get him or her to hurry up)
  • Pulling the resident’s hair

Physical abuse in nursing homes occurs for a variety of reasons. When physical abuse occurs for any of the following reasons, the nursing home may be liable for negligence :

  • Failure of the nursing home to conduct background investigations on employees who have a history of physical abuse
  • Failure of the nursing home to properly supervise staff members
  • Failure of the nursing home to hire a sufficient amount of supervisory staff
  • Failure of the nursing home to properly train employees on how to spot physical abuse
  • Failure to provide the proper ratio of staff to patients. Too many patients for too few employees can cause an inordinate amount of stress. Some caregivers snap under the pressure and take their stress out on the patients.

Mental abuse

Under the law, nursing home residents have the right to be free from mental abuse. They also have the right to be treated with dignity and respect. Unfortunately, these rights are often violated by nursing home staff members who mentally abuse residents. Mental abuse is sometimes referred to as psychological or emotional abuse. Mental abuse is the intentional infliction of anguish, degradation, fear, or distress through verbal or nonverbal acts. Mental abuse in nursing homes can be found in a variety of forms, including :

Verbal Degradation

This type of mental abuse is common in nursing homes. Although many nursing home employees offer kind words to residents, many do not. These staff members may yell or scream at the resident to act in a certain way. For example, they may yell if the resident is eating sloppily or not fast enough. They may also degrade a resident or make sarcastic remarks or insult the resident about his or her inability to control bodily functions.

Verbal Threats

This is more severe than verbal degradation. Verbal threats are often directed toward a particular resident. An example of a verbal threat is when a nursing home employee tells a resident that they will get spanked if they keep soiling their bed or eating sloppily. Another example is telling the resident that they will not be provided with food at the next meal if they don’t eat in a certain way or if they don’t finish all of their food.

Emotional Manipulation

Many nursing home residents are insecure about themselves because they are dependent on the nursing home for many activities of daily living, such as dressing, grooming, and toileting. This can lower a person’s self esteem. When a person has low self esteem and is dependent on another, he or she is oftentimes easily manipulated by the caregiver. Manipulation occurs when one person deviously influences another for his or her own advantage. Many nursing home residents can be manipulated to overlook other forms of abuse for fear of not receiving attention or care. Nursing home residents can also be manipulated to behave in ways that don’t create « problems » for the caregiver, but may create problems for the resident. For example, a nursing home resident may be fearful of the consequences of asking for a drink of water or a snack. As a result, they may place themselves at a greater risk for dehydration or malnutrition .

Emotional Threats

This occurs when a nursing home resident is placed in a position that keeps him or her from speaking out. For example, if one resident sees another resident being abused at the hand of an employee and the employee raises a fist to the witness to keep silent, that constitutes an emotional threat, because it creates the perception that the witness will become the next victim if he or she speaks out. Many nursing home residents quickly learn that they are at a disadvantage in the nursing home, so they are easily silenced because they don’t want to become the next victim of abuse.

Isolation

This occurs when a nursing home staff member gives the resident the « silent treatment » or isolates the resident from family, friends or regular social activities.

Mental abuse in nursing homes occurs for a variety of reasons, including:

  • Failure of the nursing home to conduct background investigations on employees who have a history of mental abuse
  • Failure of the nursing home to properly supervise staff members
  • Failure of the nursing home to hire a sufficient amount of supervisory staff
    Failure of the nursing home to properly train employees on how to spot mental abuse
  • Failure to provide the proper ratio of staff to patients. Too many patients for too few employees can cause an inordinate amount of stress. Some caregivers snap under the pressure and take their stress out on the patients.

When a nursing home resident is mentally abused, the nursing home may be liable for negligence.

Slip & fall injuries

Fall-related injuries are a major health threat for nursing home residents. Older people who live in nursing homes tend to fall more frequently than older adults who live within the community. Approximately 50 percent of nursing home residents aged 65 and over fall each year, and nearly 1,800 die annually as a result of their falls. About 10 to 20 percent suffer injuries, and 6 percent sustain fractures. In a typical 100-bed nursing home, 100 to 200 falls are reported each year, and many go unreported. When older people fall, they can experience decreased physical functioning, a reduction in the quality of life, decreased confidence, and an increased fear of falling, which can lead to further functional decline, depression, social isolation, and feelings of helplessness.

The law requires nursing home residents to receive adequate supervision and assistive devices to prevent accidents. When a resident enters a nursing home, a plan of care must be developed. Within this plan of care, the resident’s risk of falling must be assessed to determine what assistance the person may need to get around.

There are a variety of reasons why a nursing home resident might fall, including weakness and gait problems associated with old age. Unfortunately, however, many nursing home residents fall because of the nursing home’s negligence . Examples include falls caused by :

  • Wet floors
  • Poor lighting
  • Lack of necessary bedrails and improper bed height
  • Improperly maintained or fitted wheelchairs
  • Clutter
  • Medications, especially psychoactive drugs
  • Difficulty in moving patients, or assisting them to the restroom, due to understaffing
  • Failure to have sufficient staff to answer call buttons
  • Failure to have call buttons that are in proper working condition
  • Failure to properly train staff in lifting and handling techniques
  • Failure of the staff to adequately supervise residents
  • Poor foot care
  • Restraints
  • Weakness and gait problems associated with malnutrition and/or dehydration.

Elopement / Wandering

Elopement

The law requires nursing home residents to receive adequate supervision to prevent elopement or wandering. When a resident enters a nursing home, a plan of care must be developed. The resident’s risk of elopement and/or wandering must be assessed within this plan of care.

Elopement

« Elopement » refers to the ability of a resident – who is not capable of protecting himself from harm – to successfully leave the nursing home unsupervised and unnoticed and enter into harm’s way.

Wandering

On the other hand,  » wandering » refers to a cognitively-impaired resident’s ability to move about inside the nursing home aimlessly and without an appreciation of personal safety needs and enter into a dangerous situation. A nursing home resident’s risk of wandering must also be assessed within the plan of care.

Negligence Related to Elopement and/or Wandering

When a nursing home resident who is not capable of protecting himself or herself from harm or who is cognitively impaired, elopes or wanders and gets hurt, the nursing home may be negligent because it:

  • Failed to hire enough staff to properly supervise the resident
  • Failed to properly train staff on how to supervise residents
  • Failed to employ alarms or other devices to prevent elopement and/or wandering
  • Employed staff members who failed to properly respond to an alarm

Oftentimes, there are devices which cost only a few dollars that could be employed to prevent elopement or wandering. For example, a simple hardware-store chime or buzzer could be installed on a rear door that would alert an attendant when door has been opened.

Malnutrition & dehydration in nursing homes

Malnutrition

Malnutrition, or lack of proper nutrition, can be a serious, life-threatening medical problem for older adults. Malnutrition means more than not having enough to eat. It means not getting enough vitamins and minerals into your body. Malnutrition can lead to a variety of serious health problems, including:

  • Confusion and memory loss
  • Weakness, resulting in immobility, falls , bedsores, and pneumonia
  • Inability to fight off sickness
  • Inability to recover from an existing illness
  • Loss of muscle mass
  • Impairment of organ function
  • Infection
  • Anemia
  • Death

Dehydration

Dehydration, or inadequate hydration, occurs when a person’s loss of body fluids is more than his or her intake of fluids. Like malnutrition, dehydration can lead to a variety of serious health problems, like :

  • Confusion and disorientation
  • Urinary tract infections
  • Bedsores
  • Pneumonia
  • Death

According to the Health Care Financing Administration, dehydration was ranked one of the ten most frequent admitting diagnoses in a study on Medicare hospitalizations. Increasing age is one of the major risk factors for dehydration. In fact, those persons between the ages of 85 and 99 years are six times more likely to be hospitalized for dehydration. It is very important that healthcare providers in nursing homes recognize that elderly are at risk for developing dehydration. When a person is recognized as being at risk for dehydration, preventative measures should be taken from the offset to avoid dehydration.

A person « at risk » for dehydration should have a hydration program in place at the nursing home. A hydration program would include assisting the person with drinking, offering fluids at mealtime and in between meals, looking for signs and symptoms of dehydration, notifying the physician if such signs and symptoms are present, recording the residents and intravenous fluid replacement when the physician deems it necessary.

Negligence Related to Malnutrition and Dehydration

Two out of five nursing home residents suffer from malnutrition, and dehydration is the most common fluid and electrolyte disorder of frail older people. Malnutrition in nursing home residents can occur for a variety of reasons, including the resident’s inability to process food and ill-fitting dentures. Dehydration can occur for a variety of reasons as well, including diarrhea and the effects of medication. Unfortunately, malnutrition and dehydration can also occur due to a nursing home’s negligence in a variety of situations, including :

  • Failure of the nursing home to employ adequate staff, which results in the staff’s inability to properly feed the residents
  • Failure of the staff members to pay adequate attention to those residents needing assistance with eating
  • Failure of the nursing home to properly educate the staff on nutrition and feeding methods
  • Failure of the nursing home to provide proper supervision over those who provide nutritional services
  • Reliance on liquid supplements as opposed to making sure each resident eats enough food to get necessary vitamins, minerals, protein, and calories

If you notice that your loved one has signs of malnutrition or dehydration or if you think that they are not getting enough food or fluids at the nursing home, you should immediately notify the nursing staff and the physician to prevent potentially serious, life-threatening consequences.

Effects of Understaffing

Government statistics show that 47% of residents in nursing homes need assistance with eating. 21% of residents are completely dependent for help. In addition, patients in nursing homes often need more water than the average person because of the medications they are taking. If the nursing home is understaffed, then there may not be anyone available to take the time to see that the patient has had enough to eat or to drink.

Bedsores : a serious medical problem

Bedsores, also referred to as pressure sores and decubitus ulcers, are a serious medical problem. Unfortunately, elderly nursing home residents and hospital patients are typically the ones who develop these sores. Decubitus ulcers are painful and result from prolonged pressure on an area of the body that has a bony prominence and a thin covering of flesh. Examples of common pressure sore areas include the tailbone, heels, elbows, and shoulder blades. Bedsores can be caused by a variety of factors, including:

  • The presence of moisture due to unchanged adult diapers and wet sheets
  • Malnutrition and dehydration
  • Immobility
  • The failure of nursing care providers to reposition bedridden patients regularly

In order to prevent decubitus ulcers, it is imperative that the resident be turned and repositioned frequently. People that cannot move on their own should be turned and repositioned every two hours in order to prevent skin breakdown.

People who have bedsores suffer immense pain and can even die. In one alarming case, a Pennsylvania nursing home resident suffered a severe decubitus ulcer that was so deep, it penetrated her internal organs and her bowel drained from her hip. She eventually died.

What is more alarming is that most bedsores can be prevented. Additionally, when the sores do develop, most can be cured. Despite this, it is estimated that as many as one-fourth of nursing home residents fall victim to bedsores at some point during their stay. Many elderly nursing home residents are at high risk for developing pressure sores. High risk factors for decubitus ulcers include:

  • Residents aged 75 and older
  • Residents needing help with feeding and those totally unable to feed themselves
  • Residents who have a limited ability to reposition themselves, which may be  caused by physical inability or the use of restraints
  • Residents who cannot sense the need to reposition
  • Residents who are underweight
  • Residents who suffer from decreased mental status
  • Residents with dry skin
  • Residents who are incontinent
  • Residents with special medical conditions, including diabetes, cancer, and multiple sclerosis

The law requires that a nursing home must ensure that a resident does not develop bedsores, unless the resident’s medical condition shows that the bedsores were unavoidable.

Many times, however, the development of bedsores is avoidable, and the reason for their development is the negligence of the nursing home. It is also important to note that the law also requires the nursing home to prevent the progression of any bedsores the resident may have at, or during, admission to the nursing home facility.

Injured in a Nursing Home ?

No one ever expects to be abused, neglected, or injured in a nursing home. Unfortunately, every year, elderly nursing home residents become the victims of nursing home neglect. Often, the negligence and abuse suffered by elderly residents result in severe injuries.

Listed below are common nursing home injuries, abuses, or areas of neglect. For each topic, you will find nursing home abuse information including: specific signs that may indicate abuse, helpful tips, information on how to report abuse, and information on how to file a legal claim.

Read more about a specific nursing home injury, abuse, or area of neglect :

  • Bedsores
  • Dehydration
  • Elopement
  • Falls
  • Malnutrition
  • Mental Abuse
  • Physical Abuse
  • Sexual Abuse
  • Wandering
  • Wrongful Death

Put our experience to work for you

When a loved one as been a victim of nursing home abuse or neglect, you need an experienced law firm that will work hard to protect your loved one’s rights. The attorneys at Edgar Snyder & Associates have been helping injury victims and their families for over 40 years. In addition, our highly-rated law firm has represented more than 25,000 injured people and has answered over 350,000 injury-related legal questions. Let us put this experience to work for you.