Wandering or Elopement

Wandering and elopement are potentially serious problems in a nursing home. Patients suffering from dementia, autism, Down syndrome, stroke, head injuries, or Parkinson’s disease are all at risk for this danger.

Wandering involves the patient leaving the facility for a specific purpose in their mind, such as attempting to reduce the amount of stimulation they are receiving or to increase it. There are many different types of wandering though.

Elopement is a form of wandering and occurs when the person leaves the nursing home and does not return. This is the most dangerous type of wandering, according to experts, and will often be repeated.

Many of these above mentioned diseases cause brain functions to increasingly decline. Some of the signs include disorientation, confusion, loss of memory, and difficulty in communicating. Add this up and you can readily see how a nursing home patient could inadvertently wander away from the premises. Worse yet, when they are found, they may not be able to explain where they are supposed to be.
These are not rare events either. Approximately 20% of dementia patients will wander away at least once.

Nursing Home Security

A lack of security in the nursing home or assisted living facility can provide an opportunity for a stranger to gain access to the building and commit many types of crime. This is why it is essential that you notice if exterior doors are locked and that visitors are required to sign a log to enter.

Fire exits can provide problems with building security for patients, since they cannot be secured in case of an emergency. Alarms and a light indicator for an open door can deal with this issue though.

A proper security system can provide safety on multiple fronts in that it can control access by visitors, strangers, and keep the residents inside and prevent them from walking away. So, such a system can do double duty–help prevent strangers from entering the building undetected and assist in keeping the residents safe and secure inside where they belong, particularly those with dementia and Alzheimer’s.

Alzheimer’s Association
Annals of Long Term Care
National Center on Elder Abuse

Medical Abuse and Neglect

Here is a partial list of medical conditions and complications that may or may not be the
 result of incorrect medical procedures or care. Be aware of the procedures, treatments or medications your loved one is receiving. Do not be afraid to ask questions of the medical staff as to the benefits they hope to derive from providing them, and how they will know if they are working properly.

Problems with Medical Devices

Nursing homes and assisted living facilities have numerous medical aids for the benefit of their patients. Some of these may fail for a variety of reasons, such as inadequate maintenance, improper use, or incorrect installation. Some examples of devices that may stop working and subsequently cause injury to the patient are: bedrails, a Hoyer Lift, oxygen equipment, infusion pumps, wheelchairs, defibrillators, or ventilators. Problems may arise when the equipment is used by inexperienced or distracted staff members, causing pain and suffering, or even death on the part of the nursing home resident.

Clogged Breathing Tubes

A breathing tube (endotracheal tube) which becomes obstructed can cause brain injury or even death within minutes. Breathing tubes can become a medical necessity to provide air for a number of different reasons, including assisting the patient in breathing after a difficult surgery or with a person susceptible to choking. A breathing tube is usually used with a ventilator. This allows mucus to be removed from the patient’s lungs.

Although a breathing tube is normally only used for a few days, it does prevent the person from speaking because it passes through the vocal cords. It also stops the person from drinking or eating. Nutrients are supplied through an intravenous connection.

The breathing tube must be suctioned out periodically, and there is a risk of it becoming displaced. To prevent tampering with the breathing tube assembly, the patient may receive a mild sedative and have his or her hands restrained. If the nursing home staff does not properly monitor or respond appropriately in the time of an emergency, they could be facing successful legal action against them. They should be thoroughly trained in the maintenance of breathing tubes and what emergency actions should be taken if a problem develops.

Feeding Tube Injuries

The preferred method of providing nourishment to critically ill patients is the use of feeding tubes. Even though this is considered a safe technique, it does not mean that there are no dangers in using them.

Today, smaller diameter tubes are used, which are softer and present fewer complications when compared to the older, larger feeding tubes. In addition, they are also more comfortable for patients. The use of the newer tubes has moved away from their insertion into a central vein; however, tracheopulmonary injuries are another problem.

A study involving the placement of feeding tubes showed that qualified personnel had placed a number of tubes and were confident that they were correctly inserted. It was only after x-rays were taken that the tubes were discovered to have been improperly placed.

Although incidents of problems with feeding tubes are small, they can still result in major complications, and sometimes even death.

Needle Dislodgement

If a nursing home patient is receiving treatment, medication, or nutrients through the use of an intravenous system, the nursing home has a duty to make certain the needle is properly placed and kept functioning correctly. Needle dislodgement is not an uncommon problem involving dialysis, for instance. If a needle becomes dislodged, routine checks by nursing home staff should be able to correct the problem in a timely manner.

MRSA* Staph Infection

Being a resident in a nursing home is a major risk factor for developing the MRSA staph skin infection. This staph infection is resistant to a number of antibiotics. The media commonly refers to this as the flesh-eating bacteria. In a nursing home, MRSA can change into pneumonia or a blood infection. It is very contagious and is spread by direct contact or by sharing personal items such as a razor.

Covering all abrasions, lacerations, and other wounds with dry and clean bandages until they are healed is a good preventative measure. The key to controlling this infection is treating it very quickly.

Signs of the MRSA staph skin infection might include a bump and the infected area could be red, swollen, warm to the touch, filled with a discharge or pus, or it could be painful. It might also be accompanied by a fever. Many of these symptoms could apply to other conditions making an immediate diagnosis difficult.
* (Methicillin-Resistant Staphylococcus Aureus)


The most common cause of infection in nursing home settings is known to be pneumonia. As if that is not serious enough, 30-day fatality rates range from 10-30%. Because of this, prevention of pneumonia must carry a high priority and treatment must be aggressive.

One difficulty in managing this problem is that patients 65 years of age or older are less likely to complain about chest pain, fever, or chills compared to more youthful patients, according to one study. Other research found that three or fewer signs or symptoms were present in 80% of patients who actually had pneumonia. This, of course, hinders discovering the infection early.

For prevention, the Center for Disease Control is recommending a pneumococcal vaccination.

Sepsis (septicemia) and Septic Shock

Sepsis is a blood infection, normally caused by bacteria. It is difficult to diagnose and cure. It can develop quickly and present problems throughout the body. Sepsis can begin from nearly any infection, even something as small as an abscessed tooth. If the infection begins to multiply away from the site of the original infection, it can enter the blood stream and sepsis can be the result. Septic shock is the next elevation when sepsis becomes out of control.
Uncontrolled sepsis is a life-threatening issue and must be dealt with immediately. It can cause an organ to completely fail or weaken the heart and reduce the blood pressure. Chemicals released from the infection can initiate an inflammation in the entire body. Blood clots and leaky blood vessels can be the result. Blood flow is then hindered which reduces the nutrients flowing to the organs. This then leads to septic shock which can result in more organs failing and ultimately causing death.

Common sources leading to sepsis are a surgical area infection, MRSA, bed sores, urinary tract infections, and pneumonia. Elderly patients are one of the high risk groups for exposure to sepsis.

According to the CDC, the number of sepsis cases increased almost 100% between 2000 to 2008. They theorize that this increase could be from more chronic diseases developing, more people attaining an older age, higher resistance to antibiotics, an increase in invasive procedures like organ transplants, or better tracking of these cases.

Also, the fatality rate falls between 28% and 50%, which reflects just how dangerous this disease has become. The mortality rate of septic shock is even higher: 40%-70%.

The usual symptoms of sepsis are a fever, an increased rate of respiration and heart rate, having a hard time breathing, disorientation, confusion, and a rash.

The consequences of a recovery from sepsis are not optimistic. Many people suffer permanent damage to an organ. If someone had a problem with their kidneys before sepsis, it is likely that they would suffer kidney failure and be required to undergo dialysis for the remainder of their lives.
Because of the danger level of dealing with sepsis, you need to make certain that your nursing home or assisted living facility is capable of identifying and treating sepsis. Because sepsis is difficult to identify, early treatment often does not occur. If sepsis is diagnosed in a hospital setting, the patient is usually transferred and treated in an Intensive Care Unit. Make certain your nursing home is constantly on the lookout for sepsis and has a good plan for dealing with it. If you suspect your loved one has been a victim of neglect, call us immediately for a free, confidential legal consultation.

Medication Errors

Errors in administering medication can involve providing the correct medicine, but either in a higher or lower amount than is being prescribed. It could also be the wrong medication or administered at the wrong time – too frequently, or not often enough.

All medical professionals strive to eliminate such errors, however it is impossible to eliminate every one—humans are involved. Tablets and capsules are color coded and labeled to help reduce any such problem, though errors still occur.
One reason for medication errors can be that the caregiver is just not properly trained. It could also be that the person providing the medication is under a very heavy workload and is just under too much stress. Or, it could simply be from carelessness. Keep in mind multiple medications might adversely interact with one another.

Some patients have been on the same medications and dosages for years. If they have gained, or more likely lost a substantial amount of weight, their dosage may need to be adjusted up or downward to keep them from being over or under medicated. Their doctor should take this into account and review and update dosages as necessary. It is possible that the primary physician has not been properly trained in geriatrics and prescribes the wrong medicine or the incorrect amount. Elders could present special considerations from their health history and require a fine-tuning of dosages.

This area is certainly one that should be examined for legal action if a problem develops.

American Academy of Family Physicians
Biomed Central
Centers for Disease Control
National Center for Biotechnology Information
National Center for Health Statistics
National Institute of Justice

Inadequate Daily Care

• Inadequate Food
• Inattention
• Lack of or Improper Treatment
• Malnutrition or Dehydration
• Failure to Monitor Food and Water Intake
• Failure to Provide the Correct Medical Devices
• Failure to Recognize or Treat a Medical Condition

Inadequate daily care is a sweeping term and can be a catchall phrase for many different situations. Some of the different actions or inactions included here would be insufficient food or water, inattention, a lack of or improper treatment, malnutrition, or dehydration. Specific actions could also come under the umbrella of this category, such as failure to monitor food and water intake, incorrect use or not providing the proper medical devices, not recognizing a medical condition, or not following up with the correct medical treatment.

Understaffing can directly relate to many problems that develop with the residents in nursing homes. For instance, these might include cutting back on mandatory duties such as preventing infections, providing proper nutrition, reducing the incidents of falls, and stopping bedsores from developing.

Another example of needed daily care involves oral health. Pneumonia is the disease that is the number one killer of nursing home residents. A study has found that the accumulation of bacteria and plaque on the surfaces of teeth and dentures result in the spread of respiratory pathogens. These pathogens migrate from the mouth to the lungs where they fester and can cause pneumonia. Although a lack of training of nursing home staff and the reluctance of patients to cooperate with this regime pose problems, simple dental health could help reduce the rate of pneumonia.

Furthermore, it was noted that state inspection services of nursing homes cannot be relied on because of the great diversity of standards. In other words, do not depend on any governmental agencies to protect your loved ones. You must step up and be proactive to make certain that your relative is safe, protected, and is receiving the quality of care that you expect. Still, if you find or suspect problems, do not hesitate in contacting governmental services to get them involved as soon as possible.

Unsanitary Facilities

Every nursing home or assisted living facility should provide sanitary bedding, fresh eating utensils, clean bathroom facilities, and a dirt-free bedroom area. If these are not being completed properly, a case of negligence can occur.

Bedsores, Ulcers

Bedsores are a very common problem in nursing homes and can develop quickly. They can also become life threatening so prompt discovery and treatment should have high priorities. Bedsores are also known as pressure sores or decubitus ulcers. This type of medical problem is caused when there is unrelenting pressure to a particular location on the skin. The people who are most susceptible to this medical problem are the ones who are confined to a bed or spend a long time in a wheelchair and are not able to shift positions. This can cause an injury to the skin and the underlying tissue. At the worst, it can manifest itself into a major medical problem causing a life threatening injury reaching through the depths of skin and tissue down to the bone.

Bedsores usually appear on skin over a boney area and depend greatly on the body’s actual position. For those confined to a bed, specific bodily areas are concerned: the edge of the ears, the back or sides of the head, hips, tailbone, lower back, behind the knees, heels, and ankles. For those wheelchair bound patients, the most common areas affected are the buttocks, tailbone, spine, shoulder blades, and the rear of the arms and legs where they touch the chair. An examination of Stage 1 bedsores should be part of the ongoing daily treatment of all nursing home patients.

Bedsores are an indication of nursing home abuse, nursing home neglect, or malpractice.


Stage 1
This is the very beginning of the injury. The skin does not lighten when touched and it is unbroken. A person with light skin may show a red color, while a darker skin color may show some discoloration. The location may be tender to the touch.

Stage 2
The outer layer and the under layer of skin are both damaged. It may appear to be a shallow injury with a red or pinkish color accompanying it.
It often looks to be fluid-filled or as a burst blister.

Stage 3
Now the ulcer is deep, similar to a crater, and exposes some fat. At the very deepest part of this one, you may see yellow colored, dead tissue.
It may be larger in size under adjacent healthy tissue.

Stage 4
This is the most serious phase of the ulcer. Tendons, bone, or muscle may be seen. Dead, yellow, crusty, or dark tissue in the bottom of the injury is visible. Often additional damage can be seen under nearby healthy skin.

Department of Health and Human Services
Kaiser Family Foundation
Mayo Clinic
Rockford Health Council
Vanderbilt University, School of Medicine, Institute of Medicine & Public Health

Falls and Accidents

Falls are one of the most worrying accidents that can happen to a nursing home resident. A fall can often lead to an injury that may cause long-lasting complications or even death. About one-half of all residents in nursing homes fall each year. Out of those, approximately one in ten suffer a serious injury from the fall.

The Center for Disease Control (CDC) estimates that nursing home falls are caused by environmental hazards 16-27% of the time. These can be reduced or eliminated in most cases. Inadequate lighting, slippery floors, beds at an incorrect height, or debris in walkways can all be addressed. Also they say that up to 75% of nursing home residents fall each year, so when you visit your relative’s nursing home, be on the lookout for uncorrected hazards.

Walking problems and muscular weakness could be contributory factors in falls. If the nursing home has any sort of exercise program or physical therapy, this could help reduce this problem. Once a fall has occurred, there should be an assessment, according to the CDC, of what caused the fall, evaluating any related medical conditions, and what could be changed to reduce the chances of another fall. Since the average nursing home resident falls 2.6 times per year, it is essential that everything should be done to minimize this problem.

Considering the life or death circumstances that may result from a fall, nursing homes and assisted living facilities should be ever-vigilant to that danger. If not, negligence might be found. Contact a legal specialist for an evaluation of the circumstances if you suspect this might be the case.

Attended Falls

This is where a patient is being moved or allowed to walk with the assistance of another person, such as a caregiver, physical therapist or nurse. The patient then falls either when walking or falls when rising from a wheelchair, for example.

This could be a sign of negligence on the part of the nursing home employee or the nursing home itself.

There could be a number of reasons for the falls, including obstructions in the walkway, slippery floors, inadequate attention from the nursing home staff, improper and unsafe methods of moving the patient, or improper training of the staff.

Hoyer Lift Falls

A Hoyer Lift, sling lift, or patient lift is used to move patients with the aid of a sling. The lift is either attached to the ceiling or operates from a position on the floor. Commonly they are used to move the patient from the bed to a chair and back again.

When these lifts are used correctly, they are very safe; however accidents do happen as the result of negligence. Death or serious injury can be the result. Nursing home staff must be properly trained in the use of a Hoyer Lift and must follow the correct procedures. The patient must be properly secured in the device and in the correct position or they could slide out and fall a few feet to the floor.

Some nursing homes or assisted living facilities have a policy that two staff members be present when a Hoyer Lift is put into use. A number of manufactures of Hoyer Lifts also state that two employees are needed for that operation. However with a chronic shortage of manpower in many facilities, this rule may often be disregarded.

Unattended Falls

Just as it sounds, this is a patient’s fall when no one is attending to them. Many nursing home patients are weak and unsteady on their feet and should not be allowed to walk by themselves.

Nursing homes have a duty to monitor their patients to make certain that a resident who is incapable of navigating on his or her own is not allowed to try. Staff shortages could set up the situation where the patient gets out of bed on their own and suffers an injury from a fall.

Healthcare facilities should have several ways of notifying their staff as to which patients are fall risks. A sign may be placed on the wall or door to a patient’s room, as well as a bracelet alerting staff of the fall risk. Other precautions include putting up the bedrails so they can’t climb out, and an alarm that goes off if the patient manages to leave the bed.

Bedrail Injuries

Injuries and death from bedrail incidents happen all too often and the elderly are at a much higher risk of suffering from them. Patients can become tangled and stuck in the rails. If their neck or chest becomes compressed, they would not even be able to call out for help since the air could be squeezed out of their lungs.

The Consumer Product Safety Commission (CPSC) reported that between January 2003 and September 2012, it received reports of 155 deaths involving bedrails.
The danger from injuries involving bedrails occurs because of gaps between the rails themselves. It also could involve the space between the headboard or an opening between the edge of the bed and the rails. If these spaces are large enough, the elderly patient can inadvertently end up in that gap exposing him or her to the danger of compression or strangulation. Portable bedrails are more of a problem compared to the permanently installed rails because they do not fit as well.

Other injuries that have been reported occurred when the patient attempted to climb over the bedrails and fell, either onto the bedrail or fell when the bedrail was not properly raised into position. Incidents involving falls from or in the bed were less than 8% of fatalities involving bedrails however.

Because of the potential danger, experts recommend that the staff should regularly perform safety inspections to make certain that the bedrails are still correctly installed and are being used properly. Additionally, some bedrails have manufacturing defects and should have been recalled but have not been.

Both the CPSC and the Federal Drug Administration (FDA) are involved with bedrail injuries and deaths. As early as the 1990s, the FDA had issued guidelines concerning the potential danger from bedrail injuries. However, these guidelines only requested voluntary compliance, so little real progress was made in reducing injuries and fatalities to this day. One prime moving factor in this regard came from families who began legal proceedings after an injury or a death occurred. When a court assesses monetary damages from nursing homes or assisted living facilities, it will provide a strong force for change for the good of all.


While a burn is most likely accidental, it could be an indication of intentional physical abuse, especially if it is a repeated occurrence. This description could apply to chemical burns from solvents, such as cleaning materials, or the breathing of toxic vapors, as well as injuries from heat or flame. The skin, as well as the eyes, could be affected. The patient may have been exposed to any of these items while the area they are in is being cleaned. Burns can also be caused by extended exposure to heating elements, hot air vents or heating pads.

Symptoms of this could be:

• Stomach pain or vomiting
• Coughing, shortness of breath, or difficulty in breathing
• Pain or a discharge from the eyes
• High pitched voices or wheezing
• Chest tightness or chest pain
• Pus-like discharge from a skin injury, redness, or pain


Problems with choking in elderly patients often function in conjunction with dysphagia and aspiration. Dysphagia means difficulty in swallowing, while aspiration is an inflammation in the lungs and bronchial tubes from vomit, secretions from the mouth, drinks, or food.

Problems from dysphagia can be:

• Dehydration
• Malnutrition
• Weight loss
• Depression
• Aspiration
• Choking
• Pneumonia

Aspiration can turn into aspiration pneumonia which can cause the patient to become disabled or be a cause of death.

If a person has a swallowing disorder, caregivers should be sure the patient is not left alone while eating. If the patient is being properly monitored, food should be cut into small pieces, they should be watched to be certain the food is chewed thoroughly, and that they are not talking or laughing with food in the mouth.

Caregivers should monitor the patient during every meal and snack time, and they should know how to administer the Heimlich maneuver. It is easy to see how inexperience or inattentiveness on the part of a caregiver can lead to serious complications or death.

Agency for Toxic Substances and Disease Registry
American Association of Law Libraries
Centers for Disease Control
Dysphagia Resource Center
Geisinger Community Health Services
Michigan State University
The Chicago Tribune
The New York Times
U.S. Consumer Product Safety Commission University of Iowa