In the United Health Foundation’s 2019 America’s Health Rankings Senior Report, Texas ranked 50th in the nation for nursing home quality. The state ranked 40th overall for public health impact when compared to the rest of the nation.
About the Report
The Centers for Medicare & Medicaid Services implemented a five-star quality rating system to compare nursing homes with each other. Having a higher number of stars indicates that the nursing home is rated higher quality in that particular area. The scores are derived from health inspections, overall staffing and the quality of resident care. The ratings are meant to encourage nursing homes to achieve higher quality rankings.
The Kaiser Family Foundation’s analysis of 2015’s comparison data revealed the following trends in nursing home:
- Nursing homes that were part of a Continuing Care Retirement Community usually had higher ratings
- Smaller nursing homes usually had higher ratings
- Not-for-profit nursing homes usually had higher ratings
- States with a larger percentage of low-income seniors usually had lower-rated nursing homes
A recent study found that nursing homes with three or fewer stars in the report were usually located in the southern United States and that nursing homes in counties that had a high socioeconomic status usually had a higher star ratings. All of these statistics point to the possibility that seniors in counties with lower socioeconomic status have greater difficulty in accessing quality nursing home care.
Texas Findings
The report concluded that Texas was last for nursing home quality, which is determined by calculating the percentage of beds with four- or five-star ratings over a three-month period. The report indicated that some of the challenges to Texas seniors is low funding for community support and a high percentage of seniors currently living in poverty.
Texas also had increasing rates for obesity and physical inactivity rates, along with a 71% increase in depression since last year’s report. The state spent $206 per low-income senior adults for the year for home and community-based services, placing it 48th in the nation.
The state is currently ranked 40th in the nation overall for senior health, a statistic that it has been at or around for the last six years. Top ranking states include Hawaii, Colorado and New Hampshire.
Significance of the Scores
Seniors in nursing homes are often some of the most vulnerable people in society. They may struggle with completing daily activities, may have cognitive limitations or may have multiple serious medical conditions, which is why it is important that they receive high quality care. In 2016, 1.3 million residents lived in over 15,000 nursing homes throughout the country. Billions of dollars are spent every year in hospitalization and treatment stemming from poor nursing home care, including pressure ulcers, malnutrition, dehydration, falls, urinary incontinence and ambulatory care-sensitive diagnoses.
Another problem with poor nursing home quality is the increased risk of elder abuse. Auditors with the Health and Human Services inspector general’s office found that 18% of cases requiring emergency care for a nursing home resident where nursing home abuse or neglect were suspected were not reported, despite federal law requiring these episodes to be reported.
Types of Elder Abuse
Elder abuse extends well beyond physical abuse. There are several different types of elder abuse that the families of nursing home patients should be on the lookout for, including the following:
Physical Abuse
Physical abuse is the type of abuse that most people think of that consists of using violence or physical force against an elderly person that causes or could cause bodily harm, impairment or physical pain. Examples of physical abuse include:
- Striking the nursing home resident with an object
- Using restraints inappropriately on a resident
- Using medication to sedate an elderly person when it is not necessary
- Hitting, shoving, pinching, biting, slapping, shaking, kicking, burning or taking other types of physical action against the resident
Sexual Abuse
Sexual abuse is non-consensual contact with a nursing home resident. This also includes any type of sexual contact with a resident who is incapable of providing consent.
Emotional Abuse
Emotional abuse involves inflicting emotional pain, anguish or distress from verbal or nonverbal acts. Examples of emotional abuse include insulting, humiliating, threatening, intimidating or harassing the elder.
Financial Abuse
Financial abuse includes illegally or improperly using a nursing home residents’ money, assets or other property. It can also include trying to coerce a vulnerable resident into taking financial action that benefits the nursing home worker to the detriment of the resident or his or her family. Common types of financial abuse include:
- Taking cash or a bank card from the resident
- Taking other property from the resident
- Forging the resident’s checks
- Stealing property from the resident
- Forcing the resident to sign something he or she does not understand
- Encouraging the resident to name the nursing home worker as an agent in a power of attorney or make changes to a will or other legal document
Neglect
Unlike the abuse as described above, neglect does not require any intention to harm the patient. However, the nursing home patient is still harmed because of the nursing home or its employee’s failure to fulfill its duties to the resident. The resident may not have access to food, water, medicine, hygiene or personal safety.
Signs of Elder Abuse
The possible signs and symptoms of abuse will vary based on the type of abuse. Signs of physical abuse include:
- Broken bones, skull fractures or other unexplained injuries
- Reports of falls when there was no prior fall risk
- Bruising or welts
- Internal injuries or bleeding
- Marks around the wrists or ankles that indicate the resident was restrained
- Broken eyeglasses
- Reports from the resident of abuse
- The nursing home refuses to allow visitors
- A sudden change in the resident’s personality or behavior
Common signs of sexual abuse include:
- Bruises on the breast or genitals
- Bloody or stained undergarments
- Unexplained STDs or STIs
- Reports of this misconduct
Emotional abuse may be identified through the following signs and symptoms:
- Isolation from activities the resident enjoys
- Isolation from friends or family
- Observing a nursing home worker give the resident the silent treatment
- Lack of communication or appearing withdrawn
- The resident appears emotionally upset or agitated
Financial abuse may be realized through transactional signs or behavioral signs. Transactional signs include:
- Adding a new person to a bank account
- Large transactions out of the bank account or a series of smaller withdrawals
- Changes in the type of transactions, such as use of a debit card or ATM withdrawals when this was not previously common
- Changes to legal documents, such as a power of attorney or will
- Missing funds or possessions
- Bank transfers to someone not in the family
- Forged signatures on financial documents
Behavioral signs may include the resident receiving unnecessary services, the resident receives substandard care when he or she can afford better care, nursing home workers may claim rights to the resident’s possessions or the ability to make decisions for the resident, the resident does not have adequate resources even though he or she had access to funds, or the resident suddenly appears concerned about finances when he or she was not before.
Common signs of nursing home neglect include:
- The resident has untreated bed sores
- The resident has been diagnosed with dehydration or malnutrition
- The resident has poor hygiene, is not bathed often enough or is allowed to sit continuously in soiled undergarments
- The nursing home does not provide personal safety or comfort to the resident
- The nursing home does not treat health problems
What You Can Do If You Suspect Your Loved One Is Being Abused in a Nursing Home
If you are afraid that your loved one’s injury stems from nursing home abuse or neglect, it is important that you take immediate action to protect him or her. Report the incident so an investigation can be conducted and your suspicions become part of a documented record. Then, contact an experienced nursing home abuse lawyer who can guide you through the process of filing against the nursing home.
