Assisted Living Neglect

[ninalou]

What is the name of your state (only U.S. law)? PA

I am writing on behalf of my father (I am POA and Guardian). In Sept of 08, my father needed to move to an assisted living home. At the time he moved in, he could still operate very independently.. dressing for himself, feeding himself, laundry etc...

I visit him every week to 10 days (depending on my work schedule) and I always bring him snacks (crackers, fruit, trail mix, nuts) and beverages (milk, juice, soda) to keep in his pantry in his apartment. The home provides 3 meals per day.

In January, I noticed he was getting more and more depressed although physically he seemed fine. All they seemed to do is up his antidepressants. Then by March, I started noticing his face getting thinner. I've been asking all along, are you ok, etc.. and he would say he was fine. I got a call mid march telling me there was an 'issue' in the dining hall regarding my father, but they were addressing it immediately. When I asked specifics, they would not elaborate (as the head nurse claimed she wasn't there.) I saw him that weekend and he looked really thin and pale although, he denied any issue. The following week, they called me and told me he lost a significant amount of weight and blamed it on depression and me not visiting more frequently. (I do work an hour away from my home and own a farm... so I don't have a lot of free time... and this made me feel really bad.) I brought him groceries as usual and called him twice the following week. The next Saturday, he was rushed to the hospital. They thought he had a stroke as he had a huge bump on his head from a fall and could barely speak.

As it turned out, he did NOT have a stroke, but was suffering from severe dehydration & malnutrition, in addition, he developed pnemonia and his bladder stopped expressing urine so he was becoming septic. Basically, his body was shutting down. I also found out in the month of March, he dropped from 162 to 123. The issue in the dining hall was he was not going to any meals - yet no one told me.

My father is still recovering in a nursing home and it isn't looking good. They are feeding him 3 high protein/calorie meals a day + 3 nutritional shakes. In addition, I bring a 4th meal in the evening as well as multiple additional snacks so he can eat thoughout the day. (The nursing home encouraged this.) In the 2 weeks since he's been at the nursing home, he's still dropped 2 more pounds. He cannot function without the catheter. He has a horrible wound on his bottom.

As someone who is on a diet, it is not easy to lose that kind of weight that quickly unless you are literally starving yourself which is not healthy.

When I first signed my father up to the home, they told me if they saw any changes in his condition, we could easily change his level of care. That being said, shouldn't the Assisted Living community have told me when he first started losing weight? If they noticed a senior missed 2 days worth of food, shouldn't that be considered an issue? My dad literally missed weeks of meals - that we are paying for - and no one said anything to me until 40 pounds dropped. I am meeting with the nursing home this week for an evaluation, but from what I am told, my father's condition could have been prevented if caught sooner. (Every time I bring him meals, he has no problem eating.) Now, the Assisted Living community won't speak to me. What's worse, they sent me a bill and included 'special assistance charges' after they notified me there was a problem. I am not happy about this as I feel they neglected their duties, endangered his life and put him in a situation in which he is suffering and may not recover.

Does this constitute senior abuse?
Any input would be greatly appreciated. (If I should find an attorney, I will do so.) I am an only child, no relatives other than my parents and both divorced years ago (not well) so I don't have anyone to bounce this off of.

Thanks!
Nina

 

[CJane]

I think, in an assisted living community, the standard of care is going to be MUCH LOWER than if he was in a true nursing home. They can't FORCE anyone to go to meals/eat food that's brought to them... and they likely weren't weighing him on a daily basis.

YOU noticed weight loss and depression/lethargy and paleness... whom did YOU address these issues with?

 

[ninalou]

I think, in an assisted living community, the standard of care is going to be MUCH LOWER than if he was in a true nursing home.

In response: I think it depends on the nursing home. Last year my father went through 3; 2 of which were abusive and neglectful. The nursing homes in question forgot to bring meals.. didn't always give or enforce medication. I was SPECIFICALLY told by his doctor Assisted Livings were better because they are PRIVATE PAY and NOT Insurance.

They can't FORCE anyone to go to meals/eat food that's brought to them... and they likely weren't weighing him on a daily basis.

In response: That is an incorrect statement. They WERE weighing him on a weekly basis AND were to report any drastic changes to me. In addition, based on the level of care my father was getting when he arrived, they told me they keep track of how each resident does and if there is any change, they let the family know because there may be a need to up or down the level of service.

YOU noticed weight loss and depression/lethargy and paleness... whom did YOU address these issues with?

In response: The aides and the head nurse who does NOT return calls promptly. I do not typically see my father without clothing so I didn't realize just how thin he became. Also, he was NEVER depressed when I was there.

I was told the WHOLE POINT of moving to Assisted Living was to help him where he needs help. I basically paid them $4000 for them to ignore the fact that my father was starving to death. They saw him lose weight from week to week and said nothing. I am sorry, but if they take money to care for someone, they should have a responsibility to provide the care they agree to provide. I trusted them and the agreement I signed with them.

And by the way, I feel bad enough about the situation and the fact I have to spend 14 hours of my day away from home working (including the commute.) I am not independently wealthy where I can quit my job to devote my time soley to my father. I am also an only child so there is no one to share in this responsibility. I am doing the best that I can with no help. I learned my lesson in not to trust anyone.

 

[deerlover]

You should not have to defend yourself. That is so wrong!
My Mom was placed in an ALF in Nov 2008. She had alz and dementia but was very high functioning. She was killed by neglect.
We all have other obligations in life and can't always be there 24/7 for our parents and pay tons of money for the promises of good care. What a crock.
The place my Mom was in looked wonderful and came highly recommended. My sister visited for 2 weeks in Dec 2008 and my Mom's husband visited almost daily. All seemed ok but he did express some concern over her appearing to be drugged now and then. My sis and I called the nursing director several times and never got calls back. We called Mom every day and she was always cheerful.
When Mom went in there she was mobile but they confined her to a wheel chair due to liability of a lawsuit for any falls. When you said that you were not aware of your Dad's weight loss, I can fully understand. When you see them, they are fully clothed and always act like all is ok. My Mom developed a pressure sore on her rear from sitting and being left in her own waste. They were supposed to change her Depends and apparently didn't do it. They never reported or treated her sore. By the time they transferred her to the ER she was unable to even hold a cup in her hand and she was septic. They had to debride the sore and she had 1/2 of her rear gone. She had to be put on a respirator and was in horrible pain. She passed away a few days later as the sepsis took over her entire body and her organs shut down. This was pure neglect.
I suggest you contact an atty ASAP. One that specializes in Elder abuse and do it now before it is too late for your Dad. Don't let them kill your Dad like they did my Mom.
We have an atty now and this place my Mom was in is gonna be real sorry. Can't help my Mom but maybe some others will get better care.
Good luck to you and the best to your Dad.

 

[ninalou]

Thanks deerlover! I appreciate your supportive response. I felt like I had to defend myself from the first response as they implied I should have done more. I do wish I was in a position where I could do more... but I was not dealt those cards. It is very difficult to figure these things out on your own when you've never been in the situation before or would even know to look for these things. At $4000 per month, I am shocked at the lack of service and care. I have written a scaithing letter to my governor (not scaithing at the governor!) to inform him there needs to be change. Seniors deserve better than being raped financially and abused physically.

I am having trouble finding an attorney who specializes in Elder abuse. There are plenty who deal with the estates but not abuse.

Thanks for your support.

Nina

 

[ecmst12]

I understand that you can't be there every day and you have your other duties to attend to. However I also think that you had a feeling something was not right and you should have trusted your instincts and said something sooner. No assisted living place is going to be as proactive as a family member in taking care of someone. You can't rely on anyone you hire to care as much as you do.

 

[deerlover]

Atty's

Contact the local Bar association and see if they have a referral service. This just occurred to me, after I sent you the PM.
BTW I just moved back to Long Island NY after spending 11 yrs in Pa.

I have to say that my family never expected the same level of care that we would have given but we did expect my Mom to have enough care to not cause her death!

 

[ninalou]

I do thank everyone for your responses. I will the PA Bar Association and see if they can help. It's a great suggestion. Thank you.

I will also add, I have learned my lesson in trusting my gut. While I should have pushed further, I couldn't pinpoint why I was feeling the way I was feeling until I saw my father start to look thinner. Then I did ask, but obviously I was too trusting with the responses I was given. I naievely think about the good in people as opposed to those who try to take advantage of the situation. On another note, the AL facility had as much responsibility for my father's well being as they got paid for a service they didn't provide.

Unfortunately, I am not sure my father will make it. I went to a care conference today and was informed my father has dropped another 4 lbs to 117. (He is 5'11") He sleeps almost 18 hours a day now.

Whether or not an attorney believes I have a case or not, I do intend to write to my senators as legislation needs to change. These facilities have a responsibility to the residents in their care especially when they charge as much as they do. (If my business charged that kind of money for a service and I didn't provide the agreed upon service, I would go out of business!!!)

Thanks again!
Nina

 

[ecmst12]

It sounds like your father is terribly depressed. Is he recieving psychiatric treatment with the medical? He definitely needs as many visits as you can manage right now. Does he have any friends? Any other family at all?

 

[wyett717]

It sounds like your father is in need of more care than assisted living. Assisted living facilities are generally there to help with basic living needs, they do not usually provide intense medical care. Since your father only required assisted living services, they would not keep close tabs on his eating or other medical concerns. As you mentioned, you didn't notice the weightloss because you always see your father dressed; the staff at the facility most likely doesn't see him undressed either.

You would have a hard time proving elder abuse; one of the components of abuse is that a person or facility commits it with intent to harm someone. That doesn't appear to be the case here.

As ecmst12 said, your father sounds like he is very depressed. I would focus your time and energy on evaluating his mental health so he can get the treatment he needs. It's easy to be angry about the situation, but keep in mind that they honestly may not have realized what was happening. Best wishes to you and your father.

 

[lya]

The PA Assisted Living Consumer Alliance's website has information and references that should benefit the original poster. I followed the references and learned that:

PA does not require more than one contact hour of personal care per 24-hour period be provided to residents in Assisted Living or Personal Care Homes.

If the resident requires assistance with mobility, two hours of personal care must be provided per 24-hour period.

The facility is only required to evaluate the resident once each year. This evaluation includes a medical evaluation and a need-for-services evaluation.

The personal care staff may, in some facilities, be required to obtain training in first aid, CPR, and/or airway obstruction management.

There is no requirement for professional skilled physical or health assessment except during the once yearly required evaluation.

Hospice services can be obtained for a resident. (I did not find the PA law on Home Health services; but, I have never known Home Health Services to be denied on the basis of residency being an Assisted Living facility or Personal Care Home.)

From the description of the resident, the father of the OP, I support the advice to obtain a mental health evaluation. I believe it should be in conjuntion with a physical evaluation and should rule-in or rule-out Alzheimer's. However--the description of the resident, the father of the OP, is consistent with what happens when elderly persons live alone and is consistent with very common presenting complaints and physical findings when such an elderly persons seeks medical care or evaluation. The weight loss, malnutrition and dehydration, system/organ failure (kidney, bladder, heart, lungs, ...) scenario is a common finding in the elderly who live alone, even if the "alone" occurs within an Assisted Living facility or Personal Care Home.

I sincerely doubt the OP has any true course of action other than to join with the PA Assisted Living Consumer Alliance in their efforts to make changes.

 

[ninalou]

Thanks again everyone! I will definitely look up the PA Assisted Living Consumer Alliance website and do more homework. Based on the information in the contract of which I signed for my father at the AL facility, they state they would notifiy me of any changes. So that is where I was questionning why they didn't come to me sooner. Maybe I misinterpreted their words??? I also intend to speak with my local state representative and work with him on making changes. Not just because of my father, but from what I am seeing especially from those residents who don't have family visiting frequently. It's SCARY.

None the less, my father is depressed. His is on an anti depressant and anti psychotic. Based on his comment to me yesterday, I believe my dad has given up his will to live. He was miserable having to move to the AL facility. My goal was to sell his house, build an inlaw suite on mine, then move him to my house when he needed full time care. I just did not expect him to go downhill so quickly.

We are going to a doctor today so hopefully, we will get a little more insite to what is happening (is this more than just depression...)

Thanks to everyone for your advice and support! I found it very helpful.

Nina

 

[BlondiePB]

Thanks again everyone! I will definitely look up the PA Assisted Living Consumer Alliance website and do more homework. Based on the information in the contract of which I signed for my father at the AL facility, they state they would notifiy me of any changes. So that is where I was questionning why they didn't come to me sooner. Maybe I misinterpreted their words??? I also intend to speak with my local state representative and work with him on making changes. Not just because of my father, but from what I am seeing especially from those residents who don't have family visiting frequently. It's SCARY.

None the less, my father is depressed. His is on an anti depressant and anti psychotic. Based on his comment to me yesterday, I believe my dad has given up his will to live. He was miserable having to move to the AL facility. My goal was to sell his house, build an inlaw suite on mine, then move him to my house when he needed full time care. I just did not expect him to go downhill so quickly.

We are going to a doctor today so hopefully, we will get a little more insite to what is happening (is this more than just depression...)

Thanks to everyone for your advice and support! I found it very helpful.

Nina

Hopefully, you've notified the ALF that you're father will not be returning and have removed all his belongings. If not, do so and have a lock out on his room until you retrieve his stuff. ALFs do charge daily for the resident's room even if the resident is not there until date of move out. Look at the contract for details of moving out.

Elders thirst mechanism declines with age. That's a huge factor for dehydration. They don't drink enough fluids because the brain doesn't tell their bodies that they need to drink something too well.

If Hospice is an option, you may want to consider safely transporting dad to your home. Hospice does come to one's home. Rather than paying all that money to an ALF, consider hiring 'round the clock care for dad while you're at work in conjunction with Hospice.