hand of older person resting on dark blanket

Ensuring Nursing Home Safety

There are a number of factors that come into play regarding nursing home safety. With staffing standards in the news, it’s hard not to talk about general nursing home safety and some of the causes as well as solutions. Staff to resident ratios have a large part to play in ensuring nursing home safety, but so does our vigilance as loved ones, and our general advocacy for better care and living conditions. Here are the common dangers in nursing homes, and how we can eliminate them.

hand of older person resting on dark blanket
PC: Amisha Nakhwa via Unsplash

Restraints

Though uncommon, using physical restraints used to be a standard of care and may still be used in desperate circumstances. A physical restraint is defined as “manual method, physical or mechanical device, equipment or material that meets the following criteria:

  • Is attached or adjacent to the resident’s body;
  • Cannot be removed easily by the resident; and
  • Restricts the resident’s freedom of movement or normal access to his or her body. Centers for Medicare & Medicaid Services (CMS) State Operations Manual (SOM) Appendix PP at F604.” – CANHR

While some restraints may temporarily ensure the safety of residents (such as soft ties and hand mitts), they should not be permanent nor used as “discipline”. In fact, residents have the right to not be restrained against their will, which is outlined as part of their right to respect and dignity in 42 CFR §483.10(e)(1) and 42 CFR §483.12

In addition to being an infringement on residents’ rights, physical restraints also pose a threat to overall safety. 

“Restraints often cause incontinence, poor circulation, weak muscles, chronic constipation, pressure sores, depressed appetite, loss of mobility and increased illness.”

These consequences are in addition to bruising and other injuries caused as the resident attempts to free themselves. 

It is important to be an advocate for loved ones. In care conferences and meetings, ask that the least restrictive options be used and only if absolutely necessary. If excessive restraints are used, talk to the long-term care ombudsman or file a complaint. Most importantly, be there as often as possible to ensure your loved one feels safe during all aspects of their care.

“Preventable adverse events constitute more than half of all harms experienced by nursing home residents (OIG, 2014a). The most common of these are falls, infections, and adverse events related to medications.”

National Library of Medicine

Falls

Fall prevention is an ongoing effort amongst nursing homes and resident advocates. Roughly half of nursing home residents fall every year, suffering from a variety of injuries that can set them back health-wise or even lead to death. 

“Systematic reviews have identified a number of factors associated with an elevated risk of falls, including previous falls, whether a resident uses a cane or other assistive walking device, wandering, Parkinson’s disease, dizziness, polypharmacy, and the use of sedatives, antipsychotics, or antidepressants (Cameron et al., 2018a; Deandrea et al., 2013; Muir et al., 2012)”

While this list of factors seems long and difficult to control, there are a few things that can be done. 

First is to know the common side effects of medications. If there are any that list dizziness or muscle weakness, then the nursing home staff should be made aware and extra precautions taken. It is also vital to ensure the environment is not cluttered, dirty, or hard to navigate. If the resident uses a walker or other assistance, make sure the equipment is not broken or faulty and make sure it is easily available. 

Again, raise concerns in care meetings and ask that the resident be evaluated for fall risk so the nursing home staff is able to take appropriate precautions. 

Antipsychotics

Antipsychotics are not a new topic to this blog. Notably, we’ve discussed the loophole in reporting and therefore overuse of antipsychotics to subdue and control the behavior of residents with Alzheimer’s or dementia. 

“The way CMS has set up their QMs rating system does not require facilities to include the use of antipsychotics for schizophrenic patients as part of their overall antipsychotic usage. Steps have been taken to dissuade the use of antipsychotics among nursing home residents, but a recent study found schizophrenia diagnoses have increased exponentially, and seemingly without explanation. The question is then, are nursing homes using schizophrenia as a way to hide their use of antipsychotics? In other words, are residents still being unnecessarily chemically restrained?”

News: CMS Investigates Schizophrenia Diagnoses & Antipsychotics

This form of chemical restraint is not only unethical, but incredibly dangerous to the wellbeing and safety of residents. Antipsychotics can lead to the loss of independence, over-sedation, confusion, increased respiratory infections, falls, and strokes, increasing the risk of residents suffering major injuries or being abused in other ways. 

As an advocate, it is important to be aware of all medications prescribed to your loved one, especially if they are not able to advocate for themselves. Ask questions, demand copies of any records you can legally get, and push for alternatives. 

At the end of the day, resident safety within nursing homes is everyone’s responsibility. And though there are laws, circumstances, low staff numbers, negligence, and other factors can easily lead to unsafe environments and poor care.

If you or a loved one have been the victim of nursing home abuse or neglect, call Gharibian Law (877-460-1187) today for a FREE consultation and the best legal representation.