Signs of Neglect
As our population ages, the number of elder Americans in nursing homes and
assisted living facilities
continues to soar. Research indicates that one-half of women and
one-third of men will eventually need nursing home or assisted living
care. By the year 2020, the demand for nursing home and assisted living
beds will increase by almost 250%. Nursing homes and assisted living
facilities eagerly accept the financial benefits of the "graying of
America." They must also accept responsibility when our loved ones do
not receive the care, dignity, and respect they deserve.
Nursing
home and assisted living neglect and abuse take a variety of forms.
Pressure ulcers, falls, malnutrition, dehydration, and medication errors
are painful, but frequent, reminders that more must be
done. Fortunately, increased media scrutiny of nursing homes and
assisted living facilities and their business practices has resulted in a
heightened awareness of the problem. State and federal governments have
also come to the aid of families by enacting laws and regulations
designed to ensure that patients receive appropriate care.
Unfortunately, media attention and regulatory oversight are poor
substitutes for good care. Patients and their families need to recognize
the "red flags" of nursing home and assisted living neglect and abuse.
If your loved one is a patient in a nursing home or
assisted living facility, look carefully for any of the following signs of neglect and abuse:
- wandering and elopement
- Resident to Resident Assault
- Pressure Ulcers
- Medication Errors Malnutrition and Weight Loss
- Falls
- Dehydration
- burns, fires, other hazard
- Bedrail entrapment and asphyxiation
Malnutrition and Weight Loss
A nursing home or assisted living facility must ensure its patients
receive proper nutrition and maintain proper body weight and protein
levels. Unplanned weight loss, peripheral edema, cachexia, and
laboratory tests indicating low serum albumin levels are signs that a
patient may not be receiving proper nutrition. The amount of weight lost
during one-month, three-month, and six-month intervals reveals the
severity of the weight loss:
One Month, Significant = 5%, Severe = Greater than 5%
Three Months, Significant = 7.5%, Severe = Greater than 7.5%
Six Months, Significant = 10%, Severe = Greater than 10%
For example, a weight loss of five percent of a patient’s body weight
in one month is “significant,” but a loss of more than five percent in
one month is “severe.” The percentage of weight loss is calculated using
the following formula: (usual weight - actual weight)/(usual weight) x
100.
Malnutrition can be diagnosed clinically and with laboratory tests.
My H & H was positive for
anemia. Hemoglobin a patient (older than 60-but in my depleted state and record low of Vitamin D/Calcitonin was a red
FLAG I was headed for a malnourishment. Hemoglobin should
remain between
180-300 g/dl. Hemoglobin in males should remain between
14-17 g/dl and in females should remain between
12-15 g/dl.
Hematocrit
in males should remain between 41-53 and in females between 36-46.
My
albumin was
2.3g/dL
My hemoglobin was
67g/dL
My hematocrit was
12g/dL.
At the hospital, multiple other electrolyte and my ABG's were
fouled up BAD!!!
My total vitamin D that day was 17
Clinical signs of malnutrition include
pale skin, dull eyes, swollen
lips, swollen gums, swollen or dry tongue with scarlet or magenta hue,
poor skin turgor, cachexia, swelling in the extremities, and muscle
wasting. Laboratory tests can also detect malnutrition. For example, in a
patient over 60 years of age, albumin (which reveals protein depletion)
should remain between 3.4-4.8 g/dl. Plasma transferrin in a patient
older than 60 years of age should remain between 180-300 g/dl.
Hemoglobin in males should remain between 14-17 g/dl and in females
should remain between 12-15 g/dl. Hematocrit in males should remain
between 41-53 and in females between 36-46. Likewise, potassium levels
should remain between 3.5-5.0 mEg/L and magnesium should remain between
1.3-2.0 mEg/L. Departures from these laboratory values may, with or
without clinical symptoms, establish malnutrition.
Risk factors for malnutrition and weight loss include drug therapy
that may contribute to nutritional problems (i.e. cardiac, glycosides,
diuretics, anti-inflammatory drugs, overuse of antacids, overuse of
laxatives, overuse of psychotropic drugs, anticonvulsants,
antineoplastic drugs, phenophiazines, oral hypoglycemics), poor oral
hygiene, poor eyesight, poor motor coordination, taste alterations,
depression, dementia, cancer, a therapeutic or mechanically altered
diet, a lack of access to culturally acceptable foods, a slow eating
pace which makes food unpalatable, and poor feeding practices by staff
like removing food trays before the patient has finished eating.
In order for a nursing home or assisted living facility to ensure a
patient receives proper nutrition, the nursing home or assisted living
facility must first assess the patient’s risk factors for becoming
malnourished, plan and provide care to minimize the effects of these
risk factors, and implement and document compliance with the care plan.
For example, a nursing home or assisted living facility must monitor the
amount of food consumed at each meal and at snack times and ensure all
snacks and nutritional supplements are provided and consumed as
appropriate. The amounts of all meals, snacks, and nutritional
supplements, as well as any refusals by the patient to eat, should be
carefully documented in the records of the nursing home or assisted
living facility. Even if the patient becomes malnourished, sustains
significant or severe weight loss, or does not eat, the nursing home or
assisted living facility must consider changes to its plan of care (e.g.
by providing the patient with alternative forms of nutrition like total
parenteral nutrition (TPN), partial parenteral nutrition (PPN), or a
feeding tube) to guard against worsening malnutrition.
January 2012
February 2012
March 2012
APRIL 2012
In the hospitaHELL
BMI: 
