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"Be There -- Often"
Last February in Michigan, Attorney General Mike Cox charged eight employees from the Big Rapids-based Metron Nursing Facility with 18 felonies in connection with the death of a 50-year-old resident (all have pleaded not guilty).Sarah Comer, who had recently suffered respiratory and kidney failure, died from asphyxiation after the nursing home failed to refill her oxygen tanks. The morning she passed away, reports that she was dizzy went ignored by staff. Later, the medical examiner who looked into Comer's death was not told that her oxygen tank was empty. Cox said the facility also falsified Comer's medical records and covered up her asphyxiation.
Many experts believe that incidents like these are just the tip of the iceberg. The law requires nursing homes that receive federal money through Medicaid and Medicare to report incidents of abuse -- but self-reporting is hardly dependable. Randy Thomas, president of the National Committee for the Prevention of Elder Abuse, says, "If the nursing home is in charge of reporting and it's their neglect, why report it? If you do, you try your best to make it all look not so bad."
Over several decades, legislators in Washington have tried to force the nursing home industry to provide better care, but without much success. There are new initiatives under way, some of which have a shot at bringing about real changes (see Getting Serious About Reform).
But no legislation will ever substitute for the best oversight of all: the vigilance of families. Thomas travels the country teaching law enforcement officers, judges, forensic nurses and ombudsmen how to spot signs of neglect in nursing homes. And he has a message for the concerned families of residents. "If they don't have a lot of visitors and they have cognitive issues, then [staff] forget they are real people," he says. "They become more of a body that you have to change and feed, and it's easier to neglect them. The best advice I can give families is to be there -- often."
Getting Serious About Reform
Legislation has done little to curb elder neglect in nursing homes, but that could change: A nursing home bill, sponsored by Rep. Henry Waxman of California, would require facilities nationwide to have enough nurses on duty to provide each resident with at least four hours of care per day. Florida has funded a similar law requiring nursing homes there to provide a minimum of 2.9 hours of direct care to each patient per day.
Arkansas may have passed the most effective reform to date: a 1999 law requiring that a coroner investigate every nursing home death. According to Pulaski County coroner Mark Malcolm, who authored the bill, in the first six months after it became law, his county alone reviewed 489 deaths and found 21 cases where the causes were unacceptable.
"Today, facilities can't just say someone died of old age when the cause was sepsis from bedsore infections or starvation. Someone is going to notice," Malcolm says. "There are facilities closed as a result of the information we developed."
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