Working PIby Kelly E. Riddle, Kelmar Global
Thelma was 89, but in good health despite her Alzheimer’s disease and a bad hip that made walking difficult. When she was transferred from her nursing home to the hospital emergency room, she passed away shortly after admission. The attending physician immediately called family services because she was extremely dehydrated. In fact, renal failure was listed as the cause of her death. She was also found to have decubitus (pressure sores) on her buttocks from sitting hour after hour in the same position. The right side of her face and right arm had second-degree burns in a pattern that suggested she had been wheeled into the sunlight in her wheelchair and left unattended to cook in the sun. Thelma’s family lived two states away and could only visit a few times a year. If they hired you as an investigator, would you know where to start?
Unfortunately, elder abuse is a common scenario and as the “baby boomers” continue to age, the stage is set for more abuse. Some families try to safeguard their loved ones by putting covert cameras into nursing homes. However, in states like Texas, this can be illegal. Section 555.025 of the Health and Safety Code makes it a criminal offense to install a camera unless the facility is notified in writing, and the facility authorizes the installation of a camera. Abuse is therefore perpetuated and often not discovered until the person is deceased.
There is a fine line between abuse and neglect. Sometimes neglect can become excessive enough to become abuse. When we think of abuse, we think of someone hitting or physically abusing a person. Abuse is commonly an intentional act that causes harm and empowers another. Neglect may be an intentional or an unintentional act and may be based on several factors, such as the number of employees on duty or the laziness of the employee.
Nursing home abuse investigations are similar to other types of investigations, however there are specific differences as well. Regardless of whether you are hired by the family or the attorney, you will have to start by identifying possible witnesses. The initial investigation should concentrate on the following information:
• Police department records
• Court records
• State licensing records
• Doctor’s records
• Hospital records
• Medical Examiner’s records
A thorough background investigation into the facility, administrators and nursing staff should be conducted. The website of the state agency that regulates the nursing home industry in your state should be reviewed for any disciplinary records accessible on the internet.
A written request may be required, and you should recite the “Open Records Act” in your request. All records pertaining to any disciplinary action taken against the nursing home or any of the staff members during the timeframe in question should be obtained. The state’s inspection records for the facility, as well as a copy of the facility’s licensing records including the application, ownership and corporate records need to be obtained. Through this research you may locate a former employee that is willing to risk telling the truth.
If you are working for an attorney, they should have already obtained copies of the patient’s medical files and charts. However, if you are working for the family ask them to request the information from the facility and include a request for the patient’s daily charts which reflect their input, output, eating habits, medicines, etc. You should also ask for a list of employees as well as their work schedules during the time frame in question.
Once you have these, you can begin to investigate the charts. There are daily charts, intake/output charts, drug/med charts and similar charts that should be reviewed. It is common to see administrators fill in items before inspections or once the family is alerted. Often the person listed as completing the charts was not even on duty on that day. The drug chart should confirm that the prescribed medication was being given.
Verify that the person giving the medicine was licensed to do so and if they were actually on duty. The daily charts are examined to see if there is an unusual change in the patient’s weight and eating habits. If the charts reflect that the subject’s weight changed dramatically, it may mean the staff was guessing at the weight and not actually weighing them, or it may indicate a major health problem that was not being addressed. If the charts indicate an erratic change in eating habits, it probably means that the employee is guessing at their intake or has not been properly trained to identify the quantity of intake.
During the investigation, police department records should be reviewed as well. Each jurisdiction has different restrictions on their records and their accessibility as well as the ways in which they can access the records. When possible, ask them to check the facility by address for a period of at least one year prior to the time the subject was in the facility, through at least six months afterwards. Request they search by pulling every police call made regarding the facility’s physical address. You will be able to check for those calls regarding abuse, disturbances, thefts and similar circumstances. These may assist in identifying potential witnesses as well as further documenting that the facility has a problematic history of abuse.
A review of the District Court Clerk civil records should be conducted as they will reflect any lawsuits filed against the nursing home facility or the owners of the home. If any are found, the actual file should be reviewed to better determine the facts and parties involved. The records may also list employees’ names and other witnesses who may be helpful to your case.
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The State’s Secretary of State’s records should also be researched. The Secretary of State will have records reflecting the corporation that owns the nursing home, the officers, addresses, date it was filed, charter number and whether they are currently in good standing.
The hospital records should be obtained and reviewed to determine the course and reasons for treatment. These should be checked and correspond with the facility and doctor’s records. If the person died in the hospital, it should reflect the actual cause. The records should be reviewed for any information reflecting abuse such as broken bones, bruises, lacerations and similar identifiers.
If an autopsy was conducted, the medical examiner’s office records should be obtained and reviewed as well. The reports need to be cross-checked to determine the medications found in the person’s body (or lack of medicine), the bruises, broken bones, or similar signs of abuse. The ultimate reason for death will be noted and should be double- checked against the facility’s notes.
In all the nursing home abuse cases I have encountered, each facility is understaffed, and the employees are often poorly trained. Even when a person has a good attitude about their job and they have a genuine desire to complete the tasks in the described manner, it may be impossible for them to do so if they are short-staffed and have too many patients to care for. Many times, one aide will be responsible for six to 60 patients by themselves. Unless the patients are strictly bedridden, six to 10 patients per aide is an acceptable ratio in the industry. However, when one aide is called upon to provide care for more than this, it is obvious that even the best efforts can simply not fulfill the needs of this many patients. When a patient is forced to lie in his or her own urine for extended periods of time because the aide is off helping someone else, this is neglect.
There are those facilities that do not have the physical capabilities to take care of the number of patients that they are handling. In some cases, the home was built to accommodate one person to a room, and it has changed to two people per room. This takes a toll on all things because the kitchen was designed to feed fewer people, the nurse’s desk was designed for fewer nurses, the bathrooms were made for fewer people and these things all contribute to the neglect of the patients.
Older nursing home facilities also tend to have older pieces of equipment, which break down or have not been replaced as needed. The failure of equipment to monitor a patient or to operate properly poses another type of neglect situation. Although the staff may not intentionally try to neglect the patient, if the equipment isn’t working when the patient needs it, then the resident is neglected.
Another form of neglect is simple verbal communication. Every person needs interaction with other humans, especially when they are scared and insecure about their life. Because the staff at nursing homes are always understaffed and are rushing around trying to complete the tasks that must be done, they often fail to take time to engage in simple conversation with the patients.
Most of the elderly patients just want to hear another person’s voice and to have someone act like they care about them. Unfortunately, this lack of verbal contact is another source of neglect that the patients must endure. In addition, some family members live out of town and are unable to visit relatives on a regular basis. In a lot of nursing homes, the patient does not have a telephone in their room and family members are even less available to contact the residents. Once again, the lack of contact further complicates the neglect factor in the life of the person.
Many patients are placed in a wheelchair in the morning at the beginning of a shift and are pushed to an area near a door or window where they congregate with other patients so they can look outside. In too many instances, the patients are left in the wheelchair until time for bed. This causes pressure sores to occur on the buttock area, which is certainly physical abuse. In addition, the person endures neglect when they are parked like a potted plant without being checked or repositioned.
Another type of neglect may occur when the aides put out the food trays for the patients. Due to the patient’s physical condition, many require hand feeding by the nursing home staff. When there is a lack of staff to fulfill this duty, the person is neglected and may not get to eat, or the food becomes cold and spoiled.
Neglect often occurs in a facility when a person needs assistance in getting out of bed or walking to the bathroom. Everyone wants to maintain their self-sufficiency and dignity by handling these tasks for themselves. However, many of the elderly reach the point where they know that they need assistance to do this and will ring the call button to get an aide to assist them in this endeavor. Because staff members are often busy helping others, or they may simply be lazy, the call button goes unanswered for a period. When this occurs, the patient either lays in bed in their own waste, or they are forced to try to make it to the bathroom by themselves and risk a crippling fall. You may find during your inquiries that the cord to the call light button was cut to trick the notification system. The plug is still in the outlet, but the patient can’t use it to call or bother the nurses.
The basic premise of neglect is that a person in the care of the nursing home fails to receive the necessary treatment or care that they need. A single act of neglect by itself may not be extremely bad. However, it is common for most of these types of neglect to occur at the same time and over an extended period of time. The cumulation is debilitating and may cause physical and emotional scarring to the residents. This is a wretched way to spend the last years of a life. As you can see from the preceding, neglect can wear a variety of disguises.
Proper investigation of nursing home abuse can result in hefty settlements and jury awards. These monetary punishments may be the only means at society’s disposal to remedy a cruel and far too common situation.
About the Author
Kelly E. Riddle is the President of Kelmar Global Investigations and has more than 41 years of investigative experience. He earned a Bachelor of Science degree in Criminal Justice from the University of North Alabama. He was chosen as the “PI of the Year” by the National Association of Investigative Specialists, while PI Magazine named Mr. Riddle the #1 PI in the U.S. Kelly is the past President of the Texas Association of Licensed Investigators and is on the Florida Association of Private Investigators Advisory Board. He founded the PI Institute of Education in 1989, which provides online learning. Kelly has published 16 books, over 40 articles, and spoken at over 650 events.
We’re always listening. Send your story submission/idea to the Editor: kendra@orep.org.
