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It’s estimated that two-thirds of nursing home residents have Alzheimer’s disease or another type of mental limitation, such as dementia.

Nursing homes offer specialized care that most of their residents simply can’t get living at home or with family.

Unfortunately, residents with dementia or Alzheimer’s can be at greater risk of abuse or neglect in nursing homes because they cannot speak up and make decisions for themselves.

If your loved one has Alzheimer’s and lives in a nursing home, it is important to understand the potential risk of abuse, how to recognize the signs, and how to advocate for them when they cannot speak for themselves.

Why are residents with Alzheimer’s or dementia at risk of abuse?

Alzheimer’s is a degenerative disease that affects the brain. As the disease progresses, it causes both mental and physical decline. People with Alzheimer’s disease can have difficulty remembering, altered behavior, and impaired ability to speak.

Dementia is not the name of a specific disease, rather, it is used to describe the symptoms relating to memory loss and cognitive decline. Alzheimer’s is the most common cause of dementia.

Nursing home residents in the early stages of Alzheimer’s may still function well and live a relatively normal life. As the disease progresses, they will start to rely heavily on the care of others for even the most basic tasks.

Perpetrators of abuse know that residents with dementia often cannot communicate or even remember if they have been harmed, this can mean:

  • They are much less likely to be caught.
  • If residents ask for help they are less likely to be believed because of their condition
  • Residents may be too afraid of their abusers to speak up

How to recognize signs of neglect and abuse in those with Alzheimer’s

Knowing that someone with dementia cannot identify their abuser or remember the abuse means their family members need to be aware of the signs of neglect and abuse.

Neglect of residents with Alzheimer’s and dementia

Nursing home neglect can take a few different forms, including:

  • Basic needs. Nursing home patients are supposed to be guaranteed care that covers their basic needs, like food, water, hygiene, and a safe living environment. If any of these needs are not being met, a nursing home is neglecting its duty. Any signs of malnutrition, dehydration, or poor hygiene are red flags for neglect.
  • Medical. Nursing homes are also bound to provide residents with adequate medical care. Bedsores are a common sign of medical neglect. Many people with Alzheimer’s and dementia develop mobility issues. If nursing homes fail to help patients move, pressure can cause bedsores.
  • Emotional. Just because someone has Alzheimer’s disease does not mean they suddenly have no emotional or social needs. Being left alone for long periods of time or being treated without respect and kindness are forms of emotional neglect.

Spotting malnutrition or bedsores is easier than recognizing emotional neglect. Dementia affects mood and behavior, but watch for any sudden emotional changes that may not be related to more than just their condition.

Abuse of residents with Alzheimer’s and dementia

Alzheimer’s disease and dementia patients may also be more susceptible to:

  • Physical abuse. Unexplained injuries, such as bruising or broken bones, are a sign of physical abuse. Family members should also watch for signs of unnecessary use of restraints.

Nursing home staff members may use restraints, such as straps, ties, and vests, to manage Alzheimer’s patients. Arizona nursing home patients have the right to be free of restraints unless medically necessary. Restraints used as discipline or simply as a convenient way to manage a resident are not acceptable.

Frequent bruising on your loved one’s wrists, ankles, and torso could indicate inappropriate use of restraints.

  • Sexual abuse. Bruising on private areas of the body, sexually transmitted infections, and vaginal or anal bleeding are all indications of sexual abuse. Women and nursing home residents with dementia are the two highest-risk groups for sexual abuse.
  • Emotional abuse. Any sort of behavior, such as yelling or humiliation, is considered emotional abuse. Without actually witnessing this type of abuse, it can be very difficult to detect. If you notice your loved one is more withdrawn than usual or is fearful of a particular person, you may have reason to suspect emotional abuse.
  • Financial abuse. Caregivers may take advantage of a nursing home residents declining mental state to steal valuable possessions or forge signatures on important financial documents. Missing items from your loved one’s living quarters or unexplained changes in their financial statements are indicators of financial exploitation.

How to report suspected abuse

Someone with Alzheimer’s disease may not be able to speak up, but you can file a report on their behalf. If you suspect your loved one is a victim of abuse or neglect, make a report with:

  • Facility administration. Facility administrators are the leaders of a nursing home who are responsible for overseeing the health and safety of all residents. If an individual is responsible for neglect or abuse, the facility may not be aware. When you suspect abuse, tell the nursing home’s administration so an investigation can be conducted.

Administration should gather information on all abuse claims by reviewing resident records and conducting thorough interviews of residents, staff, and family members. After substantiating an abuse claim, the facility should implement a solution and regularly ensure that solution is working. The ultimate goal of any such investigation is to protect your loved one and any other residents, especially those who cannot speak for themselves.

  • State agencies. Arizona nursing homes are required to report cases of abuse to the Arizona Department of Health Services. Unfortunately some facilities fail to adhere to reporting requirements. If you suspect the nursing home was aware of the abuse and failed to report it, you can file a complaint with the Arizona Department of Health Services.

The state agency is obligated to investigate all abuse complaints. Representatives from the Arizona Department of Health Services will investigate, determine the severity of the problem, and outline corrections for the facility. These corrections should help to prevent further abuse to residents with dementia.

You can also file a report with Arizona Adult Protective Services (APS) and reach out to the Long-Term Care Ombudsman Program, which has offices throughout Arizona.

  • Law enforcement. You can always call 911 and have local law enforcement intervene. This can be especially important if you loved one requires immediate medical treatment for physical or sexual abuse.

How to file an abuse case

Finding an experienced lawyer is the first step in filing an abuse case against a nursing home. A lawyer who has previously represented people with Alzheimer’s disease and dementia will know how to proceed and will guide you through the entire process.

As you are preparing to file a lawsuit, you will need to determine who the plaintiff is in the case. The plaintiff in a lawsuit is usually the person who has suffered the grievance.

Someone with Alzheimer’s or dementia who has been abused will rarely have the mental and physical capacity to serve as the plaintiff in a case against the nursing home.

When the victim of abuse cannot speak for themselves,a family member can usually sue on their behalf by becoming their legal representative.

  • Obtain power of attorney. Someone chooses to grant a trusted individual, often a family member, power of attorney. Power of attorney allows that person to make decisions on behalf of the designator.

Power of attorney can be designated as springing or durable.

  • Springing power of attorney gives you authority to make decisions on someone’s behalf once they become incapacitated.
  • Durable power of attorney is effectively immediate and remains so once the designator becomes incapacitated.
  • Power of attorney can also be designated as medical or financial, allowing the person to make decisions only in one of these areas.

Who should have the power of attorney?

Power of attorney needs to be assigned by someone who is of sound mind. If your family member is in the early stages of Alzheimer’s disease, it may still be possible for them to understand what they are doing and designate power of attorney.

Someone in the later stages of the disease almost certainly does not have the mental capacity to understand and grant power of attorney. If you do not already have power of attorney when your family member is incapacitated, you cannot obtain it to file a lawsuit on their behalf.

What happens if no one has power of attorney?

  • Obtain guardianship. If power of attorney is not an option, you can petition the court for guardianship over your parent. Guardianship allows you to pursue an abuse case on their behalf.

How do I file a case?

When you have the authority to move forward, either with power of attorney or guardianship, you will need a lawyer to represent you in the case against the nursing home.

Selecting an attorney experience in nursing home cases will help you through the process. The lawyer will file the case on behalf of your loved one and manage the entire process until the case is closed.

Any settlement you receive in the abuse case can be used to cover any medical expenses that accrued due to the abuse or neglect and contribute to their ongoing care.

Abuse in residents with Alzheimer’s FAQs

Elderly people living in nursing homes often have to rely on their family members to advocate for them. This is even more so the case when that person is suffering from dementia. As their advocate, you need to ask the questions they cannot.

Will people believe abuse is happening to my loved one with Alzheimer’s disease?

Alzheimer’s disease and dementia can cause erratic and unpredictable behavior. An  accusation of abuse, if even possible, from someone with these symptoms can be easy to dismiss.

This is why family members need to advocate for their loved ones suffering from Alzheimer’s disease and dementia. If you see signs of abuse or suspect it may be happening, you can file a report with the facility’s administration and the Arizona Department of Health Services. These types of complaints are taken seriously and will be investigated.

How can I prevent my loved one from suffering abuse or neglect?

If Alzheimer’s and dementia put your loved one at risk for abuse and neglect, you can mitigate that risk by:

  • Doing your research. You can use the AZ Care Check Tool to see if the Arizona Department of Health Services has ever found a facility to be deficient. This department licenses the state’s nursing homes and investigates complaints against them.

You can also consider selecting a facility with Alzheimer’s special care units, which are specifically designed for patients who suffer from the disease and dementia in general.

  • Regularly visiting. Seeing your loved one in a nursing home can be difficult, especially as Alzheimer’s progresses. They may not recognize you, but regularly coming to see them is still important. Any potential abusers may be deterred by an actively involved family. If any abuse or neglect is occurring, you might be able to recognize the signs when you visit.
  • Acting on your suspicions. It can be hard to come to terms with the reality of abuse, particularly if you had to make the difficult decision to place a loved one in a nursing home. If you have reason to suspect any sort of abuse or neglect is taking place, do not wait to report it.

What if my loved one dies before I pursue an abuse case against the nursing home?

If your loved one dies before you are able to pursue an abuse case against the nursing home, you still have an option to do so, within Arizona’s statute of limitations.

The executor of your loved one’s estate can pursue survival action. This type of case would seek damages for the abuse or neglect suffered by the deceased. Any settlement received would go directly to the deceased’s estate.

Sources:

  1.   https://www.nursinghomeabusecenter.org/types-of-nursing-home-abuse/alzheimers-abuse/#:~:text=Nursing%20home%20abuse%20is%20disturbing,nursing%20home%20abuse%20or%20neglect.
  2.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767317/
  3.   https://www.alz.org/alzheimers-dementia/difference-between-dementia-and-alzheimer-s
  4.   https://www.alz.org/alzheimers-dementia/stages
  5.   http://www.nursinghomeabuseguide.org/elder-abuse/alzheimers-abuse/
  6.   https://www.azdhs.gov/licensing/#azcarecheck
  7.   https://www.azdhs.gov/licensing/
  8.   https://www.mallardlawfirm.com/blog/survivor-rights-following-a-nursing-home-wrongful-death.cfm
  9.   https://www.nursinghomeabusecenter.com/nursing-home-neglect/
  10. https://www.nursinghomeabusecenter.com/nursing-home-injuries/bedsores/causes/
  11. https://nursinghomeabuseguide.com/abuse-injuries/elderly-restraints/physical/
  12. https://nursinghomeabuseguide.com/legal-action/nursing-home-regulations/arizona-nursing-home-abuse/
  13. https://www.azdhs.gov/documents/licensing/ltc-facilities/consumers-guide-nursing-home.pdf
  14. https://eldermistreatment.usc.edu/wp-content/uploads/2018/09/Consumer-Voice_sexual-abuse-issue-brief-FINAL.pdf
  15. https://www.nursinghomeabusecenter.com/elder-abuse/types/emotional-abuse/
  16. https://www.nursinghomeabusecenter.org/informative/how-to-protect-nursing-home-residents-from-financial-exploitation/#:~:text=Financial%20exploitation%20is%20just%20one,elderly%20is%20a%20serious%20concern.&text=Research%20estimates%20that%20nearly%20%243,older%20Americans%20in%202010%20alone.
  17. https://app3.azdhs.gov/PROD-AZHSComplaint-UI
  18. https://des.az.gov/services/basic-needs/adult-protective-services
  19. https://des.az.gov/services/older-adults/long-term-care-ombudsman
  20. https://jacobsinjurylaw.com/2019/11/29/who-can-file-a-lawsuit-against-a-nursing-home-for-neglect/
  21. https://www.nerdwallet.com/blog/investing/springing-durable-power-attorney/#:~:text=A%20springing%20power%20of%20attorney,attorney%20is%20a%20big%20deal.
  22. https://www.alzheimers.net/2014-03-25/alzheimers-power-of-attorney/
  23. https://www.greatseniorliving.com/articles/power-of-attorney
  24. https://www2.azbar.org/legalhelpandeducation/consumerbrochures/aguidetoguardianshipandconservatorship
  25. https://www2.azbar.org/legalhelpandeducation/consumerbrochures/aguidetoguardianshipandconservatorship
  26. https://injury.findlaw.com/torts-and-personal-injuries/how-do-i-file-a-nursing-home-lawsuit.html
  27. https://www.alz.org/help-support/caregiving/care-options/residential-care
  28. https://ltcombudsman.org/uploads/files/support/Chapter_6_Investigation.pdf
  29. https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/Pages/ComplaintInvestigationProcess.aspx

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