Delaware Business Lawyer Blog

Under Delaware law, if an employee of a nursing home has “reasonable cause to believe” that a patient is being mistreated, she is required to immediately call the Department of Health & Social Services and report it. The employee is also required under Delaware law to follow up the phone call with a written report within 48 hours. The penalty for failing to make the phone call and file the written report is a fine of up to $1,000 for each violation.

In the preceding paragraph, I used the word “mistreated” to describe what must be reported. As a Delaware attorney who is very concerned about the mistreatment of nursing home residents, I'd like to discuss what’s covered by the reporting requirements:
(1) abuse
(2) mistreatment
(3) neglect
(4) financial exploitation

Each of these terms is defined under Delaware law.

Abuse can be physical or emotional. Physical abuse is defined as unnecessarily inflicting pain or injury to a patient by such things as hitting, kicking, pinching, slapping, puling hair, sexual molestation, etc. Emotional abuse is defined as ridiculing or demeaning a patient, making derogatory remarks to a patient, threatening to inflict physical harm, etc.

Mistreatment includes such things as the inappropriate use of medications, isolation, or physical or chemical restraints on or of a patient.

Neglect includes lack of attention to the physical needs of the patient, including toileting, bathing and meals, failure to carry out a treatment plan that was prescribed for a patient, and a failure to provide adequate staffing.

Financial exploitation means the illegal or improper use of a patient’s resources.

The rights of patients in nursing homes are protected by both federal and state laws. This is the first in a series of articles that discuss the laws in Delaware as they apply to nursing home patients.

In Delaware, a nursing home is defined as “a residential facility that provides shelter and food to more than 1 person who because of their physical or mental condition require a level of care and services suitable to their needs to contribute to their health, comfort, and welfare.” This definition applies not only to nursing homes, but also the following:
(1) assisted living facilities
(2) intermediate care facilities for persons with mental retardation
(3) neighborhood group homes
(4) family care homes
(5) rest residential facilities

Each year, nursing homes are inspected by the State to make sure thay are in compliance with all regulations. Interestingly, each nursing home is required by law to prominently and conspicuously post for display in a public area in the nursing home a summary of the State’s most recent inspection report. In addition, the nursing home must also post a sign that outlines complaint procedures and gives the “1-800" hotline number for complaints that can be called in 24 hours a day, 7 days a week.

The law protects patients who complain from retaliation and discrimination. Violations of this law carry fines of up to $10,000.00.

In my next article, I’ll discuss the specific rights that patients in nursing homes have.

Elderly patients in hospitals and nursing homes are often the victims of medical malpractice. They go in for one reason, and while they’re there, they become malnourished and dehydrated. They develop urinary tract infections, acute renal disease, bed sores, etc.

As a delaware attorney who protects the rights of the elderly, I've found that one type of malpractice that doesn’t receive much publicity is overmedication. It’s so common that it’s been given a name: “polypharmacy.” The patient is given a lot of drugs, many of which have side effects which cause new problems. Then, the doctor prescribes medication to treat the side effects.

If an elderly person goes into a hospital or a nursing home, and while there shows signs of cognitive impairment, the doctor or nurse usually assumes it’s a sign of dementia. Very often, however, this would be a misdiagnosis. Why? Because the side effects of many of the drugs that elderly people receive in hospitals and nursing homes include drowsiness, confusion, and impaired alertness. And so instead of suffering from dementia, and receiving treatment as a patient with dementia, what’s really going on is too much medication.

There’s been a recent Court decision that should be a tremendous help to nursing home residents who suffer from bed sores and infections. An 80 year old woman who was in a Pennsylvania nursing home died after she developed bed sores, became malnourished, and developed sepsis. This woman’s daughter sued the nursing home in federal court. One of the daughter’s claims was that the nursing home had violated her mother’s civil rights by failing to provide the level of care that’s required under a law known as the Federal Nursing Home Reform Amendments.

In the past, if a nursing home violated the standards set by the Federal Nursing Home law, the only risk to the nursing home was that the state or federal government might take action if the violations were discovered. This hardly ever happened because inspections were few and far between. As a result, nursing homes didn’t worry too much about being caught. But now, each and every resident of a nursing home is basically keeping an eye on the nursing home and can sue the nursing home to enforce the standards whenever there’s a violation. This is like having a cop on every street corner, and so hopefully nursing homes will make a much greater effort to provide the quality of care that’s required.

If you have a loved one in a nursing home who is not receiving the quality of care they deserve, contact a Delaware attorney right away to discuss your options.

Bedsores in nursing homes are preventable. If they should occur, they should be detected and treated without delay. When the staff at a nursing home fails to do this, there’s a risk that a life-threatening infection called “sepsis” can enter the bloodstream. That’s exactly what happened to a 79 year old woman at a nursing home in California who died from untreated bedsores.

I previously wrote an article about bedsores and said that any nursing home that allows a patient to develop bedsores and fails to treat that patient should be held accountable. Well, a California jury agrees, and just last month awarded $30 million to the family of this poor woman who was also suffering from dementia. The incredible thing is that she was only in the nursing home for 7 months! In this short time, she developed bedsores which went untreated. This led to sepsis, which in a nutshell, causes inflammation to extend beyond the site of an infection, To fight the inflammation, the body forms blood clots which prevent oxygen from getting to the body’s vital organs. Lack of oxygen causes organ failure and death.

Sepsis is the 10th leading cause of death in the U.S. It is more common in the elderly, and in this population it’s very dangerous. That’s one of the reasons why there are Federal Regulations that apply to nursing homes when it comes to preventing, documenting and treating bedsores.

As a Delaware attorney who is outraged by nursing home abuse, I am especially concerned that the elderly are well cared for. In a previous article, I talked about malnutrition in nursing homes. Well, like malnutrition, dehydration can lead to a variety of serious health problems. For our bodies to function properly, we need water. Most of our body systems and organs are drastically affected by water deprivation. For example, we need water to regulate our body temperature, to maintain blood pressure, and to eliminate bodily waste.

Dehydration occurs when we lose more water than we take in. It’s that simple. And dehydration can occur more easily with the elderly, especially those in nursing homes because of inadequate care. Causes of dehydration include: (1) diarrhea, (2) the effects of medication, (3) inability to perceive thirst, (4) physical inability to drink or swallow, and (5) embarrassment related to incontinence.

Nursing homes have a responsibility to provide their residents with adequate hydration. Ways to prevent dehydration include assisting the person with drinking, offering fluids at mealtime and in between meals, and looking for the signs and symptoms of dehydration. Nursing homes have to provide proper training to their employees to recognize the signs and symptoms of dehydration. So what are the signs of dehydration? They include:

dark yellow urine
sunken eyes
ashen skin
dry skin
bleeding gums
urinary tract infection
weight loss
low urine output
constipation
dizziness
dry or sticky mouth and tongue
inability to sweat or produce tears

Some of the complications of dehydration are kidney failure, coma, shock, electrolyte abnormalities, and other heat related diseases.

When elderly people are abused, studies show that their risk of dying more than doubles. As a Delaware attorney, I'm extremely concerned about how many elderly people are subjected to abuse in nursing homes. There are many types of abuse. There’s physical abuse, emotional abuse, sexual abuse, neglect, and financial exploitation. This is the first in a series of articles about elder abuse in nursing homes. In this article, let’s talk about malnutrition, which is one form of neglect.

Malnutrition can occur if you don’t eat enough food or if you don’t get the right vitamins in your diet. If malnutrition isn’t treated, it can cause mental or physical disability, illness, and sometimes death.

Federal law requires nursing homes to assess the nutritional status of its residents at the time of admission and at regular intervals of at least every three months. The nutritional assessment should identify whether the resident is at her ideal body weight and whether the resident is at risk for malnutrition and dehydration. The nursing home is required to provide for the resident’s nutritional health based on the nutritional assessment. This includes providing “well-balanced, palatable meals.”

What are the signs of malnutrition? They can vary, but common signs are fatigue, dizziness and weight loss. Other signs include:

clothes fit more loosely than usual
there are cracks around the mouth
lips and mouth look pale
dentures no longer fit
hair has been thinning or growing more sparse
wounds seem to take longer to heal
the resident appears confused (not as a result of a disease such as Alzheimer's)
the skin is breaking down
the eyes look sunken

If you suspect that an elderly person is being abused, neglected, or exploited in Delaware, call this hotline: (800) 223-9074.