A large number of the nursing-home cases we review involve patients who suffer from some form of dementia. Patients who have impaired cognitive abilities may be limited in their abilities to relate their medical state to a health care provider, may be less likely to eat and drink sufficient fluids, and may be at a heightened risk of falls or other injuries.
In 2005, the Alzheimer’s Association launched a campaign to educate and guide long-term care providers on how to best care for patients with limited cognitive abilities. According to the Alzheimer’s Association, about half of all patients in nursing homes and assisted living facilities suffer from some form of dementia or cognitive impairment. See Jane Tilly, Dr.P.H., and Peter Reed, Ph.D., Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes – Phases 1 and 2 (Sept. 2006).
In their 2006 review, Drs. Tilly and Reed released standards of care and treatment for two phases: Phase 1 – basics of good dementia care for food and fluid consumption, pain management and social engagement; and Phase 2 – dealing with wandering, falls and physical restraints. More than 24 national leading health care and senior citizen organizations have endorsed each of these two areas of recommended care guidelines. The Alzheimer’s Association encourages long-term care facilities to adopt these practices in caring for their cognitive-impaired residents.
In the Phase 1 portion, the Alzheimer’s Association recommends that good screening and preventive systems be implemented for nutritional care, since malnutrition and dehydration can cause a host of other health issues. Too, the Association correctly notes that pain is often not properly recognized and treated among patients with cognitive impairments, largely because these patients lack the ability to convey their pain, the sources and the location. Because of this, these patients tend to act out more, when they are truly in pain, which leads to overmedication of these patients.
The Alzheimer’s Association recommends that pain be treated as the “fifth vital sign”, and that it be assed like one would assess other vital signs, such as blood pressure, pulse, respiration and temperature. Lastly, in this first phase, the Association recommends appropriate social interaction with the dementia patients so as to improve their quality of life and well-being.
In the Phase II portion, the Alzheimer’s Association made observations and recommendations for resident wandering, resident falls, physical restraints and similar matters. The Association recommends that cognitive-impaired individuals be encouraged to remain mobile, while caregivers maintain a watchful eye and reduce the risks of falls and other injuries. The Association also suggests that the use of restraints be limited and notes that restraints tend to cause more harm than accomplish the desired goals of increased safety. The Alzheimer’s Association correctly notes that the success of these recommendations is largely dependent upon having sufficient staffing and appropriately trained staff.
Implementation of sufficient programs to reduce the risks of injury or harm to cognitive-impaired individuals is essential. Staffing and training are imperative. Too, having adequate facilities and equipment to minimize wandering or elopement is also important. Facilities that do not implement, or cannot do so because of limitations, should decline to accept and care for patients who are not able to care for themselves. Hopefully, following the recommendations of the Alzheimer’s Association will improve care for senior citizens who lack the mental and cognitive abilities to care for themselves. If you need any information on Nursing Home Litigation, contact Ben Locklar, a lawyer in our firm who handles the litigation, at 800-898-2034 or by email at Ben.Locklar@beasleyallen.com.
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