When Our Loved Ones Can’t Help Themselves, Then What? (by Robert Webb)

Personally, I was all over the board this term with trying to figure out what I actually wanted to write about, especially something that I feel had an impact on the volunteering that I am a part of.  With everything that I do as a volunteer as part of a fire department that is both career and volunteer, the largest piece of our job is medical and we pride ourselves on the job we do and the services we provide but a lot of what we deal with is the elderly and we get to see firsthand the care that they do and do not receive at some of these skilled nursing facilities.  I choose to write about the issues revolving around abuse in some of these facilities and what we can do to help this problem.

Skilled nursing facility abuse is a problem that has caused a stigma on skilled nursing facilities, or nursing homes. Skilled nursing facilities are institutions that have been established with the purpose of providing care for patients that are unable to complete normal daily tasks without assistance. Skilled nursing facilities cater mostly to elderly patients, but there are cases of younger patients that require the assistance that can be provided by a skilled nursing facility. Often these are cases of brain or spinal trauma that has caused the patients to become paralyzed or impaired mentally.  Also to young people that have an injury that inhibits them from performing their tasks that they could otherwise perform without help.

Abuse in nursing homes is common and has been since the early 1900s. For the most part in the last three decades the federal and state governments have worked to lower abuse in nursing homes. Much of the reasons for the abuse have to do with their facilities and staff. Unfortunately, many things are used as an excuse to provide improper care leading to the abuse one might suffer.

In the fire service, 80% of the calls we run on are medical calls and 70% of those are calls to skilled nursing facilities, memory care centers with dementia and alzheimers patients and retirement facilities.  I know now that I could never send one of my family members to one of these establishments.  I’m sure there are very well run facilities with very attentive staff that do their jobs well and I have even had the pleasure of going to such places, where the staff is friendly and place doesn’t smell like a cross between urine, feces and death.  But most are like stepping foot inside some kind of weird nightmare that most of the time when we get out of we are talking about how horrible it would to be in one of these places and even joke sometimes that we go there to see someone and we get trapped there.  The staff not believing us, that we are there assisting a patient that we were called to help.  They just node their heads and tell us they’ve heard it before and to back into our rooms……………….Twilight Zone stuff.  It is going to happen to all of us someday, we are going to have to make a decision regarding a family member that cannot provide care to themselves anymore and needs to be in a place where they can be assisted with their day to day tasks.

Or we ourselves are going to need to go to an assisted living establishment when we get that point.   All I can say is Google decubitus ulcers or bedsores and look at the images you find.  It’s horrific, so when it comes time to make a decision about where to place a loved one, remember it.

The fact is that I think people that send a family member to places like this need to do their homework and check the place out thoroughly.  Just the other day I had brought an elderly woman that had just recovered from surgery to a long term rehab facility in Portland.  The woman’s son was at the hospital and of course had the utmost concern for every action and detail that revolved around his mother.  The son met us at the facility and I could tell the first moment that we stepped into this place that he was FREAKING OUT, watching as though people had sent their loved ones to this place to die.   Before we had even leaved the building the son was already talking to management about the care and attention his mother would be receiving and I was glad to see it. Skilled nursing facility abuse can be prevented by the loved ones of patients. Family or friends must visit often and ask questions to be aware of daily events at the facility. Loved ones that visit frequently are much more likely to notice changes in behavior and appearance of patients than those who rarely visit.  Most of the time it isn’t the employees themselves, it is the environment and staffing levels.  For example, main factors for nursing home abuse include workers who are paid too low, overworked, and poorly trained. To become a CNA, an individual can study for three months with an at home program (in certain states). Some consider this less time than one should have for proper training. Care of a human life requires the training to deal with working long hours in contact with potentially difficult residents. In some cases, nursing home abuse is based more on the facility cutting staff and nursing home care costs, which means less time is spent on providing proper care.

The worst part of abuse in skilled nursing facilities is when it happens in a facility that had no outwards signs of trouble. These facilities offer a facade of cleanliness, professionalism, and being run well. Management knows that problems occur, but they do little about it. The administrative staff may be the reason behind the abuse – not providing enough staff on duty, not providing proper toiletries, and more. The abuse does not have to be physical, though this is a good indication of issues. The issues can be verbal with isolation, verbal battering, and relinquishing patients of their dignity.

A huge issue with abuse in skilled nursing facilities is a lack of proper reporting. Many elderly residents abused are too embarrassed to speak out about the horrible treatment they see. When the abuse is more extreme such as rape, battery or assault it makes it highly difficult for these elderly residents to come forward. Insults, threats, frightening behavior, and humiliation are other emotional abuses.  Neglect includes such issues as withholding water, food, medication, bedding changes, or hygiene needs. If you feel your elderly family member is being abused there are signs you can look for such as bruising or bleeding. Open wounds, cuts, burns, abrasions, and sores can also be a result of improper care. Weight changes, poor hygiene, infections, loss of hair, or bloody clothing are also very obvious. To a lesser degree you may see unresponsiveness, change in behavior, or emotional withdrawal in places with abuse.

The desire of an elderly person to stay in their own home must be weighed against the type of care they require. A time may come when your parent or grandparent will have to be placed in a skilled nursing facility. There are a few ways to choose the right home and elder care help when the time comes. Staff matters so ask about the staff turnover within the home since working in a nursing home is an extremely demanding job both physically and mentally. Any nursing home will have a high turnover rate, but a quality one will also have staff members who have been there for many years and seem to be happy. Staffing during the workweek is usually adequate, but ask what the specific staffing levels are on the weekends, holidays, and evenings. Elderly care never ends; you want to choose a facility that maintains proper staffing even during these non-peak times. Does the staff seem to genuinely care about the residents in the home? Do they interact with them and talk to them with respect and care? The job satisfaction of the staff will have a profound impact on the quality of elder heath care they provide. Take a good look at the other residents and ask yourself if they seem happy.

Look to see if any are actively engaged in activities or games. Are they clean and groomed; wearing clean clothes. Try to observe the nursing home during meal times as well as during activities. If you happen to encounter another visiting family, stop and ask them how happy they are with their elder care services and the home in general. Look for a facility that is clean and does not have any strong odors. A heavy deodorizer scent may be masking the smell of urine. Look at fire extinguishers to see if they are being turned and shaken every month in accordance with fire code. When it comes to meals a facility will have dieticians on staff to ensure that a balanced diet is being served. Find out if they can handle special dietary needs. Ask if special treats or meals are allowed to be brought in for your family member. Do the residents all enjoy meals together in one large room or do they eat separately? Regular activities are important for people of all ages, including the elderly. Find out if they have an activity director. If not, ask how they handle having regular activities for the residents. Find out if outdoor activities are included as well as indoor options. Find out if there are people on staff who are experienced in elder care nursing and can handle your loved one’s condition. Whether the concern is diabetes or Alzheimer’s, you want to know that there are people in the home who are familiar with the condition and will be able to help manage it. Ask to see the licenses held by the facility and choose one that has all required state licenses. Find out what the state requirements regarding the ratio of staff members to clients and then make sure the home you choose consistently maintains that ratio.  The location you choose is extremely important. You want to choose one that is close to home so it will be more convenient for you to visit. Choosing one that is nearby can also make it easier to bring your loved one home for holiday visits and other special occasions. Location should not be the only deciding factor, but it should definitely be kept in mind. Check for complaints and violations of state code, they will become public record for anyone to see. Don’t just look at the number of violations; look to see what they are for. Violations can range from a minor housekeeping issue to serious issues of abuse or neglect. Check into the facility’s record before making any final decisions. Perform a surprise visit; any nursing home worth using will be willing to let you drop in for a visit.


If they require that you schedule a visit days or weeks in advance, ask them why they require that much notice. Visiting at the last minute will provide you with a solid glimpse of how clean the facility normally is, how it usually operates, and what level of elder health care they are providing.

All these are great things to keep in mind when looking for a skilled nursing facility that you are going to place a loved one in. The more questions people ask, the more they care about the treatment that their loved ones are receiving means the less chance that emergency services will need to be called to these facilities.  When we do get called, a lot of times the staff has no clue about what is going on with the patient and it takes a lot more time and resources to get the answers we need to help the patient.  Please take the time to ask the right questions for their sake and yours.






“Advocacy Groups and Government Agencies.” Nursing home Abuse Center. Nursing Home Abuse Center, n.d. Web. 8 Sep 2013. <http://www.nursinghomeabusecenter.org/resources/advocacy-groups&gt;.


“Nursing Home Abuse Risk Prevention Profile and Checklist.” National Center on Elder Abuse. U.S. Department of Health and Human Services, n.d. Web. 8 Sep 2013. <http://www.ncea.aoa.gov/Resources/Publication/docs/NursingHomeRisk.pdf>.


“Nursing Home Abuse.” The FBI Federal Bureau of Investigation. U.S. Department of justice, 08 May 2012. Web. 8 Sep 2013. <http://www.fbi.gov/news/stories/2012/may/nursing-home_050812>.






One comment

  1. The real-world applicability of this writing is one of its greatest strengths, as is your passionate for this topic. Good work using your own experiences as expertise to back your persuasive point. Continue to work on the fine details of each assignment so that you get full credit and cover all of the bases. Thank you for sharing this with all of us!

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