Approximately 1.6 million Americans live in nursing homes. Ironically, Alabama pays its nursing homes some of the highest Medicaid rates in the country, but yet we have some of the worst records in accident prevention, food sanitation, and staffing levels. Alabama has 235 nursing homes, with a population of approximately 23,000 individuals. Currently, the state has 1200 complaints against nursing homes which are backlogged because the state does not have the resources to investigate all of the complaints. Alabama spends considerably less on inspections than other southeastern states.

The Faces of Abuse Nursing home abuse and neglect manifest in:

• physical abuse,
• physical neglect,
• and breach of contract/fraud cases.

Physical abuse generally involves situations where a nursing home resident is intentionally harmed by an employee or staff member of the nursing home or by another resident. Physical neglect of nursing home residents includes pressure sore formation, malnutrition, dehydration, contractures and infections. Without sufficient staffing, it is not uncommon for nursing home residents to wander away from the facility and suffer injuries or death. In such cases, a formal complaint should be filed with the nursing home as well as the Alabama Department of Public Health.

Cases involving breach of contract or fraud generally involve the mismanaging of the assets of a resident. It can also involve a resident's being billed for services that are not provided.

What's Important

It is vitally important to record all events of suspected abuse or neglect of a loved one in a nursing home. That record should include:

• the date
• the name of the person(s) involved
• names and addresses of all witnesses
• the harm done
• the nursing home response

Also, the resident's general care physician should be alerted to the situation and if immediate care is needed, the resident should be taken to the closest emergency room.

Alabama standards and regulations for nursing homes are set forth in the Rules of the Alabama State Board of Health, Division of Licensure and Certification, which is found in the Alabama Administrative Code in Chapter 420-5-10. These regulations address areas such as resident rights, quality of care, delivery of skilled nursing care and services, management of nursing homes, and quality of life.

Federal Regulations

The federal regulations are set forth in the Requirements for States and Long Term Care Facilities, 42 C.F.R. Part 483, in the Nursing Home Reform Act, found at 42 U.S.C. ? 1396 (r).

These regulations, in part, require a nursing home to provide:

• competent nurses, aides and orderlies
• adequate numbers of personnel to provide for the needs of the resident
• an accurate recordkeeping system that documents the condition and progress of residents
• quality assurance programs that assess deficiencies and provide for?correction
• a plan of care for each resident
• adequate amounts of food, supplies, equipment, and medication

An evaluation of a particular nursing home's compliance with state and federal regulations can be found at the Medicare website. That URL address is www.medicare.gov\NHCompare\home.asp.

Alabama has a program to assist nursing home residents with problems they are having with the facility that cares for them without having to go to court. Unfortunately, it is vastly understaffed. It is recommended that the state have one ombudsman for every 2,000 long- term care beds, but Alabama only has one ombudsman for every 5,000 long-term care beds.

Fortunately, Alabama does have the highest percentage of family group participation in long-term care of any other state in the nation. Don't be afraid or discouraged to complain about mistreatment in a nursing home facility.

Things to consider when choosing a nursing home:

• Ask physicians, co-workers, and friends for recommendations
• Take the formal tour, but also make unannounced visits to all three shifts
• If possible, try the food, eating breakfast, lunch and dinner
• Observe staff members who provide daily care interacting with residents
• Speak to nurse's aids and nursing assistants about their work and how well they like the facility
• Look at detail, including how long it takes for call lights to be answered
• Check for spills or obstacles in the hallways
• Inspect smell of the facility, grooming, and hygiene of residents

Prepare a list of medical questions to present to the facility and find out if the facility is able to take care of special needs.