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    People at Risk
    Neglect in Nursing Homes
    David T. Marks

    Inhumane treatment and needless suffering in nursing homes have been repeatedly chronicled in the media and at congressional hearings during the past three decades. Although the 1987 Nursing Home Reform Act has positively influenced certain aspects of care, systemic and deadly neglect still abounds.
    Why? Because there is a lack of ac countability for long-term care facilities, and there is unwillingness by physicians to recognize the existence of nursing home neglect.
    Erratic enforcement of state laws de signed to protect the health and dignity of nursing home residents has created an environment where facility management believes it can safely sacrifice the well being of residents for the sake of profit. About 40 percent of all facilities certified by the Health Care Financing Administration have repeatedly violated federal standards over the last four years.’
    Unlike the drunk driver whose license is suspended and who then may be jailed if convicted of driving -while intoxicated, the habitual nursing home offender can repeatedly endanger residents without meaningful sanction. Fines imposed for violations of nursing home safety laws routinely go uncollected. When paid, they are regarded as the cost of doing business by offending homes. Facilities are rarely, if ever, closed.
    David T Marks practices with Crowley, Marks 6- Douglas in Houston, Texas.
    The taxpayer, not the nursing home, pays the cost of the neglect. According to the U.S. Senate Committee on Labor and Human Resources, billions of tax dollars are spent annually on damage resulting from poor care-treating bedsores that Should never have developed, hydrating residents who should never have become dehydrated, amputating limbs that should never have withered .2
    Physician response to this problem has been disappointing. Studies have found that physicians are less effective than other professional groups in identifying cases of elder abuse, and they are unfamiliar with laws that require health care workers to report suspected abuse and neglect cases. 3
    Rarely do physicians use differential reasoning to rule out neglect as a cause of injury. In over 100 death cases involving injuries recognized by the Institute of Medicine as prima facie indicators of nursing home neglect,4 our firm has seen fewer than five cases where the attending physician considered neglect as a possible cause.
    Nursing home neglect is defined by state and federal regulators as “the deprivation of life’s necessities of food, water, shelter, or the failure of an individual to provide services, treatment, or care to a resident which causes harm, mental or physical injury, or death.”5 Systemic nursing home neglect results from a breakdown in fundamental systems that were designed to ensure delivery of care to residents.
    Federal and state regulations require nursing homes to establish operational systems that ensure the adequate care and safety of residents.

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