Preventing Elder Neglect: The Importance of Monitoring Changes in Condition
Shifts in a resident’s health are common in nursing homes. They often signal underlying medical concerns or the need to update the resident’s care plan. Changes can range from subtle to severe and may relate to mental state, physical health, or behavior. When staff fail to recognize and address such changes promptly, the consequences can be serious, leading to preventable injuries, declining health, or even death. Many elder abuse cases center around staff neglect regarding the monitoring of — and response to — significant changes in a resident’s condition.
So what should nursing homes and other long-term care facilities be doing to monitor and manage changes in condition?
Timely Response.
Timely recognition of changes in condition and action are critical to protecting residents’ safety and well-being. A delayed response can result in avoidable complications, such as untreated infections, falls, or progression of health problems that could become life-threatening. Early detection allows care providers to intervene before the condition worsens.
Assessment.
The first step toward managing a change in condition is making an accurate assessment. Staff must be trained to detect both obvious and subtle changes to the physical, mental, or emotional health of the resident. This includes monitoring for symptoms such as fever, weight loss, or agitation, as well as understanding the impact of chronic illnesses or cognitive decline. Facilities must provide staff with the skills and resources to conduct thorough assessments. When assessments are neglected, opportunities for treatment may be missed—an issue frequently at the center of elder abuse litigation.
Scope of Practice
. Assessment responsibilities differ depending on the caregiver’s scope of practice. Registered Nurses (RNs) have a broader scope of practice that encompasses comprehensive assessments, nursing diagnoses, and care planning. RNs are trained to interpret complex conditions and make clinical judgments. In contrast, Licensed Vocational Nurses (LVNs) have a more limited scope, with the ability to collect data and perform basic assessments but are not (usually) permitted to diagnose or create care plans. The role of an LVN generally emphasizes providing support, often under the supervision of an RN or physician.
Reporting and Notifications
. When a change in condition is observed, timely communication between all relevant parties is essential. Typically, that will include the resident’s physician, the resident themselves (if they are able), and family members, all of whom should be notified without delay. These conversations must be clearly documented — including when the notification occurred, who was contacted, and what information was shared.
Documentation and Monitoring
. Thorough, accurate documentation is critical at all stages. Facility records must reflect any changes in condition, staff actions taken, and follow-up care. Ongoing monitoring is also necessary to evaluate whether interventions are effective. If the resident’s condition continues to decline, that too should be documented, and further steps taken to continue monitoring the situation.
Root Cause Analysis
. When a resident’s health worsens, facilities must investigate the cause or causes of the change in condition. A root cause analysis helps determine whether the decline was due to medical issues, inadequate care, or something else. Examples of questions asked during a root cause analysis include:
- Was the resident dehydrated from insufficient fluid intake?
- Did a bedsore occur because the facility fail to take preventive measures like repositioning the resident?
- Were the proper infection control procedures followed prior to the contraction of disease?
Identifying and addressing these causes is vital to preventing further harm. Failure to investigate signals a lack of commitment to resident safety and may endanger others in care as well. Nursing homes are legally required to monitor residents for any significant changes, and to respond promptly when such changes occur.
If you believe your loved one’s facility has failed to act on a change of condition, a dedicated elder neglect attorney can help you determine whether you have a case. Contact Dudensing Law to talk to an elder abuse attorney in Los Angeles, San Francisco, or Sacramento.
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