Be nice to your children; They pick the nursing home

It is unfortunate that nursing home care is often not satisfactory.  In Japan, by contrast, where elders are the most highly honored group in their society, nursing home facilities are phenomenal. Photo: Bessie Cooper/Associated Press

WASHINGTON, D.C. – As a Plaintiff’s trial lawyer, I used to handle what we called “Nursing Home” cases.  These involved claims against nursing home facilities when individuals who were residents at these facilities were abused, neglected, or died.  Family members would come to my office and tell me stories that would make even the most hardened among us cry. 

The behavior of the nursing home staff and administration would subject these people to criminal charges if the acts were not in the setting of a nursing home facility.  Typical claims involved dehydration, malnutrition, falls involving broken shoulders, arms, hips and legs, bedsores, medication mismanagement, and death.

Nursing home administrators blamed the residents, their families, or otherwise denied responsibility, often claiming that the resident was “old” and was medically unmanageable. 

When you trust a nursing home to care for your relative in the last stages of their life, you want to know that the care will be at least adequate.  You hope, certainly, that the experience of living at such a facility for your loved one will be peaceful, enjoyable and respectful.  Often nursing homes are the last home for our parents.  They gave their lives to us; we want to see them honored in the last stages of their life.

Nursing homes are often under-staffed.  This one fact is the primary reason for reduced care that leads to problems.  The reason for the understaffing is often money.  Many nursing homes are businesses and they place profits before residents’ health.  Thus, they fail to hire enough people.  The routine daily work of aides, who are often “certified,” includes feeding, bathing and helping residents with an array of daily activities and tasks that they can no longer do for themselves, because of either mental or physical limitations, or both. The daily tasks also include turning and repositioning the residents who cannot move themselves, to prevent bedsores.  

These aides and their supervisors, nurses, are typically loving, wonderful caring people.  They just do not have enough help to properly care for all of the residents. One aide, in an eight-hour shift, can arguably assist 8 to 10 residents.  Think about how long it might take to properly feed someone who cannot lift a fork or a glass.  When an aide is assigned 15 or 20 residents, care suffers.  Gramma, who needs 40 minutes to be properly fed, only gets 15 minutes.  What do you think happens when every day, grama does not get the nourishment she needs?  Her body breaks down; she becomes malnourished or dehydrated, or both; her skin becomes weaker and is more likely to develop bedsores.  Aides are routinely assigned an unmanageable number of residents, thus grama does not get enough food or nourishment, and turning her is skipped.  Can you picture grama gravely thirsty, physically unable to reach the call bell, and unable to even pick up the glass of water sitting on the table next to her bed?  Can you picture gramma getting depressed because there is nobody to help her get up out of bed and see the outside of her room or visit with other residents?  Is it any wonder some nursing home residents “give up?”

Some residents are rowdy because of mental infirmities.  We can give cranky infants a bottle of juice, a toy, or something to suck on, to quiet them.  With adults with dementia, such tactics do not work.  Medications are often given, not because they are prescribed, but because the medications quiet the residents, making life easier for the staff.  On these medications, sometimes, residents do not want to eat. 

I am writing about this highly upsetting situation, present to some degree in most nursing homes, because I want to warn you about placing your loved one, parent, spouse or child into a nursing home facility.  What triggered this effort on my part now was a report I saw that came out last week.  My work in “nursing home” cases stopped about ten years ago. 

In that decade, unfortunately, apparently, not much has changed.

According to a report by the Health and Human Services Office of the Inspector General (OIG), nearly all nursing home facilities fail to comply with federal regulations governing residents who are prescribed “atypical antipsychotic” medications.

The report found that in nearly all (99.5%) nursing home facility staff failed to meet one or more federal requirements for resident assessments and/or care plans for residents taking atypical anti-psychotics. An assessment is a formal process that occurs within a day or two of the admission, to determine what needs the new resident has and what limitations exist.  By way of example, it would be important for nursing home staff to know that dad’s legs are not stable, to make sure then, that someone helps him get up and around, so he does not fall and injure himself.  A care plan is a formal written document that sets out what and how and when the nursing home will do to care for dad.

The OIG found that 99% of the records it reviewed did not contain any evidence showing compliance with federal requirements for care plan development and one-third of the records did not comply with federal requirements about resident assessments.

This study tells us that many nursing home facilities fall below the level of care we all expect, and demand, for our elderly loved ones.

When the difficult decision is made to move a parent, grandparent, or other relative to a nursing home, many of us believe that the facility is top-notch and run by a highly qualified, and competent staff of professionals. The OIG report is evidence that a large majority of nursing home facilities are unprepared or consciously disregard the regulations designed to prevent injuries to residents requiring atypical antipsychotic drugs.

You should purchase long term care insurance if you are financially able to do so.  This insurance can allow for, and will pay for home care for you in your declining years.  If this insurance is not an option, and a nursing home is in your future, make sure your family or support system are actively involved in what happens to you on a daily basis.  This does not mean someone has to be with you at the nursing home every second of every day, but simply, the more, the better. 

Before checking mom or dad into a nursing home, meet with the Administrator, ask about staff to resident ratios, and walk around the facility and observe.   When observing, ask family members of other residents about their experiences.  There is no “Angie’s List” for nursing homes. 

Too bad. 

It is unfortunate that nursing home care is often not satisfactory.  In Japan, by contrast, where elders are the most highly honored group in their society, nursing home facilities are phenomenal.


Paul A. Samakow is an attorney licensed in Maryland and Virginia, and has been practicing since 1980.  He represents injury victims and routinely battles insurance companies and big businesses that will not accept full responsibility for the harms and losses they cause. He can be reached at any time by calling 1-866-SAMAKOW (1-866-726-2569), via email, or through his website. He is also available to speak to your group on numerous legal topics.  Paul is the featured legal analyst on the Washington Times Radio, on the Andy Parks show, on Wednesdays at 5:15 P.M., and he is a columnist on the Washington Times Communities.

His book The 8 Critical Things Your Auto Accident Attorney Won’t Tell You is free to Maryland and Virginia residents and can be obtained by ordering it on his website; others can obtain it on Amazon.








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Paul Samakow

Attorney Paul Samakow brings his legal expertise to the headlines from life and real-life experience to The Washington Times Communties. A native Washingtonian, Samakow has been a Plaintiff’s trial lawyer since 1980, with offices in Maryland and Virginia. 

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