Dehydration often a threat to life, health in nursing homes, senior living centers

 Drinking Water

Water is the source of life, health experts say.  And in those golden years, it becomes even more abundant.  Yet in nursing homes and senior living centers, where often people can't go and get the things they need themselves, water is not available at regular intervals nor in the desirable amounts, causing risks to life and health in nursing homes.

Long-term care facilities are heavily regulated in most states, and yet simple dehydration remains a common cause of injury and even death among seniors.

Keeping patients safely hydrated is the responsibility of those who care for the elderly.  Often this duty is too often neglected.

This writer reflects on a Mother's care at the end of life, in a care facility for dual-diagnosed patients.  The elderly parent had dementia caused from long-term mental health problems as well as physical limitations from a broken hip and arthritis.  There had been no history of kidney problems, and yet these were on the chart just prior to her death.  This daughter, who lived out of state, had been assured by family members that Mother's care was guaranteed; but a routine visit just one week prior to her death found that care had not been given nor the proper vigilance provided by those involved in relating with nursing home staff.

Perhaps the death was premature; perhaps it was not.  An 82-year-old often has years left to live, but life ended far too soon relative to the illnesses prior to the residential care.

Too often family members find the neglect too late, and permanent damage is already done.  In the case of many elderly across the country, and likely around the world, insufficient water is a serious problem at a time when the senior needs special attention to health care needs.

What is dehydration? It is simply stated fluid shortage when a body loses more water than it takes in.  A person can survive only about four days without fluids.

There are many causes for dehydration.  These include diarrhea, frequent urination, sweating and vomiting.  Low levels of fluid in the body causes it to lose electrolytes like potassium and sodium.  These are the elements for the cells to function normally.Dehydration is often caused by vomiting, diarrhea, frequent urination or excessive sweating. In addition, low fluid levels cause the body to lose electrolytes.

The Mayo Clinic reports that mild to moderate dehydration may cause dry mouth, fatigue and dizziness, thirst, dry skin, headache, constipation, decreased urination and more.  There are several signs of dehydration that indicate medical emergency that include confusion or irritability, rapid breathing, dark urine or no urination, sunken eyes, fever, and low blood pressure.   And in the case of more serious dehydration there can be  brain swelling, seizures, shock, kidney failure, coma and death.

When a young person becomes dehydrated additional fluid intake can remedy the problem.  With older, people, however, intravenous hydration with electrolytes may be needed, since the senior is more at risk.  Diabetics are potentially even more than other seniors.

Care staff are required to monitor the fluid level of residents to make sure they are well hydrated.  When a problem occurs, the negligence can create legal problems for the residence and for the workers.  It is a perfect storm for the patient and for everyone, when proper care is not undertaken, including making sure the senior has enough water to remain as healthy as possible in those later years of life.

Black Americans are more at risk for abuse in nursing homes

[caption id="attachment_14215" align="alignleft" width="300"] Taunton Nursing home[/caption]

Amber Paley - Nursing home abuse in the United States isn’t a problem that seems to be improving; it is, however, one that is being studied and talked about more and more.  Recent government reports demonstrate that certain factors make some residents more at risk than others to abuse and neglect.  One particular report demonstrates that race is one such factor; according to it, black Americans are more at risk for experiencing nursing home abuse than other races.  But first, how prevalent is this problem in the U.S.?

The U.S. Department of Health and Human Services (HHS) conducted a study of nursing homes between 2005 and 2007[1].   The study yielded some frightening results: “In each of the past 3 years, over 91 percent of nursing homes surveyed were cited for deficiencies….  During those same years, the most common deficiency categories cited were quality of care, resident assessment, and quality of life.  Additionally, 17 percent of nursing homes surveyed in 2007 were cited for actual harm or immediate jeopardy deficiencies….”  To clarify, if a nursing home is guilty of the three deficiency categories mentioned, they are guilty of neglect and abuse; the three categories, combined, protect residents from physical, emotional, and chemical abuse (e.g. unnecessary sedatives/psychoactive drugs), neglectful care, and ensure a clean, homelike environment.

The most common forms of abuses in nursing homes are financial exploitation, neglect, physical abuse, sexual abuse, and verbal abuse.  Upon researching the causes of nursing home, one will discover several unnerving answers; but an analytical view of that research demonstrates that understaffing is at the root of the problem.  It causes undertraining of staff members, high staff turnover rates, insufficient time spent with residents, and the hiring of abusive staff members.

Ninety percent of nursing homes are understaffed.  Based on 2004 Centers for Disease Control (CDC) data, for every 1 nursing staff member there are 1.64 residents.  Here are the specific nursing staffs to resident ratios:

• 119,500 registered nurses; 1 RN for every 12.6 residents.


• 184,000 practical nurses; 1 PN for every 8.2 residents.


• 600,000 nursing assistants; 1 NA for every 2.5 residents.


• 12,500 nurse aides and orderlies; 1 for every 120 residents.

But given all of this, why are black Americans more prone to abuse and neglect than other American nursing home residents?  According to the CDC, it is due to black nursing home residents’ functionality.  The CDC’s 2009 Data Brief examined how black American nursing home residents’ functionality compared to other American races and found that black nursing home residents had poorer functional status than residents of other races.  According to the report:

• Black residents were more likely to be totally dependent in both eating and toileting.


• There were a higher percentage of black nursing home residents dependent in all five activities of daily living, i.e. eating, toileting, bathing, dressing, and transferring, than other races.


• Black nursing home residents were more likely to be incontinent of bladder, bowel, or both.


• Among bladder-incontinent nursing home residents, black residents were less likely than those of other races to have scheduled toileting plans.

The following is a racial comparison chart of the 5 basic care activities and can be found with other comparison charts in the 2009 Data Brief mentioned above.

Nursing home residents with mental and physical disabilities, or who simply need more care than others, have a higher risk of experiencing neglect and abuse according to the National Center on Elder Abuse.  Thus, because black Americans in nursing home settings tend to be more dependent on staff members, they are more vulnerable to both atrocities.  And it’s not simply because black Americans are more likely to have lower functionality that they’re more prone to abuse and neglect; according to the CDC 2009 Data Brief, black nursing home residents, “may be more likely than residents of other races to reside in facilities that have serious deficiencies, such as low staffing ratios and greater financial vulnerability.”

The factor that causes black Americans to be more dependent in nursing homes was not examined in the CDC’s Data Brief.  However, differences in healthcare throughout life may explain, at least in part, this racial discrepancy among nursing home residents.  According to the Agency for Healthcare Research and Quality, “20 percent of black Americans lack a usual source of health care compared with less than 16 percent of whites…. [And] African Americans… are far more likely to rely on hospitals or clinics for their usual source of care than are white Americans (16 … percent, respectively, v. 8 percent).”

As the baby boomer generation starts to enter the senior citizen generation, it is expected that nursing home populations will grow.  This raises the following questions:  Will nursing homes find a way to increase their staff levels to accommodate the growing nursing home population?  What, if anything, will change to protect black American nursing home residents, since they are among those most at risk to experience abuse and neglect in nursing homes?

Hopefully, as nursing home abuse becomes a social problem increasingly discussed by citizens, the government, and the media, something will be done to end the atrocities taking place in our nursing homes.

Amber Paley is a guest post and article writer bringing to us information on why black Americans are more at risk to experience abuse and neglect in nursing homes.

Amber spends the majority of her professional life researching and writing about  nursing home abuse at her website: http://www.nursinghomeabuse.net

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[1] Levinson, Daniel R. Memorandum Report: "Trends in Nursing Home Deficiencies and Complaints" Rep. U.S. Department of Health and Human Services, 18 Sept. 2008. Web. <http://oig.hhs.gov/oei/reports/oei-02-08-00140.pdf>.