Chapter 12: Dealing With Problems Yourself

Your mother will be amazingly lucky if she never has any problems with the care she gets in the nursing home.  What to do when she is having problems depends on the kind of problem.


1.  Use your notebook.

Keep track of problems and what you do about them in your notebook.  Write down what you and other visitors see and what you are told about any problem.  Write down who at the nursing home you talk to about the problem, what you tell them, and what they tell you.  Date each entry.  


2.  When to talk to whom.  

In general, if the problem is how a particular person is or is not doing her job, the best way to start is by talking with that person.  If an aide is not giving your mother water, or putting on her socks and shoes when she gets her dressed, start by talking to the aide, not the Director of Nursing or the administrator.  If dressings are not being changed, start with the charge nurse; if a medication has not been prescribed, start with the doctor.  If this direct approach does not work, go up the hierarchy: the charge nurse, the Director of Nursing, the administrator and Medical Director.

There are times when it makes no sense to start with the person whose behavior is the subject of your complaint.  If your mother has been hurt or is frightened, or you have some reason to think she has been abused, you may want to start with an aide or a nurse to find out what (s)he says happened, or you may want to go directly to the Director of Nursing and the administrator.  Read the nurses’ notes in your mother’s record to see what the nurses or aides have written about what happened.

If your mother has been hurt, you should not be satisfied with just the promise of an individual staff member that the problem will not happen again.  At a minimum, you should talk to the Director of Nursing,  the administrator and the Medical Director to see what steps they are taking to prevent it happening again, and decide if what they have done makes sense to your and is enough.  

Always talk to your mother’s doctor if she has been hurt.  You can see from the nurses’ notes if the staff has done this, but you will not know what they told him.  It is critical that her doctor have an accurate understanding of her situation.  The nursing home is required to follow the doctor's orders, so if he is willing to order that a certain procedure be followed or care be given, the nursing home is required to do so.  


3.  Mandatory abuse and neglect reporting.

If your mother needs medical care for suspected abuse or neglect, the medical personnel who treat her –  Including nursing home staff, paramedics and hospital emergency room staff –  are required to report their suspicions to the Illinois Department of Public Health.  This rarely happens, which is particularly unfortunate because Public Health tends to take seriously, complaints from medical personnel, especially from doctors and hospital staff.  You should talk to the emergency room doctor or nurse, or her treating physician at the hospital, to make sure they meet their legal obligation to report their suspicions that your mother has been abused or neglected.

If the nursing home staff suspect your mother has been abused (including threatened or verbally abused) or neglected, they are required to tell the Illinois Department of Public Health.  They must do this regardless of whether your mother needs or gets any kind of emergency medical care.  Ask the administrator if he has called Public Health.  It is not enough to fire an employee suspected of abuse: the nursing home administrator, and all staff who are aware of the suspected abuse or neglect, are required to tell Public Health.  Telling the Department of Public Health can help make sure that the employee does not find work in another nursing home.  Aides who Public Health finds have abused or neglected a resident, are listed in the state CNA registry and forever banned from working as CNA’s in nursing homes.

The nursing home is required to remove any employee accused or suspected of abusing or neglecting a resident from direct contact with all residents, while it investigates an allegation or abuse or neglect.  If the administration believes the allegation is true, the employee may not be allowed to have direct contact with any resident unless the Department of Public Health finds there has been no abuse or neglect.   

The nursing home is required to tell the Department of Public Health, if a resident has been abused by any person, including a visitor or another resident.  If the abuse is by another resident, the nursing home is required to immediately change the abusive resident’s care plan to make sure the abuse does not happen again.


4.  Calling the police.

Nursing home staff are supposed to call 911 to tell the police whenever they believe a crime has been committed by anybody against a nursing home resident.  If they believe a resident has been abused or neglected (both of which are crimes in Illinois,) or if a resident’s property has been stolen, they are supposed to call the police immediately.  

If you believe your mother has been hurt intentionally, or seriously neglected, and the police have not already been called, you should consider calling the police or state's attorney, especially if you cannot reach the ombudsman immediately.   You can do this even if the abuse is by another resident.  Many nursing home staff assume that discharging an abusive nursing home resident, sending him to the hospital for psychiatric care, or changing his medication, are their only choices when one resident threatens or injures another.  This is wrong.  The decision about whether a person who commits a criminal act can be charged criminally, is not the staff’s to make.  A person who is not competent to stand trial may be charged criminally and held in a secure environment.   Your calling the police or state’s attorney may get the nursing home staff to take more action to protect your mother and other residents than they would otherwise.

You cannot assume that either the police or the state’s attorney will want to pursue any complaint you make.  Some police departments refuse to get involved in nursing home “problems,” including incidents they would automatically pursue if the victim were not a nursing home resident.  Some state’s attorneys have never prosecuted anyone for a criminal act against a nursing home resident.  Getting them to change how they behave can be at best difficult.  It can also be worth any difficulty.

Often family members are afraid of retaliation for reporting abuse.  You must weigh this fear against the fact that the abuse can and probably will keep happening until the abuser is stopped.