7. Do you see bruising?
Don’t assume that any black-and-blue mark you see on your parent is a sign of abuse. As people age, their skin becomes more fragile and certain medications make the skin more sensitive. But some bruises should not be ignored. “A finger-shaped bruise around the upper arm is a very suspicious injury,” says Stang. Also look for handprint-shaped marks on the face or stomach or bruises on the back, areas which are unlikely to be bruised by a fall.
8. How does the home handle a fall?
Falls can happen under even the best of circumstances, says Stang, but it’s important to watch how the staff reacts to one. Did they check for injuries? Did they help your parent get up off the floor safely? Was he or she checked later in the shift for injuries that weren’t apparent at first, such as a closed head injury that would make a person act more confused than normal? And how did you find out about the fall? After any fall, the staff should call you immediately and meet with you to determine why the fall happened and whether any changes should be made (such as a chair alarm that alerts staff when your parent gets up, or a lower bed) to protect your parent from future falls.
9. Are there unexplained bedsores?
Bedsores are often unavoidable, especially as a parent becomes more sick and frail, says Stang. “My concern would be if my loved one were capable of being up and around and hadn’t shown any signs of refusing food, yet all of a sudden he’s developing bed sores,” says Stang. “That’s when I’d talk with the staff about, ‘Why aren’t you getting him up? Why is he spending so much time in the same position?’ ”
If your parent is confined to a bed, ask how often he or she is being rotated. This should correspond to the doctor’s orders, which can be every hour or two, and rotations should be marked on your parent’s medical chart.
10. Are personal care needs being met?
If your parent is incontinent, ask how many times a day her adult diapers are changed. “If a memo goes out to the staff saying, ‘nobody is to have more than six changes a day,’ for instance, that is a problem,” says Somers. “If you don’t change a diaper and keep the area dry and clean, that can lead to wounds.” At Workmen’s Circle MultiCare Center in New York City, diapers are changed every two hours. “But if the resident needs more changes, the certified nursing assistants would know the different routines of that resident and would check them more frequently,” says Eva Marie Fabian, Workmen’s director of nursing.
If you have issues with your loved one’s care, your first conversation should be with the unit manager for your parent’s floor, says Fabian. If that conversation doesn’t resolve the issue, continue up the line of command. “If it’s an issue that is persistent and it’s something that is reoccurring, then we have always encouraged family to write a grievance form or complaint form,” says Fabian. The issue should then be addressed within 48 hours. If it’s not, talk to the nursing home administrator. And if you are still unsatisfied, file a complaint with the state agency that regulates nursing homes.