Physical Elder Abuse in Nursing Homes
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Bruises are a common injury involving discoloration of the skin indicating physical trauma to that specific region. Some people bruise more easily than others, gaining them from just minor bumps and hits; however, bruising can also be indicative of a serious impact. Bruising is especially prevalent among the elderly, as their bodies do not recover from impact and trauma in the same way as a healthy, young body.
Understanding Bruises & Contusions
Bruises (medically known as a contusion) are a soft tissue injury involving blood leakage just beneath the skin. First signs of a bruise include soreness and redness. Over time, the bruise will turn blueish-black. As the healing process proceeds, it will fade to green and yellow.
There are three levels of bruising severity:
- Subcutaneous – Beneath the Skin
- Intramuscular – Within the Underlying Muscle
- Periosteal – Bruise on the Bone
Bruises beneath the skin are the most common; the other two are much rarer and usually only occur when the victim has suffered from some form of trauma. In a nursing home, they may indicate a serious fall.
Elder Abuse Statistics
The National Center on Elder Abuse was established as a resource center dedicated to the prevention of elder abuse and neglect. Their mission has been to provide access to research, training, and best practices for patients, family members, and facilities alike. Elder and nursing home abuse research suggests:
- Almost 1 in 10 nursing homes have been cited for violations that have caused harm, injury, or risk of death to patients.
- Of the various types of abuse complaints, physical elder abuse accounted for nearly 30%.
- Of the abused, the majority of victims were 75 years or older, female, and unable to communicate.
Types of Physical Elder Abuse
Physical abuse in nursing homes can range in types, from flat out active abuse to assault. Physical abuse types include:
- Physical assault: shoving, punching, kicking or inflicting other types of physical harm. This can lead to falls, bone fractures & breaks, and other signs of physical trauma.
- Sexual Abuse: Victims of elderly sexual abuse can be identified by potential signs, including unexplained STIs, bruising on thighs and genital areas, and panic attacks, and increased aggitation.
- Physical Neglect: Nursing home neglect can be caused by understaffing or intentional lack of care. Caregiver neglect can result in serious harm to the patient, including bed sores, poor hygiene, sepsis, choking, and even wrongful death.
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Causes of Bruises
Bumps, bruises, and minor injuries are commonplace and happen to us all, presenting in different ways on the surface of the skin. Skin becomes increasingly thinner as a person ages, which makes bruising even more common for elderly people. Skin also becomes more fragile, especially in the hands and arms.
For elderly people, bruising can happen in many ways, such as bumping into things or even dropping an item on themselves. They may not know what caused the bruises, how or when the bruises happened, or even feel any pain or discomfort.
Various medicines that are commonly prescribed to an aging person can also contribute to bruising. Blood thinners like aspirin and warfarin are often prescribed to the elderly. Understanding the side effects of these medications is important when assessing any bruising concerns.
A balanced diet and proper nutrition are important for the elderly to maintain health and strength. A diet lacking in Vitamin C can cause bruising, and an iron-deficient diet can also increase the chances of bruises occurring.
There are many potential causes of bruising for people of any age. When it comes to the elderly, however, bruising could be a sign of a more serious issue.
Bruises and the Elderly
When faced with the overwhelming duties and costs of handling an aging parent or loved one, choosing to place them in the care of others in a home setting or within a nursing home, assisted living facility, or similar care environment can be a helpful and comforting option.
Sadly, the National Council on Aging (NCOA) reports that between 1 and 2 million Americans age 65 or older have been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection. As you consider the care of your aging parent or loved one, it is important to be aware of statistics like these.
There are many signs that may point to potential elder abuse. One of the most recognizable indicators is bruising. Let’s explore some simple science about bruises to understand the different types and causes, as well as some research-based examples of when a bruise could be a red flag.
MedlinePlus—a service of the National Library of Medicine (NLM), the world’s largest medical library—defines a bruise as an area of skin discoloration. A bruise occurs when small blood vessels break and leak their content into the soft tissue beneath the skin.
There are three types of bruises:
- Subcutaneous – beneath the skin
- Intramuscular – within the belly of the underlying muscle
- Periosteal – a bone bruise
Bruises present as different colors, beginning with a wide variance of blues to purples, progressing with time to a greenish-yellow tone. As the injury heals, skin once again reverts the person’s natural skin color.
Natural Bruising vs. Red Flags
Perhaps your loved one is behaving differently, or the bruising is in places that don’t add up or make sense. They may seem fearful or uncomfortable in their care environment—or something just feels “off.” When considering the heart-wrenching possibility that your loved one may be the victim of elder mistreatment or abuse, there are certain signs that commonly occur.
According to a study published by the Journal of American Geriatrics Society, bruises that occur as a result of physical elder mistreatment are often large (>5 cm) and are typically located on the face, lateral right arm, or posterior torso (including the back, chest, lumbar, and gluteal regions). These areas of bruising appear significantly more often on abused adults than on adults who were not abused. Being able to recognize the signs of normal bruising compared to bruising that indicates something more sinister is critical to your loved one’s safety.
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Effects of Bruises
If your elderly loved one lives in a nursing home, they have the right to expect safe conditions and appropriate monitoring. In many cases, elderly residents slip and fall due to elder abuse or neglect, which can result in serious bruises. While some effects of bruises remain minor, some result in serious medical conditions and complications. If your elderly loved one lives as a resident of a nursing home, make sure to always closely inspect and monitor their skin and overall health to ensure that they receive proper treatment and care. If you notice any severe bruising or a pattern of bruising over time, you may be witnessing signs of elder abuse or neglect.
Causes of Bruises
There are many causes of bruises in any person; however, elderly adults have certain circumstances and conditions that may make them more vulnerable to easy bruising.
As people age, their skin becomes more and more fragile, and thus more prone to injuries. In many cases, an elderly person may simply not remember how they received their bruise. A nursing home should take extra care to moisturize residents’ skin as well as always monitor them so that they do not slip and fall, which may cause not only bruising but broken bones and internal organ damage, according to the Centers for Disease Control and Prevention (CDC).
Nutrition and Hydration
Nursing homes must provide appropriate nutrition and hydration to all of their elderly residents. Vitamin C and iron play an important role for any person, especially elderly people who may have challenges with their blood vessel walls. Any diet provided in a nursing home should include proper nutrition so that an elderly person can have a healthy immune system, bruise less easily, and have more resilience regarding their overall health.
Some medications (such as blood thinners) cause bruising or cause a resident to bruise much more easily.
Elder Abuse and Neglect
In some cases, a nursing home fails to monitor its residents, leading to seniors attempting to get out of bed or wheelchair by themselves. Often, residents will then fall and suffer serious medical issues or bruising. In other cases, seniors of nursing homes may suffer direct elder abuse. Reports indicate that some nursing homes attempt to forcibly restrain residents who have dementia or Alzheimer’s disease and often become confused and wander. In other cases, nursing home employees may physically abuse elderly residents if they remain non-compliant or if the nursing home employee becomes frustrated, overworked, or unable to control their feelings of anger regarding a nursing home resident.
Effects of Bruises
While many bruises will heal on their own, some large bruises indicate serious medical issues. In fact, if you notice that your elderly loved one has a large or serious bruise, you should have them seek immediate medical attention to determine if any internal bleeding or damage occurred. In fact, some effects of bruises require emergency care in a hospital. Bruises around the torso of an elderly person create concern for internal damage. In other cases, a bruise could signal a fractured or broken bone underneath the bruise. Always seek the advice of a medical professional in these cases.
If bruises in your elderly loved one appear tender and persistent, they may indicate a medical condition or elder abuse and neglect in the nursing home. Any persistent bruising or a bruise that does not begin to heal within a week should receive an examination by a medical professional even in the absence of suspicion of internal damage.
What to Do if You Suspect Elder Abuse or Neglect
If you suspect that elder abuse in a residential long-term care setting led to the bruising of your elderly loved one, you should immediately contact the management of the nursing home. Additionally, you should consider contacting Adult Protective Services, as well as the police, dependent on the circumstances. Bruising located anywhere on the torso or in areas that would not have occurred due to a fall should receive close scrutiny by a medical professional to determine if elder abuse occurred. If your elderly loved one continues to receive bruises with no explanation, they may suffer from elder neglect. The nursing home staff may provide inadequate monitoring for their residents, leading to falls and injuries.
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Bruises can happen frequently in a variety of situations. A person may unexpectedly run into an object, like a door or pole, causing a bruise. Or a person might fall and create a bruise. In nursing homes, older residents might stumble on a loose carpet or awkward stair and create a bruise from the fall.
But what about intramuscular bruises? These are more serious deep-tissue types of bruises. What happens when you find that your loved one in a nursing home shows signs of an intramuscular bruise? This might be the result of neglect or abuse.
You have every right to be suspicious and ask questions. Injuries of this sort should not happen to a loved one in a nursing home. Read below to understand your position for pursuing legal options if you find yourself in this situation.
Identifying an Intramuscular Bruise
An intramuscular bruise happens when the “belly” of the muscle suffers damage, according to MedlinePlus. This can occur due to an impact from a heavy blow.
For an older person in a nursing home, this can be a devastating injury. A muscular bruise like this causes redness, discoloration, pain, and swelling. It will also limit movement around the bruised area for the injured person. And the time to re-heal can take much longer for a senior citizen, due to the thinner skin and muscular aging issues.
How Neglect or Abuse Can Cause an Intramuscular Bruise
In nursing homes, bruises can occur from a number of situations. Your loved one may have frail skin and take a fall, causing deep bruising.
Falling can be a sign of neglect. If the nursing home resident has a history of or risk of falling, then it is up to the nursing home team to devise a fall prevention plan for the resident. Failure to create or follow a fall prevention plan would be considered neglect on the part of the nursing home.
There are other ways in which a nursing home resident could suffer bruises, according to the National Center on Elder Abuse. Bruising can also occur in situations with physical violence, in which the nursing home resident suffers abuse from either a nursing home worker or another resident. Common types of abuse to seniors in nursing homes could include physical cuts or bruises, small impact wounds, or even cases of broken bones.
Any of this type of physical violence could hasten symptoms of pre-existing health conditions in nursing home residents, and possibly lead to premature death. Those nursing home residents already suffering from dementia may even face higher risks.
If your loved one is in a nursing home and you see skin discolorations and signs of bruising during your visits, it may be time to ask some hard questions.
- Did a staff person physically hurt your loved one?
- If so, what happened and when?
- Has this abuse been an ongoing occurrence?
- Does your loved one have any audio or video evidence, possibly from a cell phone, that could provide evidence to back up the story of harmful behavior?
Holding the Nursing Home Liable for Abuse or Neglect
If you have confirmed signs of abuse for your senior in a nursing home and you are actively looking to work with a nursing home lawyer, here are some things you can do to help your case:
- Gather whatever available evidence that you can. This could include researching your senior’s recollection of the abuse, including a timeline.
- Ask other residents if they have ever seen forms of anger, yelling, or physical intimidation involving your loved one or other residents.
- Research law firms who have won cases in previous nursing home abuse lawsuits
- Narrow down your law firm choices down to those with direct experience handling nursing home abuse cases
Elder abuse in a nursing home is a tricky legal matter. While you can handle a case on your own, most people do not have experience handling an injury case. Trying to file a lawsuit on your own could possibly lead to errors that hurt the case.
Most law firms working in this area of nursing home abuse will not charge you any upfront fees when they choose to work with you. Rather, the firm will collect a small percentage of any possible compensation from a settlement as the fee. If you are finding that some law firms want to charge you in advance for work, you may want to walk away from any agreement with that firm.
Nursing home abuse and neglect are unfortunate realities across the United States. Cases are vastly underreported because victims often think nothing will get done to address the problem or they fear retaliation if they speak up. Subcutaneous bruises may indicate that your loved one has been abused or neglected. If you notice subcutaneous bruises when you visit the nursing home, ask your loved one to explain what caused the injuries.
Signs of Possible Abuse or Neglect
A blow to the body—whether it be from an accident or abuse—can break capillaries, or tiny blood vessels. This can cause bleeding under the skin and a subcutaneous bruise, which may appear red or blue. Subcutaneous bruises are the most common type of bruises. They may occur if a person gets hit, slapped, or pushed. They can also form if an individual accidentally bumps into an object, such as a piece of furniture. Subcutaneous bruises on the knees or elbows often point to a fall, which might have been accidental or might have occurred if the individual got shoved.
Even if bruises have healed, the National Institute on Aging confirms that emotional effects of abuse or neglect may linger far longer. Victims of mistreatment in nursing homes may become withdrawn, depressed, agitated, violent, or fearful. They may stop eating as much as usual and lose weight. or they may lose interest in activities they used to enjoy.
Nursing Home Residents Often Do Not Get the Care They Deserve
According to the Centers for Medicare & Medicaid Services, in residential facilities such as nursing homes, “Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.”
Despite this clear mandate, senior citizens and younger people who are disabled still suffer abuse and neglect in nursing homes.
Federal law requires nursing homes to take steps to prevent abuse and neglect and to intervene if either occurs. Even though abuse and neglect of nursing home residents are violations of federal and state laws, many vulnerable people are victimized by staff, fellow residents, and visitors each year.
Residents of nursing homes may experience physical, mental, psychological, verbal, and sexual abuse. Physical abuse can take many forms, such as pushing, shoving, hitting, slapping, and pinching. These types of physical abuse often leave behind telltale signs, such as subcutaneous bruises, that can alert family members to a problem.
Nursing home residents who are victims of neglect may not receive proper care or may not be protected from harm. Neglect may be intentional, or it may be due to inadequate training or understaffing. Nursing home residents who do not receive proper care may suffer accidents that can leave behind subcutaneous bruises.
Know Who Is Most at Risk
Senior citizens who live in nursing homes are often at the greatest risk since they may have dementia or Alzheimer’s disease in addition to physical disabilities or limitations. Seniors may be unable to communicate clearly or explain what they have experienced. Family members who visit infrequently may not witness abuse or neglect firsthand or see any direct evidence of it, such as subcutaneous bruises.
What to Do if You Suspect Your Loved One Has Been Abused or Neglected
If you visit your loved one and notice subcutaneous bruises or other signs of possible abuse or neglect, try to find out what happened. Depending on your relative’s cognitive state, it may be difficult to figure out exactly what led to the subcutaneous bruises. Ask your family member to explain what happened to the best of their ability. Try to determine whether the bruises occurred as a result of an accident or whether your loved one was assaulted.
If your relative says they experienced assault, believe them. Then get as many details as possible, including the name and description of the person responsible. If your loved one says the subcutaneous bruises are the result of a fall, they may have been pushed. It is also possible that your relative was left in an unsafe situation or tried to get to the bathroom alone because calls for help went unanswered. Ask what happened prior to the fall and what kind of assistance or treatment they received, if any, after it occurred.
Be sure to report suspected abuse or neglect and any relevant information you can gather. You can file a report with the nursing home’s administrator, local or state police, your local Adult Protective Services agency, your state or local ombudsman, and your state licensing agency.
What to Do if You Have Been Unable to Get Justice for Your Loved One
Sometimes family members are frustrated because they find it difficult to get agencies and authorities to take allegations of nursing home abuse and neglect seriously. Subcutaneous bruises can have many causes. It may be difficult to convince investigators that they are signs of abuse or neglect—and not an accident—without direct evidence or a statement from an eyewitness. In some cases, family members find that it is necessary to go to court to pursue justice for their loved one.
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Contacting a Nursing Home Injury Lawyer
If your loved one has suffered from bruises of some kind, and you suspect that they are tied to some form of abuse or neglect, we encourage you to contact our nursing home abuse attorneys today. We partner with top-litigation firms around the country—meaning that you get two firms for the price of one. Our lead attorneys have more than 50 years of shared experience between them and have been successful in recovering millions for our clients nationwide.