Nursing homes make record- keeping mistakes. Sometimes the mistakes are innocent. Sometimes, as The Bee's Marjie Lundstrom has demonstrated in her investigative report on bogus nursing home record-keeping, they are deliberate – a pattern of deception intended to lull family members into believing that their loved ones are receiving appropriate care and to protect corporate nursing homes from lawsuits when a patient is seriously injured or killed.
Anyone who's taken care of an elderly relative with multiple health challenges, dementia, high blood pressure, cancer, broken hips, heart disease, pneumonia – the list goes on and on – knows how daunting caregiving can be. There are often multiple medications to keep track of. Toileting assistance can require caregivers not only to clean the patient but to take note of the number of bowel movements and their consistency.
If the patients are bedridden, they have to be repositioned frequently to guard against bedsores. Then there is feeding and bathing and exercise and social interaction. That overworked and understaffed nursing home personnel might fail to document all of their actions is understandable but also dangerous. Of course, when they falsify their actions, it's criminal.
Even though the number of citations for fraudulent record-keeping in the state has declined dramatically in the last decade, prosecutors who specialize in elder abuse cases suggest that falsification is common. The cases described in The Bee series show that sloppy and false record-keeping can be deadly. In some of the cases reviewed, those who signed medical reports did not exist or were not working the days they claimed to have performed the services. In other cases, nursing home workers say they were ordered to alter records. Detection and prevention is not always easy.
Technology can help. For example, computerized record-keeping can prevent nursing home personnel from changing entries after the fact. It also allows for more accurate and reliable notifications than sometimes illegible handwritten notes. The hurried check-the-boxes kind of record-keeping before the work is done, a practice described in the series, is more difficult to detect.
In an era when the public is unwilling to pay more taxes and everyone is clamoring for less regulation and smaller government, it's unlikely that government inspections of nursing homes or nursing home records will increase.
Concerned and committed family members or friends are the best protection. While it seems not to have worked in the case of Johnnie Esco – before she died, Lundstrom reports, her husband of 61 years visited her in her nursing home faithfully every day – in most cases patients receive better care when an advocate who loves them pays close attention.
Finally, there is also a need to be realistic about the limitations of health care. Elderly people with multiple diagnoses including dementia are often unable to communicate their needs, to even signal that they are in pain.
Not every nursing home death merits a lawsuit, but given the abuses Lundstrom documented, some of these suits are clearly warranted.
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