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Dehydration – A Silent Killer In Nursing Homes (part 1)
Dehydration is a form of nursing home neglect.
Nursing home neglect can manifest itself in many in different ways. Studies have found that 1 out of every 3 nursing home patients may experience harm or injury as a result of the care they receive. We have discussed many of them in previous articles, including pressure sores, dangerous falls, medication overdoses, sexual assault, among others.
One insidious form of neglect that often goes unrecognized is dehydration caused by the nursing home simply failing to ensure that patients were provided the hydration they need to survive. Dehydration can be difficult for family members to recognize, and may not be discovered until the patient’s condition has taken a serious turn for the worse. Below is a tragic example of one such case:
Eighty-one-year-old Theresa, a loving wife, mother, and grandmother, suffered debility following a recent hospitalization and had difficulties walking and performing many of her daily living activities. With the assistance of her husband, she was able to cope and live at home. But one day, Theresa fell at home and, although she broke no bones, she suffered a number of injuries and needed advanced care and monitoring, which her husband, in light of his own increasing debility, was unable to provide. Theresa was taking medication for cognitive deficits such as confusion and required professional nursing care and therapy services. She was admitted to a local nursing home.
But unbeknownst to Theresa and her family, this nursing home facility had recently been cited by state surveyors for various care deficiencies, including the failure to properly care for patients who were at risk for dehydration. When Theresa was admitted to the nursing home, she was known to be at risk for fluid balance fluctuation (caused by dehydration).
In the weeks to come, the nursing home staff failed to assess whether Theresa was receiving proper hydration. She was supposed to receive at least 30 cc’s/kg of fluid intake each day, or approximately 2,000 cc’s per day. Instead, the nursing home’s own intake records showed that Theresa was receiving significantly less than half that amount on many days, and sometimes received less than 100 cc’s in a given day.
Theresa’s physician was never made aware of this significant fluid insufficiency, nor was she notified of Theresa’s decline. In fact, there was no indication that the nursing home staff even assessed Theresa’s hydration intake during that critical time period, despite the fact that they noted that Theresa was “lethargic” and “moaning out.”
Ultimately, Theresa was transported by ambulance to the local hospital, where the emergency staff noted Theresa’s lips were “very dry and cracked” and that she was unresponsive to any stimuli. The emergency room staff also documented that Theresa’s mucous membranes were very dry and pale and a “large amount [of] dried food and sputum [were] suctioned from [her] mouth.” She had become so dehydrated that she was literally unable to form the saliva necessary to swallow her food. Blood tests confirmed her condition; she was diagnosed with severe dehydration, acute renal failure, urosepsis, and possible aspiration pneumonia, which was likely due to receiving inadequate fluid intake. Her condition deteriorated and she died several days later.
After Theresa’s death, critical information came to light that, had Theresa and her family known of it at the time she was admitted, would have led them to have had Theresa admitted to another nursing home — one which could have provided her the care she needed — and one that would not have neglected one of her most basic needs.
When a patient becomes severely dehydrated, that is often indicative of serious systemic care failures within the facility, that result in multiple and repeated acts of neglect. For example, when nursing homes do not hire enough staff, the nursing staff that is present is forced to cut corners and may not have time to make sure patients’ water pitchers are kept filled. Or they may not have time to assist patients who need help taking drinks. In some cases, we have encountered understaffed facilities where the aides reduce the amount of fluids they give to patients so that they won’t have to toilet them, or change their undergarments, as frequently.
In Theresa’s case, it was discovered that the facility was cited by state investigators prior to Theresa’s admission, and investigators found that on 27 of 30 days in the month reviewed, a patient received at least 600 cc’s of fluid less than the patient needed. The investigator noted: “Documentation was lacking to reflect the 24-hour totals and ongoing assessments of intake and status communication to the physician prior to dehydration and complications warranting hospitalization.”
To address the citation, the nursing home administrator submitted a plan of correction which included the promise that the facility would offer special training to its employees on hydration issues. But according to one facility employee, this training never happened. This employee testified during her deposition that she was never made aware by facility administrators that state investigators had concerns about patient hydration, nor did she recall any special hydration training during this period.
This broken promise in all likelihood caused Theresa’s premature death.
Nursing homes are cited every day throughout the State of Indiana and hardly anyone ever becomes aware of care violations, other than those responsible for the nursing home and the person who made the complaint. Think about it: every soft drink sold in America requires the nutritional value to be prominently displayed on the can for the consumer. But nursing homes are not required to explicitly warn families as they seek information on which facility they should entrust to care for their loved one. Sure, there may be some limited data available if you know where to find it tucked away on the internet, but there is nothing to compel a nursing home to affirmatively forewarn you that they have been caught by state investigators providing sub-standard care.
Since nursing homes too often fail to ensure patients receive the fluids they need to avoid dehydration, the more information the family has the better. We are devoting our next article, to providing important information on how families can look for warning signs that may indicate their loved one is not receiving the hydration they need
Jeff Powless is an attorney and the author of the 2017 book, Abuses and Excuses: How To Hold Bad Nursing Homes Accountable. Abuses and Excuses breaks new ground in helping patients and families hold bad nursing homes accountable, sharing a wealth of insider strategies and insights. It’s an eye opening account of corporate greed, acts of neglect and abuse, an insidious industry culture of cover-up, and the actual harm that inevitably befalls vulnerable nursing home patients all across the country with shocking frequency.
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