Refusal of Care and Nursing Home Neglect

Can a patient with dementia refuse care? There is a fine line between refusal of care and nursing home neglect. Nursing home staff should provide quality care while also respecting the dementia patient’s right to refuse treatment if the patient has adequate mental capacity.

When caring for patients with dementia, caregivers must be patient, empathetic, and ready to form trusting relationships to provide necessary care. That calls for nursing home staff to be well-qualified and trained in managing the needs of such patients.

If you or a loved one are a victim of nursing home abuse or neglect, call a nursing home lawyer at DePaolo & Zadeikis today. (312) 263-7560.

When Does Refusal of Care Become Neglect?

Refusals of care can escalate into neglect in several ways if not handled correctly.

Nursing home staff may consider refusal of care to be uncooperative behavior, and as a result, fail or refuse to meet the dementia patient’s needs. This might include providing food, medicine, supervision, a safe living environment, medical care, and other services contributing to the resident’s well-being. Caregivers may fail to pay attention to a patient’s social and emotional needs, such as social stimulation and companionship. Refusal of care can lead to abandonment, with caregivers leaving a resident alone for long periods without care.

A caregiver could accept a patient’s choice to refuse care without explaining the consequences of the decision to the patient, or later checking in with the patient to see whether he or she still maintains the same decision. The patient may be mentally incompetent at the time of refusal, which could negate his or her right to refuse care and lead to neglect. For instance, a patient may refuse help with walking despite lacking adequate medical capacity to refuse care. This patient could later experience a fall if he or she tries to walk without assistance.

Many nursing homes are understaffed, which can cause existing staff to become exhausted and stressed as they provide care. This may cause compassion fatigue from meeting the stringent care requirements of dementia patients, leading to unintentional neglect.

Does Nursing Home Neglect Lead to Abuse?

Neglect may be accompanied by other kinds of mistreatment, like abuse. Nursing home staff who view the refusal of care as uncooperative behavior may become angry and lash out at dementia patients. The staff members may react abusively in response to the refusal or to deter residents repeating the behavior.

What Is Considered Nursing Home Abuse?

Nursing home abuse encompasses various forms, including physical, emotional, sexual, and financial mistreatment, as well as neglect. Physical abuse involves causing bodily harm or injury through force or restraint. Emotional abuse includes verbal threats, insults, or intimidation causing distress. Sexual abuse involves any non-consensual sexual activity. Financial abuse entails unauthorized use of a resident’s assets or coercion to control his or her finances. Neglect is the failure to provide adequate care, leading to harm or endangerment. Any form of abuse violates residents’ rights and may result in legal consequences under Illinois law.

The most common form of nursing home abuse is emotional or psychological abuse. This form of mistreatment involves verbal threats, intimidation, humiliation, or isolation, causing emotional distress and harm to the resident. Perpetrators may engage in manipulation or coercion to control and manipulate the resident’s behavior. Emotional abuse can have severe effects on the well-being and mental health of nursing home residents.

What Causes Nursing Home Abuse?

Factors that contribute to nursing home abuse include under-staffing, inadequate training, and caregiver burnout. Under-staffing creates a high workload, leading to rushed care and neglect. Insufficient training leaves caregivers ill-equipped to handle challenging situations, increasing the risk of abuse. Burnout among staff due to stress and long hours can result in frustration and apathy toward residents. Poor management, lack of supervision, and institutional culture that prioritizes profit over resident welfare can foster an environment where abuse goes unchecked.

Nursing homes may hire staff without giving them proper training in specialized care that cognitively impaired patients need, a key contributor to dementia patient abuse. Without appropriate training, situations may not be managed in a way that respects the legal rights of dementia patients. Under-supported staff working in poor conditions also contributes to nursing home abuse. The chances of caregivers losing patience and abusing dementia patients are higher when they’re inexperienced, poorly trained, underpaid, and overworked.

Can Nursing Home Staff Provide Care Even if it’s Been Refused?

In Illinois, nursing home staff cannot provide care if it has been explicitly refused by the resident or his or her legal representative. The only exceptions are emergency situations where the refusal of care poses an immediate risk to the resident’s health or safety. Staff should respect the resident’s autonomy and right to refuse treatment or care, except in emergencies. 

If a resident refuses care, staff must document the refusal and explain the consequences of the care that was refused to the patient. Nursing home staff must uphold the resident’s rights while ensuring his or her safety and well-being. Healthcare providers should educate residents and their families about the importance of certain types of care and encourage open communication to address concerns or preferences regarding treatment and care.

Antipsychotic Medication and the Refusal of Care

A common instance where nursing home staff members insist on providing care against a dementia patient’s wishes is in the administration of antipsychotic drugs. The use of antipsychotic medication in nursing homes is a controversial issue due to risks and concerns about overprescribing. While these medications are intended to treat conditions like schizophrenia and bipolar disorder, they are sometimes used off-label to manage behavioral symptoms in elderly residents, such as agitation or aggression. 

Antipsychotics carry significant side effects, including sedation, increased risk of falls, and cognitive decline, especially in older adults. Regulatory agencies and advocacy groups emphasize the importance of minimizing the inappropriate use of these drugs, promoting non-pharmacological interventions, and ensuring prescriptions are based on careful assessment and monitoring of residents’ needs.

Many residents are given the drugs despite asking not to receive them. The drugs have been linked to heart problems, falls, and increased chances of death in people with dementia. Nursing home staff members routinely over-medicate dementia residents with antipsychotic drugs without anyone’s consent to make the residents easier to control. 

Signs of Dementia-Related Neglect and Abuse

Signs of neglect and abuse can be challenging to spot in people with dementia. Some signs are similar to typical symptoms of dementia.

You can protect your loved one by watching out for clusters of these warning signs of neglect or abuse:

• Physical Abuse: Evidence of physical mistreatment includes cuts, bruises, fractures, burns, and other signs of physical trauma. Your loved one may act fearfully when you try to touch him or her. That could be a sign that he or she receives physical harm, such as strikes, from an abuser.
• Sexual Abuse: Watch out for bleeding or bruises around the genitals or breasts and stained, bloody, or torn underwear, as these are signs of sexual abuse.
• Emotional Abuse: A caregiver may exhibit controlling, threatening, or belittling behavior. The caregiver may only allow you to see your loved one if he or she is present. All these may point toward emotional abuse. Other signs of emotional abuse include your loved one showing increased agitation signs like sucking, rocking, and mumbling to themselves, withdrawal from regular activities, and sudden depression or change in alertness.
• Neglect: Signs of neglect could appear in unique ways for dementia patients, such as fear of care, reduced communication, mood swings, rapidly emerging health issues, and worsening dementia symptoms. Common signs of neglect include malnutrition, unusual weight loss, and bedsores.
• Inappropriate Use of Medication: Nursing home residents with dementia may receive antipsychotic medication for off-label use. Pay attention to your loved one’s prescription medications to see whether there are new medications that don’t correspond to a condition or diagnosis. 

If you see signs of nursing home neglect or abuse, intervene on behalf of your loved one and ensure the perpetrators are held accountable. A nursing home abuse lawyer can provide assistance by guiding you through the legal process, investigating the circumstances of the abuse or neglect, and advocating for your rights and the rights of your loved one. He or she can gather evidence, navigate complex legal procedures, and pursue compensation for damages such as medical expenses, pain and suffering, and punitive damages. Your nursing home abuse and neglect lawyer can hold negligent parties accountable and work to prevent future instances of abuse.

If your family member has been neglected or abused in a nursing home due to refusal of care, contact an attorney at DePaolo & Zadeikis for help.