Caregiver Neglect

What is neglect?  Neglect is the failure to provide necessary services to a care dependent person and can take many forms.  Not providing proper nutrition, failing to give medications, not assisting with daily hygiene, or failing to provide any other needed service.  Neglect is also a form of abuse.  Who can be a victim of neglect?  Any person who is dependent on another person for any care.  Who can perpetrate neglect?  Any caregiver from a family member, to an in home caregiver, to the caregiver in a facility.  We all want to believe that we have made the best choices to get the best care for our loved ones.  Fact is neglect happens.  Even if you implicitly trust the caregivers it is important that you remain vigilant and watch for signs of neglect.  So, what should you look for?  Neglect can cover a lot of ground depending on what services should be provided but there are some general signs to look for, and there are common areas of neglect.  

Let me begin by saying you need to listen to your loved one and you need to watch their behavior.  If they report being uncomfortable with a caregiver, if they say they have not received certain care, if they shy away from touch, or if you see a negative change in behavior, you need to investigate.  Yes, even for the person with dementia, especially if they are uncomfortable around certain people or there are behavior changes.  Dementia does change the way they see the world and their surroundings but the body retains it's ability to sense and react to danger well into the progression of the disease.  Caregivers often don't understand dementia and believe the person will not know the difference.  But they do know, and we have to be open to receiving the signals they give us.  Over more than twenty years in the industry I have observed how the demented person interacts with caregivers.  Every time the resident had a negative reaction to a caregiver there has been a reason.  Not every reason was abuse or neglect, but in every case I could identify a reason.

Other signs to be alert to:

• Weight loss - if getting a weight is not practical, look for clothing that seems too big and changes in the face.
• Dehydration - Look for red, irritated eyes, dry mouth and lips, dry skin, decrease or absence of voiding, and constipation.
• Sores - Bed sores and pressure ulcers.  These always occur in areas that bear weight.  A person in bed not regularly re-positioned may get them on their heels, buttocks, back, and shoulders.  A person spending too much time sitting up without re-positioning may get them on hips, buttocks, and thighs.  They are usually painful and often times smell of infection.  If you suspect a sore but are uncomfortable looking in these areas ask a trusted spouse, family member, nurse or friend.  The sooner it is identified the quicker it can be healed.  It is worth noting here that ulcers developed or present at end of life may never be successfully healed.
• Dirty home, apartment, or room - If part of the services provided is to include cleaning, look to see if it is happening.  Be alert for offensive smells.  Proper attention to cleaning will eliminate persistent smells.  Look at floors, bath rooms, and the kitchen.  These areas are typically the first to show signs.
• Hygiene - In my experience hygiene is a commonly overlooked area with oral hygiene being the most commonly overlooked or skipped service.  Be alert for complaints of mouth or tooth pain.  Monitor hygiene supplies, are they being used?  Are there bodily odors of sweat, urine, or feces?  Is the same towel and wash cloth in the same place for days on end?  Have finger nails been trimmed and cleaned?  Is hair combed and clean?
• Clothing - Do you see your loved one in the same clothing day after day?  Are clothes soiled?  Can you identify the most recent meal by the stains?  Are socks soiled?  Your nose can be an effective tool here as well.
• Lack of medical aids - Are eye glasses on and clean?  Are hearing aids in place and working?  Are braces or special orthotics in place?  Is the walker, cane, or wheel chair within reach?
• Medications - Are there medications missing or do you find they need refilled before they should be?  Have you been notified that medications need refilled on a regular basis?
• Caregiver behavior - Does the caregiver answer questions you ask your loved one?  Does the caregiver get defensive when you ask question about the care they provide?  Is there always an excuse why something was not done, or why something happened?

This is by no means an all inclusive list but it should help to put you in the right mind set.  If a service should be provided do a little investigating to make sure it is.  Show up unannounced at unexpected times.  Is there a used towel and wash cloth when you show up at 8:00 am?  Are there dishes in the sink after meal time?  Is the care giver coming in late or leaving early?  

If your loved one requires care and you are not personally providing it for them, be their eyes and ears.  If there is significant distance between you, many reputable Elder Care Consultants offer monitoring services to help you know what is, and isn't, happening.