Pain of Nursing Home Abuse – Suffering through Elder Abuse

Insufficient care and medical negligence can cause undue pain and suffering to patients in nursing homes. A form of elder abuse, pain and suffering of elderly patients is very real, but can be difficult to detect and even harder to prove in a court of law. Greenville attorney Andy Arnold learned about the pain and suffering of elderly patients when he handled his first nursing home neglect lawsuit. Not only did this South Carolina nursing home neglect lawsuit result in the largest verdict (at the time) in Union County, but it also changed Andy Arnold's law practice.

In this section of the nursing home guide, Andy Arnold discusses the suffering associated with pain for elderly patients and gives you warning signs.

Patient Pain and Suffering

Pain is defined as "an unpleasant sensation, occurring in varying degrees of severity as a consequence of injury, disease, or emotional disorder." Pain is a common and treatable condition among the elderly. Even though pain is a familiar ailment of the elderly, it is not normal. Unfortunately, many assume that pain is just a normal part of growing old and consequently pain suffered by the elderly is frequently ignored, unnoticed or under treated. Pain can be one of the most exhausting and overwhelming side effects of aging. If pain is left untreated it can lead to depression and poor self-esteem and can affect the quality of life.

Recent studies show that severe pain among nursing home residents is prevalent, persistent and poorly treated. Our ability to recognize pain suffered by a loved one, to monitor the treatment of the pain, and to understand the full range of consequences of pain will make us better able to protect those we love.

Pain for Nursing Home Patients with Alzheimer's Disease or Other Dementia

An expert in forensic psychiatry, pain management, and pain medicine explained to me that an individual with severe dementia (such as Alzheimer's) cannot reason through their pain. Pain torments those with dementia. The expert further explained that an individual with dementia who experiences pain also experiences fear and anxiety. Fear and anxiety lower the threshold of pain thereby increasing the sensation of pain felt by those with dementia. The increased sensation of pain increases fear and anxiety, which in turn lowers the threshold of pain, creating a vicious cycle of suffering.

Expression of Pain

Sometimes the best indicator of pain is what the person says or expresses. The person with pain is the expert about his or her pain. Recognizing pain in people who experience cognitive impairment can be a matter of noticing differences in their behavior. There is no test or exam for pain and people respond differently to pain. People express pain in different ways: some cry out, some stay still, some try to bear pain without showing it, some frown and some look sad.

During one study, researchers videotaped the facial expressions of participants during a procedure. The people with dementia were five times more likely to use facial expressions than cognitively normal patients. The study concluded that even though people with dementia did not show the same response as people who were cognitively intact, both their behavioral and physiologic responses indicate they were feeling pain. Thus, increased heart rate, confusion, anger and irritability might signal underlying pain that is not being treated appropriately.

Pain Management for the Elderly

Pain management is the systematic study of clinical and basic science and its application for the reduction of pain and suffering. Pain management is a newly emerging discipline with a goal of reducing pain.

There are some reasons why pain management in the elderly is considered tricky business. First, elderly people usually have multiple medical problems and a determination has to be made as to which health problem is causing the pain. Memory impairment can also create a problem in pain management. Additionally, there is an increased possibility of side effects of medications in the elderly. However, these problems should never hinder the proper assessment, treatment and management of pain. Pain should be treated wisely, appropriately and aggressively.

A "team approach" to managing pain in a long-term care facility works well. First, the administrator of the facility should establish a "team approach". The administrator is also the person at the facility who is responsible for enforcing the appropriate state and federal rules and regulations. Second, the nursing supervisor should oversee the pain management plan and should educate the staff properly about the pain management plan for the individual patient. Finally, the nurses must carry out the pain management plan and observe the patient.

Recognizing and Acknowledging Pain in Nursing Home Residents

The primary caregivers, who work closely with the residents helping them do all the activities of daily living, should be able to identify when someone is in pain. While nursing assistants do not administer pain medication, they are usually the primary caregivers in this setting, providing 90 percent of the direct care in nursing homes. But if the caregivers do not recognize pain in the resident, there is a breakdown in system of effectively managing pain.

Nursing home staff more often than not underestimates the pain that the residents experience. A solution to the problem of nursing home staff underestimating pain would be to educate nursing home staff, especially the nursing assistants who are typically the least trained, so that they might better identify pain and manage pain. It takes an attentive and enduring caregiver to notice pain, observe the trial of treatment and relieve pain. Pain needs constant reassessment. Pain assessment in nursing homes should be the "fifth vital sign", regularly checked.

Questioning Some Pain Assessment Studies

Because nursing home staff often underestimates the pain that residents experience, you should be leery of studies and research resulting from data collected by nursing home staff. The Minimum Data Set (MDS) is a nationally mandated nursing home resident assessment instrument, which is used to collect details on residents including assessing pain symptoms. In December 2000, the Inspector General (IG) of the US Department of Health and Human Services issued a report wherein it suggested that the MDS document and the process are flawed. The Inspector General recommended that the Health Care Financing Administration work with the nursing home industry to provide enhanced and coordinated training to nursing homes.

Monitoring Pain and Avoiding Potential Elder Abuse

Here are some questions you can ask to help determine if a facility may be treating pain adequately: Does the facility require periodic assessments of possible pain? When potential pain is identified, does anyone respond? Does the response to serious pain include opiate drugs on a regular schedule?

I would suggest that family members inquire about the pain assessment, treatment and management policies practiced by the nursing home or long-term care facility. I would also recommend that the family get involved as much as possible in the pain management plan of their loved one. You as a family member should be a strong advocate for your loved one to ensure that they receive proper and adequate pain relief.

Family members pay attention to signs of pain: Facial expression, confusion, and moaning. Take notes.

Using Nursing Home Abuse Laws to Remedy Pain and Suffering

The law provides a remedy for pain and suffering. These damages are as real as lost wages and medical bills, although providing juries with a way to quantify and calculate damages for pain and suffering can be a challenge for a lawyer. It is just another reason finding an attorney experienced in representing victims of nursing home abuse and neglect is important.

Based in Greenville, South Carolina nursing home abuse lawyer Andy Arnold has experience successfully proving pain and suffering in a case of elder abuse due to neglect. Contact our aggressive nursing home neglect attorney for a free elder abuse consultation.