Florida Nursing Home Abuse Lawyer

Attorney Lindsey Gale: There is a lot of evidence that is needed or can be used to prove nursing home abuse. The first and most important are the resident’s medical records. We go through the resident’s medical records with a fine tooth comb to see what care was or was not provided to the resident and determine if that failure to provide that care caused injury or harm to the resident.

Attorney Lindsey Gale: I think the number one change that needs to happen in the nursing home industry to prevent abuse is to increase the minimum staffing requirements. People prioritize cutting costs, keeping costs down. These nursing homes are a business. They’re not in the business of caring for people. They’re in the business of making money. And we need to go back to the time when these nursing homes were in the business of caring for people. And you care for people by providing them with the number of staff that they need to remain safe.

Attorney Lindsey Gale: In Florida, the steps to filing a nursing home abuse lawsuit is first you need to send what’s called a notice of intent to initiate litigation to the prospective defendant and let them know about what you’re alleging, what the claims are. There is a 75day pre-suit period where both the plaintiff and the defendant get to investigate the claims and determine if there is a claim and if it is worth trying to negotiate. There’s also requirements of what’s an unsworn statement and a pre-suit mediation where the unsworn statement they take a statement of the client to determine what they know about what happened. And then with the pre-suit mediation, the parties attend to determine if there’s a possibility of settling the suit prior to suit being filed. If the case is not able to be resolved in pre-suit, we go to the courts, we go online and file a lawsuit against the facility.

Attorney Lindsey Gale: There are a lot of different types of nursing home abuse cases that we handle. The most common types are bed sores or pressure sores where you leave a resident in bed for too long and fail to turn them. There’s a lot of cases involving falls, sexual assault, resident on resident abuse, medication errors. Some of the biggest warning signs of nursing home abuse aren’t until after the abuse is occurring. Usually, you will find your loved one in the nursing home and they will have an unexplained injury. And unfortunately, that is when a lot of the times the family even discover the abuse.

Attorney Lindsey Gale: Understaffing contributes to nursing home neglect and abuse because the problems occur usually when there are not enough staff in the facility to provide the care that each of these residents need to remain safe. If there aren’t enough staff members there, the resident who needs to be turned, the resident who needs to go to the bathroom will not have someone there to help them do that.

Attorney Lindsey Gale: Family’s documentation of injuries or behavioral changes is so important in these nursing home cases. If I talk to a family member while their loved one is still in a nursing home, I tell them to get a notepad. I’ll give them a notepad and tell them to write everything down every interaction. And I also tell them that if they’re going to be interacting with any of the staff at the nursing home to ideally have it in writing and give it to me because if it’s not documented, it’s not done. And we tell that to the nursing home staff all the time. And so that also applies for our clients and what they’re saying happened.

Attorney Lindsey Gale: Families regular visits and communication with the nursing home is so important. It’s crucial to ensuring that their loved one remains safe in the nursing home. The reason it does this is because the staff at the nursing home know that there are going to be people checking up on that resident and making sure that they are safe and cared for and taken care of. They know that these people are not just being thrown in the nursing home, that someone is checking in on them.

Attorney Lindsey Gale: Poor hygiene and bed sores can be considered neglect because they are leaving these residents in their own feces. They are not bathing them. They’re not turning them. They are leaving them in bed helpless and they’re not doing anything. And they’re not providing them the care that they tell the family members and the residents that they’ll provide for them. And they’re not doing that.

Attorney Lindsey Gale: Nursing home abuse cases are sometimes settled out of court. The goal is to always get a resolution for the client that is beneficial for them and that makes them feel they have some closure in a horrible situation. And if we’re able to do that without going to trial, we will do that. But if the facility, the defendant, the nursing home is unwilling to pay what the client deserves, then the case has to go to trial.

Attorney Lindsey Gale: Expert witnesses are often retained in nursing home cases. There are different types of witnesses, experts that we retain. There’s nursing experts to review to see if the nursing home provided care within the standard of care as the nursing home’s required to do. And there are also experts that we retain if there is a death in the case to determine if that abuse or neglect caused that resident’s death.

Prior complaints against a nursing home absolutely help us to prove a case. We want to prove patterns, not an isolated incident. Isolated incidents are one thing, and it’d be great if something was just an isolated incident, but it rarely is. If you see one, then chances are you’re going to see two, you’re going to see three, you’re going to see four. And so we track things in these nursing homes, like the number of residents that have pressure sores, pressure sores that were acquired in-house. But if you’re not an experienced nursing home lawyer and you don’t know what to ask for, and you don’t know what’s in the records that aren’t just the regular medical record, how are you going to tell that story? How are you going to get to the why? That’s why you need to hire an experienced nursing home lawyer and why you need to hire us.

Nursing home inspection reports are, again, a valuable tool to see what it is that’s going on at a particular moment, and it’s a way of tracking patterns. Are they having the same violations time and time again? Are we seeing lack of staffing that’s going on? Are we seeing an increase in pressure sores happening in that nursing home? An increase in infections? It is a piece of the puzzle that we look at in order to tell this bigger story.

Residents in a nursing home have several rights that are mandated by law. The most important right is to be treated fairly, to be treated adequately, and the right to good medical care. That is the nursing home’s obligation. It is the promise that they make. It is why people feel comfortable saying, “I’m going to put my mom, I’m going to put my dad here.” And if they break that promise, your mom or your dad is hurt, then we’re going to hold them accountable.

Staffing records are an incredibly important part of our proof of a nursing home neglect case. When I first started doing nursing home cases, the staffing stuff was all on the old cards, and I’d have to sit down for hours, and I would create these charts of days of the week, hours that were worked, and all of that, and a story would be told. Days of gaps of not enough employees, or the same employee working 70-hour weeks, week after week after week. How are they possibly going to be able to give good care when they’re tired down and worn out? Now it’s easier for us to do that charting because everything is done through the computer, but this all tells us a story of what happened. And really, what we’re often looking for is not just what happened, but why it happened. And that often takes us back to this truth. Why abuse and neglect happens in a nursing home to our loved ones is because somebody is trying to save a buck, and they’re putting profits over the patient’s safety.

Nursing home incident reports can be very important. Unfortunately, what happens is the nursing homes try to hide behind certain legal maneuvering to prevent us from getting those incident reports. They direct, “Don’t put these into the medical records.” They tell their people not to talk to the family about them. “Don’t tell them the truth.” That’s always the default, right? Don’t tell the people, the family, the truth about what happened. That’s why you need to hire us, because we’re the ones that are going to get to the truth for you.

Photos are incredible evidence in these cases, and if you suspect that there is nursing home abuse or neglect, absolutely take photos. They are the best evidence.

So medical records in a nursing home abuse case are incredibly important. We need to get all of the medical records from the nursing home, any doctor’s visits that are there, any hospital visits. And we kind of go through a process that’s there. Let’s take a pressure sore case, for example. And often for our nursing home residents, they’ll have been in a hospital, then to a nursing home, then back to a hospital for something, to a nursing home. So what we’re looking for is where did that pressure sore start? Did it start in the hospital? Did it start in the nursing home? When it started, what was done to address the development of the pressure sore? How did they deal with it? Did they do what they were supposed to be doing? So we create a timeline of the development of the different thing. If it’s a wound infection, when did the wound start? Was it documented? Oftentimes, for example, on a pressure sore, the first documentation that we will see in the record is a pressure sore at a Stage 3. Well, that means that it went through Stage 1, the redness, and Stage 2, which was the initial breaking of the skin, down into a deeper wound without anybody noticing it. What does that tell you about the quality of care that is being given and the attention that is being paid to that resident? So it is important to know how to look through these records. It is important to hire a lawyer who is experienced in looking into these records, and often it’s not just what is in the records, it’s what’s not in the records that helps tell the story. And it’s only somebody like me who’s looked at hundreds and thousands of these records over the course of a career that can really tell the difference.

Poor wound care is absolutely nursing home neglect. We see this all the time. Bandages that aren’t changed for five, six, seven, eight days. Medication that’s not being given, wounds not being cleaned. And something that should have been just a small minor inconvenience healed up in a week, turns into a raging infection, becomes septic, and they die.

Pressure ulcers are preventable. There are certain times where they are not. There are patients with advanced cancer, advanced nutritional needs, or some folks that are unable to be turned for whatever reason. That is a small percentage of the nursing home residents. In virtually every other resident, if they develop a pressure sore, it was an avoidable pressure sore, and it happened because the nursing home wasn’t doing the job that they were collecting money and making a promise to do.

Pressure sore cases or bed sore cases, there are different levels of those types of injuries. You have a stage one, which is just some redness. That’s usually not sufficient for a lawsuit. It’s usually when we see that it has broken through and has moved down through the layers of the skin and you start to see bone. One of the things that’s really difficult about these pressure sore, bed sore types of cases is people when they come in, they’re not pulling the sheets and the blankets off of their loved one. They’re not rolling them over saying, “Let me do the inspection on you.” They’re trusting the nursing home to do the job that they are supposed to be doing. Under federal and state regulations, an unavoidable pressure sore is what they call a never event. It should not happen with good care. It only happens because the care was substandard.

Bedsores, we see those unfortunately weekly in cases that are brought to us. And what is a bedsore? I hate the term bedsore because it’s really a pressure sore. It is caused by pressure because somebody is in their bed or left in a chair, they’re not turned adequately to relieve the pressure. The skin starts to break down, and you go through different stages of that, and we’ve seen these cases where the pressure sores are down to the bone. They become infected, lead to sepsis, and can lead to death. If you see something like that, call me right away. Call the Agency for Healthcare. Get the doctor and get them the heck out of there because that just is an absolute sign of neglect that is happening, and you can’t afford to leave that loved one in that nursing home for another day.

Neglect in a nursing home can often lead to infections. Nursing home residents, older folks, their skin is thin. They rub up against something, it can get an open wound that happens. If it’s not cleaned, if it’s not cared for, places like that are just hotbeds for bacteria and other germs to be able to get in there and cause that infection. And so particularly with older folks who you want to make sure that things don’t happen to start with, because once things start happening, it’s much harder to get them back on track than it might be for somebody who is younger and healthy.

So the warning signs of dehydration or malnutrition in a nursing home, you start to see sunken cheeks. You start to see crusting around the mouth from the dehydration. You start to see sort of a dullness in somebody’s eyes. They stop moving as much. They’re not as active. Obviously, the weight loss that you start to see, sunken cheeks.

Malnutrition is absolutely grounds for a lawsuit in a nursing home. One of the very first nursing home cases that I ever handled in my career 30 years ago, the patient had premature Alzheimer’s, 65 years old in the nursing home, and his wife would come to visit him every day. They had two daughters that both lived up in New York, and both of them were giving birth within a month of each other. Mom says, “I’m going up to New York to be with them for the birth of our grandchildren,” and she takes a picture of her husband to take to the two girls to show them, look how wonderful dad is doing. She comes back six weeks later. He had lost over 40 pounds in that six weeks. They weren’t feeding him. They were bringing him his tray, taking away a full tray. And that case was revealing to me because I was young. I didn’t really understand what it was that was going on. And I saw that and I’m like, “Oh my gosh, I had no idea that this is what happened.” And so a big motivator for me to say, I’m going to take on these cases, and I’m going to do all I can to make sure that people who are helpless, who need the help of others, who are being promised, families that are being promised, we’re going to take care of your loved one, we got this, that people live up to those promises, or they’re going to be held accountable.

Dehydration is one of the primary types of cases that we see that’s an absolute sign of neglect and abuse in a nursing home. It is their job to make sure that people are adequately hydrated. It’s one of the biggest problems that we have, is that these residents in there are not drinking enough. They’re not being given enough fluids that are there. They’re supposed to be tracking how much is coming in, how much is coming out. If they’re not doing their job, dehydration, we see it, and we know what the effects of that can be.

If a resident suddenly becomes withdrawn, suddenly becomes fearful, obviously, the first thing you’re going to try to do is talk to them. What’s going on here? You want to speak with the people who are in charge of the facility, speak to their doctor, get the doctor in to see them. Those changes can be a sign of a disease process, natural aging, or it could be a sign that they are being subjected to abuse. And of course, if your gut is telling you it’s abuse, give me a call. We’ll find out the truth.

Verbal abuse by a nursing home staff can lead to a lawsuit. Unfortunately, it’s among the most difficult of the cases. In the early 1980s, there was a grand jury that was empaneled in Miami-Dade County to look into nursing home abuse and neglect. Out of that came what is called Chapter 400 in the state of Florida. It’s statutes specifically designed to protect nursing home residents. One of the key factors that was in that was that if the nursing home resident prevailed on a case against the nursing home, that they could collect attorney’s fees. So if you had a case of emotional abuse or neglect, or verbal abuse or neglect that didn’t really result in physical injury, it’s a hard case to take because the value of it in front of a jury is probably not going to be that large. You’re not going to get a big verdict. So the legislature recognized, important to vindicate those rights, so we’re going to give the ability for the attorneys to be able to take these cases through having the attorney’s fees transfer. In 2003, 2004, they changed that law. They took away the attorney’s fees. They did other things as well, and in fact, now nursing home residents have fewer rights in Florida than they did before that grand jury convened. So this whole history and whole story of nursing home residents’ rights and who it is that is being protected, is it the residents that are being protected, or is it the people who are taking the money out of the system that are being protected? We know the answer to that. We’re seeing that happen today. We’ve seen the pardons of these folks who stole money from the nursing home system. They were convicted of fraud. They’re getting pardoned. What is going on here?

Signs of emotional abuse in a nursing home resident are things like you see them withdrawn, you see somebody teary, crying constantly, fear. Those are the things that you’re going to see with emotional abuse. Somebody, a caregiver gets in the room, and all of a sudden, there’s a change in your loved one’s behavior because they’re afraid of them.

Emotional abuse in a nursing home absolutely can be part of a legal claim. It’s hard to prove. It’s really hard to prove, particularly if you have a patient who suffers from dementia, from Alzheimer’s, getting them to be able to tell the story that’s there. And that’s why you need to hire somebody like me who’s handled a lot of these cases, because we can see the signs, see the clues, follow the path, get the witnesses to establish that case. But under both federal and state law, there are specific rules that preclude and prevent emotional abuse.

So physical restraints in a nursing home can have a very broad definition. For example, bed rails can be considered a physical restraint. Then there are straps that are utilized in nursing homes as well. There are rare occasions when those types of restraints are appropriate, but they are only appropriate when there is a thorough and appropriate evaluation and the order is given for the benefit of the patient. It is never appropriate when it is not done based on a thorough evaluation by an appropriate healthcare provider, and instead it is done for the convenience of the people who are running the nursing home because they’re refusing to invest in adequate staff. That’s never okay. It’s against the law.

Chemical restraints absolutely can be considered nursing home abuse. In the appropriate case for the appropriate patient based on a doctor’s evaluation and a doctor’s order for the benefit of the patient, you can use chemical restraints. But absent that, if they’re being used, not because a doctor has done a thorough evaluation and it’s for the benefit of the patient, but rather the nursing home is saying, “Hey, I’m going to go ahead and drug this person up so that they lay in bed and they don’t bother me, and I don’t have to deal with them.” That’s abuse, that’s neglect, and it’s wrong.

Over-medicating a nursing home resident is absolute abuse. It’s absolute neglect. There is no excuse for it. And in fact, it is against the law to use medication to sedate a patient for the convenience of the caregivers that are there. One of the ways that they deal with them not investing in having enough staff who are properly trained is, “Oh, let’s go ahead and sedate the patients, and they’ll sit in bed, and we don’t have to worry about it.” That is against the law. If you see something like that happening, don’t walk, run, call me, and we’ll take care of it.

Common signs of medication neglect in a nursing home may be sudden change in consciousness, where somebody was talking, walking, and communicating, and all of a sudden they’re not. That could be a sign that they’re getting too much medication. Pain can be a sign of it because they’re not getting the medication that they need. A lot depends on what is the medication for, and are you seeing that thing that it’s for being taken care of, or are you seeing it not being taken care of, and if it’s not, why?

Medication errors in a nursing home can lead to lawsuits. What we see often is residents will come in with orders for medication. Those medication orders aren’t filled. We will see medications that are ordered that are filled, but they’re not given to the patient. We’ll see where they’re given more than they should be given. So all types of things happen with medications. If they don’t do what they’re supposed to do and your loved one is hurt due to one of these medication failures, give me a call.

The number one thing that a nursing home needs to have to protect all of their residents, but particularly residents who are suffering from dementia, Alzheimer, or other memory disorders, is sufficient staff to meet their needs. That is the law, that they must be sufficiently staffed to meet the needs of the residents who are in that facility. And that’s where it all starts with is staffing. Most, if not all, nursing home cases, in my experience, the root cause of it is that the people who ran the place were trying to save money, and they weren’t staffing based on the needs of the patients. And so this is where we get into this really crazy scenario. So the government has minimal staffing standards, but there is a dramatic difference between the needs of a nursing home. Let’s say you have 100 patients in a nursing home, and none of those patients have any memory problems, and only 10 of them are fall risks. Think about the need of that population where I’ve got a nursing home with 100 patients, 95 of them are at risk for falls or risk for elopement or that type of thing. What is the difference that you think that we need to look at in staffing? Is minimum staffing going to be adequate for this scenario? Of course it’s not. That’s why the law says we have minimum staffing, but they are required to constantly be evaluating the actual care needs of the residents who are in the facility and staff to those needs. And time and time and time again, they do not do that.

Dementia patients are at higher risk for nursing home neglect and abuse because they’re not able to tell their story, and people aren’t going to believe them. So if they get hit, if something bad happens, and you come in and you say, “Hey, mom, what happened? Dad, why do you have these bruises?” They’re not going to be able to reliably tell you the story. That puts them at higher risk.

Nursing home elopement is a fancy way of saying that a nursing home resident walked outside of the facility without anybody knowing that they had left. That is a no-no. That should never happen. The nursing home is responsible for making sure that people are safe, and that includes not allowing them to walk away. Often, they’ll say, “Well, they’re entitled to do whatever it is that they want to do.” And we all have our freedoms, but the reason the person is in the nursing home is because they aren’t often having the ability to think clearly for themselves, and the nursing home is making that promise and collecting money. They’re not doing it out of the goodness of their hearts. They are collecting money and making profit, and the deal that they are making with you is, “Don’t worry about it. We got this taken care of. We will protect mom, we will protect dad.” And part of that is saying, “We’re going to make sure that they don’t walk out into the street. We’re going to make sure that they don’t walk out of here and fall into a canal, fall into a river, get eaten by an alligator,” which has happened. That’s their job.

A nursing home can be liable if a resident walks away. You put your loved one in a nursing home because they can’t be cared for at home. And what’s the promise that they’re making? The promise the nursing home is making is that we have the resources, we have the people to make sure that your mom, your dad, are safe. And part of being safe is not allowing somebody who’s suffering from dementia or Alzheimer’s, or is otherwise infirm, from just walking out the front door and walking into traffic, or we’ve had cases where people walked away and they fell into canals or rivers. Really bad things can happen.

First thing that a family should do after a nursing home fall is make sure that their loved one is okay and getting the healthcare treatment that they need. If they need to go to the hospital, they need to go to the hospital. If they’ve fallen and hit in their head, always go to the hospital. Always get that evaluated because falls where people hit their head can lead to brain bleeds. It can lead to some really bad things happening, and you just can’t tell by looking at somebody whether or not that’s going on. So you always need to get that investigated. You want to make sure that your loved one is getting a head-to-toe assessment. Is there any pain that’s happening? If there is, let’s figure out what’s causing it. Did they fracture something? And you got to be really careful about it because study after study shows that nursing home patients and elderly patients that suffer fractures, their death rate within a year of that fracture goes up dramatically. So it’s not just about treating the fracture. Prevention, prevention, prevention is everything.

Broken bones in a nursing home are often a sign of abuse and neglect in a nursing home. It’s a sign of a fall, could be a sign of a physical attack, and it’s often hard to make that determination on your own as to whether or not it is something that just happened. And sometimes people’s bones are so brittle and so weak that they can just move in the bed and it can cause a fracture. That’s a very limited time of it. Most of the time, it’s because they fell. And what we see in our cases often is a documentation of somebody says, came into the room, found the patient in bed complaining of terrible pain, and they’ve got a hip fracture, or they’ve got a through and through fracture in their leg. They say nobody saw it. Well, you know what had to happen? That person fell on the ground. Somebody picked them up, put them in the bed, and walked away from it. If that isn’t an admission that they did something wrong, I don’t know what is.

When a nursing home resident has unexplained bruises, it can mean a lot of things. One, it can be benign. Older people, their skin is thinner. Bruising can happen just from banging against the back of a chair. But we’ve all seen that. We know what that looks like. And then there’s the bruising that happens because somebody fell, or bruising because somebody was hit. And that happens in nursing homes, not just because of an employee doing it, but oftentimes there are other residents in there that are violent, and they can come into people’s rooms and they’ll hit them, not because they intend to, but just because they can’t control their impulses. But the nursing home is responsible for knowing who their residents are and making sure that that doesn’t happen.

Falls in a nursing home are not always considered neglect. There are some times that there are people who legitimately aren’t fall risk, but maybe they caught their foot on a chair, or they got caught up with another nursing home resident. So just like in life outside of a nursing home, sometimes things happen, and it’s not because anybody was doing abuse or neglect. But often, trying to figure out in a nursing home where you’re not there, what really happened, and you’re dealing with people who often aren’t able to tell the story themselves because of memory issues. I suggest to people call a nursing home abuse and neglect lawyer who’s experienced in that area, let them investigate, and let them let you know whether it’s abuse or not.

A nursing home can be held responsible for repeated falls, particularly when they result in injury. Unfortunately, most of the people who are in nursing homes, they’re older, their bones aren’t as strong, and so they’re more susceptible to injury when they fall. And there are whole ways that the nursing home is supposed to evaluate a person for, are they a fall risk or are they not a fall risk? Once you evaluate somebody at a fall risk, then there are a whole bunch of precautionary measures that are supposed to be taken to prevent them from falling and prevent them from hurting themselves. If somebody has fallen a couple of times, or one time even, and they weren’t hurt, you’re lucky that they weren’t hurt, but the chances of them falling again are high. So complain to the people that run the nursing home. “There’s been a fall. What are you doing to deal with this to make sure there’s not another fall?” So, the old thing of the squeaky wheel gets the oil, be the squeaky wheel.

Nursing home abuse complaints are investigated by a couple of people. You can make complaints to the Agency for Healthcare, which will come in. CMS, which is the federal government, Medicare and Medicaid, they will come in and do reviews as well. But really, if you want an in-depth review and a real review of whether or not there was abuse and neglect for somebody that’s important to you, you need to call me. It’s only an experienced nursing home abuse and neglect lawyer that is going to find out the truth, that’s willing to dig as far as needs to be in order to get the answers.

You should report nursing home abuse to the authorities as soon as you suspect it. That’s their job, is to investigate these types of cases, and if it ends up not being a case, better to have made the claim and let it be investigated and turn out not to be true, than to have been silent and allow abuse to go unaccounted for.

If a family suspects nursing home abuse, they ought to do a couple of things. They ought to yell from the rafters. They ought to be saying, “I want to speak to the people that are running this place.” They ought to call the agency for healthcare that’s responsible for overseeing the nursing home and letting them know about the complaints, and they ought to call me.

Oftentimes people are asking me this question: Is this a case of nursing home abuse or neglect, or is this just what we can expect to happen in a nursing home? Oftentimes, that line is not a clear demarcation that’s there. That’s why you have to hire a nursing home abuse lawyer, somebody who’s experienced like we are in evaluating these cases. Listen to your gut. If you’re walking in and you’re feeling like something didn’t happen right here, call us. Let us investigate it, and we’ll give you the real answer.

There are several warning signs that a loved one may be abused in a nursing home. There is noticeable loss of weight that you see. There’s fractures from falls, the development of pressure sores. Things like that are what we see primarily as the cardinal signs. The other thing that’s more subtle than the injury is when you walk into the nursing home and nobody’s there, right? The hallways are empty. Where’s the help? You push the call button for somebody to come, that person needs to go to the bathroom and they need assistance, and it’s 15, it’s 20, it’s 25 minutes before they come there. And if that’s happening when you’re there, imagine what’s happening when nobody else is there. Or better yet, what’s not happening.