The medical director's role: neglect in long-term care.

Elder mistreatment is a significant problem in nursing homes. Analysis of databases generated from annual state surveys and formal complaints showed that more than 30% of the nursing homes in the United States were cited for abuse violations that had potential for significant harm to residents. Many frail elders are fearful of residing in facilities because of concerns involving mistreatment. Allegations of neglect constitute a significant portion of elder mistreatment. In general, neglect of a resident typically involves the failure to provide life essentials such as food, water, medication, comfort, safety, personal hygiene, clothing, and other necessities as required by the individual’s physical condition. The US Code of Federal Regulations establishes requirements for care of long-term care residents (42 CFR Part 483). These requirements include the charge to maintain a resident’s functional status and to prevent medical problems that are commonly present in cases of neglect. In the nursing home, poor care or care below accepted medical standards may result in signs and symptoms of neglect. Signs of neglect may include dehydration, malnutrition, pressure ulcerations, poor hygiene, and contractures. For the year 2004, complaints of gross neglect reported to the National Ombudsman Reporting System (NORS), made up 0.9%, or 2056 of 227,721 complaints. Twenty-nine percent, 65,075 of 227,721, of the complaints under the “resident care” category, included improper handling, delayed assistance, care planning, contractures, pressure sores, and unattended symptoms. Some of these complaints could also qualify as neglect. Incidents of neglect are underreported, especially given the difficulties inherent in defining and recognizing this type of mistreatment.