Monte Sereno, California

Welcome to the City of Monte Sereno’s elder abuse and neglect website for Yeroushalmi Law. Our attorneys are experienced in nursing home and assisted living facility elder law cases. Long-term care facilities are responsible for maintaining the quality of life of their residents. We believe that the provision of poor quality of care to an elderly resident that results in negative health outcomes is reprehensible.

Dehydration among nursing home residents occurs far too often. According to a recent study, 6-month incidence of dehydration was as high as 1 in 3. Up to 1.4% of residents in a single nursing home are dehydrated. In Taiwan, fluid intake of 45% of residents was below the estimated requirements. Moreover, 7.8% of hospitalized older individuals are dehydrated.

Water-loss dehydration is linked to numerous conditions that are prevalent in older adults. Frailty, poor cognition, falls, delirium, disability, and mortality are just a few. There are a number of reasons why older individuals are so vulnerable. Due to age-related biological decline, older adults fail to develop thirst at the onset of dehydration. Kidneys lose their ability to retain fluid with age. Sarcopenia leads to low fluid reserves because muscle, the body’s major water storage organ, quickly degenerates in old age. Other common risk factors for dehydration in older adults is diabetes mellitus (which leads to fluid dieresis), polypharmacy and diuretics used to treat ankle edema, and excess sweating and hyperventilation due to infections or chronic obstructive pulmonary disease.

Nursing home staff should be highly adept at identifying residents who are at risk of dehydration due to reduced fluid intake. Although certified nursing aides utilize strategies to promote fluid intake and improve fluid-intake experience, dehydration remains an important reason for hospital transition. Effective screening tools should be used in nursing homes to determine residents’ dehydration risk.

Oral fluid intake should be increased to treat dehydration. However, this may be difficult to implement for older adults with dementia or other conditions such as dysphagia. Older adults should be drinking 2 to 2.5 liters of fluid a day with 20% coming from food to meet the minimum fluid requirement. Nursing home staff can use various strategies to increase fluid intake in residents such as flavoring water (with mint leaves, lemon, or orange zest) to make liquids more attractive and offering fruits and vegetables high in water content (i.e. watermelon, cucumber, etc). Although greatly underutilized, subcutaneous infusion can be used for residents who are unable to hydrate orally. This strategy is the easiest way to give fluids in nursing homes and can significantly reduce hospital admissions.

It should be noted that because death from dehydration is not an uncomfortable process, an individual with end stage dementia or who is actively dying in a hospital from other causes should be given the choice (or their responsible party) to limit fluid intake to whatever level is adequate to the person.

If you or a loved one has been abused or neglected in a long-term care facility, please contact the Yeroushalmi Law for a free consultation. We are prepared to advocate on your behalf until a just resolution is served.