There are many reasons that Maryland nursing home abuse and neglect might go unnoticed for a significant period of time. Often, the victims themselves are vulnerable or even disabled, making it hard for them to report or explain what is happening to them. In some cases, they may not even be able to understand it themselves. Sometimes, their loved ones visiting might suspect that something is wrong, but with some nursing homes limiting and restricting visitation due to the COVID-19 pandemic loved ones may be unable to check-in, and abuse and neglect may continue to fly under the radar. Precisely because this abuse and neglect can fly under the radar for so long, it can be shocking and heartbreaking once family members do discover it. Family members of an abused nursing home resident may find themselves wondering—what do I do now?

For example, take a recent account of a nursing home where multiple residents were found neglected or otherwise harmed. According to a news article, one of the incidents happened in March of 2020. A resident in the home was found to have a bruised face, with a huge gash on her forehead and a lump “the size of a golf ball,” according to her daughter. Police were called to the home to investigate and were concerned about possible abuse happening in the facility. A subsequent investigation found that between 2019 and 2020 there were 272 calls to 911 from the home, with a range of concerning incidents. For example, firefighters once found an injured resident alone lying on the floor and asking for help. When they asked why no one was helping, the woman in charge laughed. In another instance, a patient’s ventilator was not working correctly. Firefighters who responded found that none of the electrical outlets were working in the room. These are just some of the concerning instances that can happen in Maryland nursing homes and sometimes go unnoticed by authorities or loved ones.

When residents’ families discover this abuse or neglect, they often wonder what to do next to protect their loved ones, stop the harm, and hold the nursing home accountable. In the case of the nursing home above, police were called in to investigate. While calling the police can be an important step to take in these circumstances, it is important to remember that criminal charges, while they can hold the nursing home accountable for their harm, do little to actually help those most harmed by the facility’s actions. That’s why many families decide to also file a personal injury lawsuit. These lawsuits have the goal of helping those injured. While they cannot undo the damage that has been done, they can ensure that the victim and their family are given the financial compensation they deserve for their pain and suffering, their medical bills, and other related expenses.

Establishing causation in a Maryland nursing home case can be difficult, particularly because residents are often sick when they enter the home. With residents that were already sick, it can be difficult to prove that the nursing home’s neglect or abuse caused the resident’s injuries or death or accelerated them. Additionally, residents also may be unable to testify because they lack competency or have already passed.

A plaintiff in a nursing home negligence case in Maryland must prove that the nursing home’s negligent act or failure to act was both a cause-in-fact of the resident’s injuries and a legally cognizable cause. Proving the cause-in-fact means showing that but-for the nursing home’s negligent conduct, the resident’s injuries would not have resulted. In cases where more than one factor may have caused the resident’s injuries or death, Maryland courts use the substantial factor test. Under this test, a court will consider whether the nursing home’s conduct was a substantial factor causing the plaintiff’s injuries.

Proving that the defendant’s conduct was a legally cognizable cause means demonstrating that the defendant’s conduct was sufficiently related to the injuries that the defendant should be held liable. Courts may consider whether the resulting injuries were a foreseeable consequence of the defendant’s conduct and whether holding the defendant liable would be fair under the circumstances. A plaintiff must prove causation (and other elements of the claim) under the preponderance of the evidence standard, which requires showing that it is more probable than not that the defendant’s negligent act caused the plaintiff’s injuries. It is insufficient that it is a mere possibility that the defendant’s conduct caused the resident’s injuries.

Maryland residents who have loved ones in nursing homes have likely been particularly worried about their loved ones’ health, as well as nursing home abuse and neglect, during the COVID-19 pandemic. Due to the large numbers of people living in one area and the relative vulnerability of those living in nursing homes, it is perhaps not a surprise that the facilities have been hit particularly hard by COVID-19. Outbreaks have spread through nursing homes at alarming rates, and there are concerns that they have potentially been fueled by negligent staffing, medical neglect, and lack of proper sanitation procedures. Additionally, there have been high death rates of individuals living in nursing homes, with recent news revealing that those rates may have been undercounted.

Last month, New York State Attorney General Letitia James released a new report based on an investigation into nursing home policies that caused abuse and neglect and threatened the lives of residents and staff alike. One of the key findings in this report was that the number of nursing home deaths tied to COVID-19 has been undercounted by Governor Andrew Cuomo’s administration by as much as fifty percent.

Part of the problem that seems related to the fact that the state only counted residents who died on nursing home property, rather than including those who were transferred to a hospital. But the new report indicates that many deaths occurred in hospitals once residents caught COVID-19 in their nursing homes and were then transferred. For example, one facility reported five confirmed and six presumed COVID-19 deaths to the state’s Department of Health. But the same facility reported a total of 27 COVID-19 deaths at the facility itself and another 13 deaths in hospitals. Discrepancies like this were found in multiple nursing homes.

Nursing home abuse and neglect is, unfortunately, a rampant problem in Maryland and across the nation. While Maryland state law, recognizing this problem, allows individuals whose loved ones are injured by instances of nursing home abuse and neglect to file a civil negligence lawsuit against the negligent staff or home, many Maryland families may be unwittingly signing away this right. This is because nursing homes may often ask residents or their families to sign an arbitration agreement when the resident moves in. But Maryland residents should always read the fine print of these agreements very carefully and, generally, should avoid signing these arbitration agreements.

Arbitration agreements are essentially contracts stating that if any dispute comes up between the individual and the nursing home, it must be settled through arbitration rather than through a civil negligence lawsuit. Basically, nursing home residents who sign these can be barred from pursuing their case in court. And in most cases, arbitration is not an adequate substitute for having a case heard in court. Arbitration processes do not include a jury, may cap damages to way below what is available in court, and may limit a family’s ability to access or provide evidence of the abuse and neglect their loved one faced. Arbitration is also binding, with very little opportunity to appeal.

Importantly, the arbitrator (the decision maker in the process) is usually chosen by the nursing home, giving them an incentive to decide in favor of the nursing home. Nursing homes tend to like arbitration agreements for all of these reasons, as well as the fact that arbitration processes are covered by strict confidentiality rules, meaning that the nursing home’s abuse and neglect will stay hidden from the public. In contrast, filing a lawsuit against a nursing home provides plaintiffs with all the rights given to them by law, which may include the availability of larger monetary damages, a jury trial, access to more evidence regarding the abuse and neglect, and an impartial decision maker.

After the COVID-19 pandemic hit, many families were prevented from visiting their loved ones living in Maryland nursing homes. Visits often serve as a time when families can spend time with their loved ones, and also observe their loved one’s condition in-person. Some advocates claim that there has been a surge in reports of neglect among nursing home residents. Federal data reflects that almost 30 percent of nursing homes report staff shortages now across the United States. Nineteen percent of nursing homes in Maryland report a shortage of nurses and/or aides.

Federal regulations established through the creation of Medicare and Medicaid allow federal oversight of many nursing homes. Even before the pandemic, in surveys conducted from January 2019 through March 2020, 39% of facilities had incidents with suspected or alleged reports of abuse, neglect, or misappropriation of property. Yet, the Centers for Medicare & Medicaid Services (CMS) actually suspended survey activities last March except in some circumstances. More recent guidance allows for survey activities to resume if the state has progressed in its reopening plan or at the state’s discretion. Nursing homes have a responsibility to care for their residents, keep residents safe from harm, and prevent abuse and neglect. Claims can be filed against facilities in cases where nursing homes or staff members have abused or neglected a resident.

Local Group Calls for Reform of Nursing Homes

As arbitration agreements have become routine in many nursing facilities, questions may arise after ownership of the facility has been changed. Like other agreements, Maryland nursing home arbitration agreements can generally be assigned. An assignment of an agreement allows the assignee to “stand in the shoes” of the original party to the contract by granting all the rights the assignor previously had under the agreement.

A recent federal court decision considered whether an arbitration agreement could be enforced against residents after the facility had been transferred to new owners and new agreements had been signed. The case raised issues about when an arbitration agreement is properly assigned and transferred.

In that case, two residents entered a nursing facility in 2019. In April 2019, one resident entered the facility and signed numerous admission documents, including an arbitration agreement, though the agreement was not a condition of admission. The arbitration agreement stated that all claims relating to the resident’s stay were required to be decided through arbitration. In August 2019, the second resident was admitted and signed the same admission documents. In February 2020, the facility was sold and transfer to a new entity. A transfer agreement assigned the new entity as the assignee for certain agreements.

One of the reasons that Maryland nursing home abuse and neglect are so horrible is because they can fly under the radar for so long. Nursing home residents who are being abused or neglected may be cognitively impaired and not even understand what is happening to them, or have trouble letting other people know. Unfortunately, the COVID-19 pandemic has only exacerbated this problem, making it even harder for Maryland nursing home abuse and neglect to be identified and investigated.

The COVID-19 pandemic has hit nursing homes particularly hard, and many of them are hot-spots for the virus, with the unfortunate combination of group living and COVID-vulnerable residents. Extra precautions have been taken in many to prevent the spread of infection within the facilities, or from the facilities to the surrounding area. This led to the Centers for Medicare and Medicaid Services to halt on-site visits and surveys to state-run nursing homes, and, in general, investigators and those tasked with monitoring the facilities have not been able to enter nursing homes to respond to complaints.

Additionally, due to the COVID-19 pandemic, many nursing homes have restricted the visiting of residents. Before, family members played an important role in spotting nursing home abuse and neglect—they might notice red flags before anyone else. If they suspected that their loved one was being mishandled, not being given their medicine, or being underfed, they were able to report that concern or ask their loved one about it. But now, with COVID-19 concerns and restricted visiting hours and opportunities, family members may not be able to play this important role, and abuse and neglect might go unseen.

Many nursing home residents rightfully rejoiced this week as nursing homes began receiving vaccines for distribution. Long-term care facilities have suffered many of the COVID-19 deaths in the country. At least a third of COVID-19 deaths in the United States have been among residents and employees of nursing homes and other long-term care facilities. There have now been more than 20,000 cases of COVID-19 in Maryland nursing homes, group homes, and assisted living facilities and at least 2,200 resident deaths during the pandemic. Deaths in these facilities have accounted for about half of the state’s death toll.

According to a recent news report, CVS and Walgreens pharmacies are finally beginning to distribute COVID-19 vaccinations this week in the state’s long-term care facilities. Many residents are anxious to get vaccinated and end a long period of isolation from their families. Vaccinations have begun to be administered in facilities just as the conditions in the facilities have deteriorated again. According to the American Health Care Association and National Center for Assisted Living, there have been almost 20,000 cases and about 5,000 deaths per week in recent reports.

However, even as residents and staff are beginning to get vaccinated and celebrate this milestone, Maryland nursing homes and long-term care facilities must still take care not to spread COVID-19 in the facilities by relaxing precautions yet. Vaccinations are voluntary, so most nursing homes likely will not be able to vaccinate all residents and staff. Facilities may also have difficulty obtaining informed consent from patients who lack the capacity to make the decision on their own. Facilities will still have to protect residents who do not get the vaccine. In addition, it is not clear if the vaccine will be 95 percent effective among older people who are more vulnerable to disease in general.

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It’s hard to believe that Maryland nursing home abuse and neglect occurs. When individuals place their families in a nursing home, they expect that the home and the staff will take care of them, look after them, and keep them safe. Families place loved ones in a facility to be cared for because their aging family member can no longer care for themselves. That is one of the reasons the reality of Maryland nursing home abuse and neglect is so tragic, and it can be difficult for individuals to wrap their minds around.

A recent tragic example of nursing home abuse was reported last month, concerning a 91-year-old disabled woman. According to a local news report, the incident occurred late at night and into the early morning, when one staff member put the resident on the toilet inside of her apartment at 8:20 PM. The staff member instructed another caregiver to put the resident to bed once she was finished. But the caregiver never did. Instead, the resident was left on the toilet. She was not found until more than six hours had passed, around 2:45 AM, at which point she was on the floor. The whole ordeal was captured on video by a camera that her daughter had placed in her room. In the video, the woman could be heard moaning, crying, and repeatedly saying, “help me.” To add insult to injury, the two employees were caught on video surveillance cameras in a dining room, taking selfies for over an hour, according to an arrest report.

In addition, the resident’s daughter told investigators that this was not the first time her mother was left on the floor of her apartment. Once before, her mother had been left for five hours—a concerning pattern.

Nursing home residents may feel as though they have lost the ability to make decisions for themselves and that they have no rights when they enter a facility. This may be particularly true during the COVID-19 pandemic, when many nursing homes have limited the movement of residents and while many facilities struggle to meet resident needs. However, all Maryland nursing home residents have rights and legal protections, even during a pandemic.

Maryland’s Office of Health Care Quality monitors the quality of care in the state’s health care facilities. Under Maryland law, suspected abuse of assisted living residents must be reported to the Office of Health Care Quality. Reports of abuse can be made at 877-402-8219. Maryland’s Department of Health Long Term Care Unit investigates complaints of abuse and assists with the prosecution of abusers.

Under the Code of Maryland Regulation 10.07.09.08, Maryland nursing home residents are afforded some of the following basic rights.

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