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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When Joe Biden is sworn into the office of the President of the United States, there are going to be some major changes. Indeed, he and President Trump clashed on many of the most important issues facing the country. However, one very important issue that got relatively little attention was how a Biden administration might impact Maryland nursing home arbitration agreements.

Arbitration is a way for litigants to settle a claim out-of-court. Instead of filing a case in court and letting a judge or jury decide the outcome, in arbitration, a neutral arbitrator hears the evidence and issues a binding decision. While this may seem good in theory, it often works in favor of nursing homes, who get to choose the forum and are intimately familiar with the rules of arbitration. Additionally, there are generally very few ways to appeal an arbitrator’s decision, limiting a resident’s ability to obtain any form of judicial review. For these reasons, and others, many nursing home residents end up at a major disadvantage when they are forced to arbitrate their claims.

During the Obama administration, the Centers for Medicare and Medicaid Services precluded nursing homes from asking residents to sign pre-admission arbitration contracts. The reasoning behind this was that nursing home residents and their families may not be in a position to negotiate the terms of the agreement, and would likely just accept them, even if they are against their interest.

Although there has been significant attention given to the risk and prevalence of COVID-19 in nursing homes throughout the pandemic, the pandemic may be the cause other detrimental circumstances suffered by Maryland nursing home residents. According to one news source, advocates say that workers in nursing homes that are overburdened because of the pandemic have not been able to properly care for residents and that many are suffering as a result. Advocates say that there has been a surge of reports of neglect, including residents being left in dirty diapers until their skin peeled off and others with bedsores that cut to the bone. In addition, some residents’ mental health has significantly declined because of their prolonged isolation, which some believed led to their death. One expert estimated that for every two COVID-19 victims in nursing homes, another died prematurely due to other causes.

The numbers suggest that other residents who were lucky enough not to contract COVID-19, were also impacted—as staff attended to infected residents or because staff members were absent because they were infected themselves. A 75-year-old man became so malnourished and dehydrated that his weight dropped to 98 pounds. There were signs of an untreated urinary infection, poor hygiene, and that he was not getting the help he needed to eat. His son claims that the nursing home abandoned his father. An 83-year-old woman in another nursing home died from dehydration, according to her daughter. As COVID-19 spread throughout her facility, while she did not contract COVID-19 herself, staff members failed to ensure she was drinking enough fluids. Federal data reveals that almost 1 in 4 nursing homes report staff shortages now in 20 states.

The Rights of Maryland Nursing Home Residents

A Maryland nursing home resident has the right to be free from abuse and neglect and live in a safe facility. A Maryland nursing home claim can be filed in cases where nursing homes or their staff have abused or neglected a resident. Some potential signs of abuse and neglect are bedsores, unexplained injuries, insufficient funds, and fear of certain persons. Signs of neglect may include poor personal hygiene, lack of mobility, unexplained injuries, unsanitary living conditions and inadequate security, physical symptoms from lack of nutrition, and psychological issues, including anger, resentment, and depression.

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Abuse and neglect can, unfortunately, run rampant in Maryland nursing homes, putting residents in danger of serious injuries, illness, or even death. Oftentimes, incidents of abuse and neglect may go unnoticed or unreported, and residents or families of residents may have no idea of the extent of the problem. If, for example, 20 residents are all being abused or neglected in subtle ways not recognized by their families, family members may think their loved ones are in a safe facility and well taken care of when in reality they are not. Even if individual family members realize that their loved one is being harmed, they may assume that it is an isolated incident, or chalk it up to an accident. This is one of the key reasons that nursing home abuse and neglect in Maryland nursing homes can go on for so long and cause so much harm.

According to a recent news report, a group of about 15 people gathered outside a nursing home decided to speak out against the alleged abuse and neglect that their loved ones suffered during their time at the facility. The group believes that the situation is a crisis. For example, one woman’s father claims he was punched by a nursing home staff member. His family also found multiple bruises going up and down his body, which suggested that he was carelessly slung into a wheelchair. In addition, family members believe that residents are not being fed properly. One woman told reporters that her father lost almost 50 pounds, and that she believed “they are not feeding these people. They are starving them.” Another woman reports that her 76-year-old mother, who uses a wheelchair, has had three major falls in just seven months, including one where she broke her femur.

As explained above, it can be difficult for families to uncover nursing home abuse and neglect. But when they uncover these tragic and alarming instances, state law allows them to hold the nursing home accountable through a Maryland personal injury lawsuit. These lawsuits can be incredibly valuable for victims of abuse and neglect and for their families. If successful, they can result in large monetary amounts awarded to the plaintiffs to cover the harm that was caused, including for medical expenses, pain and suffering, or even funeral and burial costs if the resident dies.

Many Maryland families will one day make the decision to place a loved one into a nursing home, if they have not already. As the population ages, nursing homes are becoming more and more necessary for individuals who can no longer care for themselves and need assistance in their daily activities. While many residents may have pleasant experiences in their nursing homes, the tragic fact is that nursing home abuse and neglect are still common occurrences in Maryland and nationwide. In fact, one survey of nursing home residents showed that up to 44% of them had been abused at some point, and almost 95% had witnessed someone else be neglected. Despite its prevalence, this abuse and neglect might sometimes fly under the radar, especially when the resident victims are ill, confused, and unable to report it themselves.

Thus, unfortunately, the onus may be on family members to identify abuse or neglect in nursing homes. In some situations, the signs will be subtle, or easily written off as something else. Still, family members should, when visiting their loved ones in Maryland nursing homes, pay close attention to some “red flags” that may indicate abuse or neglect.

Some of the signs are situational—what are the living conditions like? Unsanitary conditions in the residence may be a sign of general neglect. Other signs have to do with resident behavior. Does the resident act oddly when staff members are around? Do they have sudden unusual behaviors, such as a fear of being touched or extreme irritability? Lastly, the physical condition of the resident can shed some light on the situation. Unexplained bruises, cuts, or other injuries should definitely raise concern, as should poor hygiene, sudden weight loss, falls, fractures, or infections.

Maryland nursing homes must meet certain standards under state and federal regulations. They must follow state laws and regulations applicable to nursing homes. In addition, facilities that accept Medicare and Medicaid patients are also required to meet federal nursing home standards. Federal and state regulators ensure compliance by conducting surveys, visits, and investigations.

According to a recent news report, the Democratic candidate for president Joe Biden has said that he plans to spend $775 billion to expand community-based senior services if elected. He also wants to enact nursing home reform in the wake of the coronavirus pandemic. The current administration has generally maintained less oversight with a goal of reducing perceived paperwork burdens and focusing on public-private partnerships to tackle issues. For example, the administration plans to rely on retail pharmacies CVS and Walgreens to distribute a COVID-19 vaccine in nursing homes. The administration has proposed less frequent surveys of the highest-ranked nursing facilities to concentrate on “low performers.”

Biden has said he would make federal nursing home surveys more frequent and increase the current penalties to force compliance with federal standards. He also proposed requiring that each facility have a mandatory infection disease specialist, requiring the federal Department of Health and Human Services (HHS) to audit nursing home cost reports, and increasing personal protection equipment (PPE) supplies by invoking the Defense Production Act. The proposal also calls for restoring a previous ban implemented by President Obama on forced arbitration agreements for residents—a ban that President Trump reversed.

Arbitration is a process in which the parties agree to have a private arbitrator decide the case instead of having the case decided by a court. Although arbitration has some advantages, it can put Maryland nursing home residents at a great disadvantage in many instances. For residents that agree to arbitration as part of their admission paperwork, arbitration agreements can be difficult to get out of—in part because the Maryland Uniform Arbitration Act provides that arbitration agreements are favored.

But there are successful challenges to arbitration. For one, the parties must consent to the arbitration. Consent to arbitration in the nursing home context generally occurs by signing an arbitration agreement as part of an agreement to be admitted to the facility. Because both parties must consent, in some cases, an arbitration agreement is not valid or enforceable because the resident (against whom the agreement is often enforced) did not sign the agreement. For example, a family member may have signed the agreement who did not have the authority to sign on the resident’s behalf.

Agreements may also be unenforceable because they are unconscionable. The language may be unclear or hidden, and unreasonably favorable to one party, leaving the other party with no choice but to accept. Under these circumstances, an agreement may also be unenforceable.

When Maryland families move a loved one into a Maryland nursing home, they are entrusting the home and the staff to take care of their loved one, to keep them safe, healthy, and comfortable. Tragically, however, nursing home neglect is a significant problem in nursing homes across the country, and Maryland is no exception.

Nursing home neglect can take many forms. Perhaps staff members fail to check up on a sick resident every hour, as they are supposed to, and as a result, the resident suffers alone with no one realizing. Neglect can also be medical neglect—failing to take medical concerns seriously, or administer medication on time. Sometimes neglect can simply be leaving the resident alone when they are in dangerous circumstances.

For a tragic example of neglect, take a recent nursing home death where a 90-year-old woman was found dead outside her nursing home one morning. According to a local news article covering the incident, the resident allegedly got into an argument with a staff member at the nursing home one night and walked outside to get some space. The next morning, she was found dead on a bench on the property. Temperatures that night dropped to around 26 degrees, and it is suspected that the resident froze to death. The resident’s family was not even contacted by the nursing home—they found out of the death only through the local coroner’s office.

The Centers for Disease Control (CDC) recently revised its COVID-19 guidelines to state that the coronavirus can be spread through aerosols, raising questions about the practices of Maryland nursing homes. It was previously known that the virus could be spread through respiratory droplets, such as when an infected person coughs, talks, and breathes. But experts now say that the virus is also spread through aerosols, which can remain in the air for hours and travel more than six feet. Experts still believe that the virus is mainly spread through respiratory droplets, but believe that airborne transmission does occur. Dr. Anthony Fauci stated that he was pretty confident that there was some airborne transmission of COVID-19.

Aerosols are microscopic droplets or particles and remain suspended in the air for some time, as opposed to respiratory droplets, which drop to the ground. Aerosols can accumulate in a confined space like a poorly ventilated room. Air purifiers and open windows can help to mitigate aerosol transmission by increasing ventilation within a confined space.

Some researchers have raised this issue in regards to nursing homes. Some research reported on one case of a COVID-19 outbreak in a nursing home with inadequate ventilation. One ward in a nursing home had a rate of 81% positive COVID-19 cases among residents, as opposed to no cases among the other six wards in the nursing home. Based on the low rate of the virus in the community, fast rate of transmission within the ward, the documented poor ventilation, and despite the use of surgical masks, the data suggested that the outbreak was caused by aerosol transmission due to inadequate ventilation.

It’s no secret that the COVID-19 pandemic has had an especially large impact on nursing homes, where tens of thousands of residents and staff members have gotten sick and even died. Because nursing homes combine communal living and vulnerable individuals, and because they often have high rates of abuse and neglect, the COVID-19 pandemic has hit those living in a nursing home particularly hard. In some homes, hundreds of residents have caught COVID-19, with dozens dying. The pandemic is thus raising concerns for Maryland families who have placed family members in nursing homes; many are fearful that nursing home abuse and neglect could be fatal for their loved ones.

In some cases, the situation has gotten so bad that the FBI has been sent to raid nursing homes with a high number of COVID-19 cases. According to a recent news report, two Pennsylvania nursing homes were raided and searched just last month by investigators from the FBI, as well as the state attorney general’s office and other agencies. This followed concerning reports of deeply troubling conditions and practices, including a lack of trained nurses, filthy living conditions, and lax sanitation protocols. Data from the State Department of Health shows that 447 residents and staff members tested positive for the disease as of early September, and 73 people had died.

Tragically, this example is just one of many nursing homes across the country, failing to keep their residents safe during a deadly pandemic. But it is important to know that many of the issues leading to the spread of disease were present even before COVID-19 began spreading through the United States. Nursing home abuse and neglect is not new, but COVID-19 is showing just how widespread and deadly it can be. While there have been reports of unsanitary and even filthy living conditions at Maryland nursing homes before, the lack of sanitation is especially apparent when a contagious disease is spreading through the facility. The same is true for medical neglect: a long-standing issue at many facilities, but even more deadly during the pandemic. Even just carelessness on the part of the staff—not wearing a mask at all times, failing to wash their hands regularly—now has an incredibly large impact on the safety and well being of nursing home residents, many of whom require constant care and are unable to move out and care for themselves.

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