Nursing home residents comprise a large and rapidly growing segment of the national population. Despite this fact, the majority of deaths occurring in nursing homes are not investigated because of the significant medical illnesses suffered by most residents. In some deaths, there could be an attempted concealment of the cause and manner of death. Fearing criminal or civil proceedings, nursing home personnel may attempt to conceal homicidal or accidental deaths in nursing home residents.
Because of the serious, chronic illnesses suffered by these patients, attending physicians are often willing to sign death certificates without personally investigating the circumstances surrounding the patient’s demise. Attending physicians and death investigators should be urged to investigate more fully sudden deaths in nursing home patients.
Are We Missing Anything?
Many jurisdictions around the country will do little more than gather basic information over the phone, and if correct answers are given by the nursing home staff, then C/ME office’s release jurisdiction and simply allow the attending doctor to sign the death certificate. But are we missing anything? Is it possible that accidents, or even homicide deaths, are going unreported and un-investigated. Hospice deaths fall into this category as well and in most C/ME jurisdictions they are handled in the same manner as nursing home deaths.
Logistics
I know as well as anyone what budget restrictions are like. If we adopted a policy that investigator eyes had to be one every nursing home / hospice death within our jurisdiction we would run into a nearly impossible task, simply from a man power standpoint. How then would be correct the problem excpt by hiring additional staff? But with lack of money, and C/ME office are always the last to be funded, how is that possible.
The Answer
Actually, I do not have an answer. In this episode of the podcast I talk with an expert in case review about these topics. I hope that even though I have no answer as to the logistical boundaries, we do make progress in the understanding of the need.
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I thought this was good and something to look at, as a nurse investigator for the NYS Justice center I review medical record and death cases for any vulnerable individual under NYS Mental Hygiene law.
In my county our office maintains iron control over every death that occurs. There have been a few times that I have gone out to a hospice death just because. The two agencies that provide hospice death care services in our county, live in constant fear of our chief deputy coroner, who has no qualms about shutting down hospice services if they start hiding things. As it stands now, for hospice its better for the service to throw their own nurse overboard rather than upset the system we have now. 🙂 As for nursing homes again, it only takes having EVERY single death investigated at a facility for a year or two to keep them honest. Granted, the county that I work in is extremely proactive and have an extremely close relationship with EMS and Law Enforcement officers. Both of them feed us information regarding things that they are seeing allowing our office to focus on problem homes.
I think there is a real problem with the issue here in the UK. If there is a “Do not Resuscitate” decision in place the resident will pass away without, it seems, any adequate investigation.
My concern is where the Care or Nursing home has poor standards of Care, for example people not being supported to eat and drink, this could lead to a dramatic weight loss or dehydration which can lead to the death of residents. These deaths do not appear to be investigated.
When we rely on the Care Quality Commission to inspect the Care Homes we are looking at a report, normally produced when the Care or Nursing Home has notice of the inspection. Unannounced inspections often lead to very different results.
There has been a Care home in Northampton where concerns were raised by a number of agencies about the care provided to residents, particularly with residents being underweight and not being supported to eat and drink.
How do we know if this led to a significant deterioration in the health of any residents at that Care Home which could have been a factor in their death?
As far as I am aware there is no investigation into the recent deaths of residents of that Care Home.
I feel that a more effective way to monitor Care Homes and investigate the deaths of people who reside there are needed.
You bring up some very good points. The issue, and I hate it, is that money is limited to investigate these deaths so the standard has been to let it go. I’m sure the ‘problem’ is bigger than anyone really knows. But until the law, in your Country and mine, changes I am afraid these deaths will still go under investigated on a general scale.