The Dangers of Dehydration in Nursing Homes and How to Spot It

The thought of your loved one suffering from something as basic as a lack of water in a nursing home, rather than a complex illness, is horrifying. Yet, studies show that a shocking number of nursing home residents, potentially up to 30%, may suffer from dehydration.

If you believe a nursing home’s negligence has led to your loved one’s dehydration and suffering in South Carolina, the Hughey Law Firm is ready to listen. Call us at (843) 881-8644; our Charleston nursing home abuse lawyers operate on a “no win, no fee” basis, so you pay nothing unless we win your case.

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Dehydration in Nursing Homes: What Is It, and How Does It Affect Residents?

Dehydration refers to a dangerous deficiency of water and essential electrolytes – minerals like sodium, potassium, and chloride – that the body needs for nearly every function, from muscle contractions to nerve signals. When these reserves plummet, the body starts to malfunction, sometimes catastrophically.

Older adults are particularly vulnerable due to a confluence of factors:

• Diminished thirst sensation: The body’s natural alarm system for needing fluids gets less sensitive with age. They might not feel thirsty until they’re already significantly dehydrated;
• Age-related decline in kidney function: Kidneys become less efficient at conserving water and concentrating urine, leading to more fluid loss;
• Common medications: Many older adults take medications such as diuretics (for blood pressure) or laxatives, which actively increase fluid output;
• Cognitive impairments: Conditions like dementia or Alzheimer’s can make it difficult for residents to recognize thirst, remember to drink, communicate their need for water, or even know how to get it;
• Physical limitations: Arthritis, weakness from a stroke, or other mobility issues can make it hard for residents to reach a water pitcher, lift a cup, or swallow safely without assistance.

The Domino Effect: How Dehydration in Nursing Homes Wreaks Havoc on an Aging Body

What starts as seemingly minor issues can quickly spiral out of control when an elderly person is dehydrated.

Initial problems often include things like persistent urinary tract infections (UTIs), uncomfortable constipation, nagging headaches, and dizziness that significantly increases the risk of falls. But it doesn’t stop there. If not addressed, the consequences become far more severe and life-altering:

• Kidney strain and potential failure: Without enough fluid, kidneys work overtime and can become damaged, sometimes irreversibly;
• Electrolyte imbalances: These can trigger serious cardiac arrhythmias (irregular heartbeats) or even seizures;
• Thickened blood: Dehydration makes blood more viscous, heightening the risk of dangerous blood clots like deep vein thrombosis (DVT) or pulmonary embolisms (PE);
• Worsening of bedsores (pressure ulcers): Skin becomes less elastic and more fragile, making it harder for bedsores to heal and easier for new ones to form;
• Increased medication toxicity: With less fluid in the system, medications can become more concentrated, leading to adverse effects or overdose symptoms;
• Acute confusion or delirium: Dehydration can cause sudden and severe confusion, sometimes tragically mistaken for a worsening of dementia. Research confirms dehydration is a direct contributor to higher rates of illness and death in older adults, proving it is more than a side issue.

This Isn’t an Isolated Incident. It’s a Systemic Problem

Don’t make the mistake of thinking dehydration in a nursing home is just a one-off bad day or a rare occurrence. Statistics paint a grim picture: as alluded to earlier, a significant portion, potentially around 20-30% of nursing home residents, may be dehydrated at any given time.

The Sneaky Early Signs

If you know what to look for, you can catch it early:

• Dryness: Persistent dry mouth, visibly chapped lips, or a tongue that appears dry or coated;
• Changes in urination: A noticeable drop in how often they urinate, or urine that is consistently dark yellow or amber and has a strong, concentrated smell. Infrequent trips to the bathroom can be a key indicator;
• Sudden behavioral changes: An uncharacteristic onset of confusion, unusual irritability, agitation, or lethargy. If your normally cheerful relative is suddenly cranky or sleepy, pay attention;
• Dizziness or lightheadedness: Complaints of feeling dizzy, especially when standing up from a sitting or lying position (orthostatic hypotension);
• Fatigue and weakness: Unexplained tiredness that’s more than their usual fatigue, new muscle weakness, or complaints of muscle cramps, particularly in the legs;
• Sunken eyes: Their eyes might appear somewhat sunken into their sockets.

When It Gets Ugly: Obvious (and Dangerous) Dehydration Symptoms

If those early warnings are missed, dehydration can escalate quickly. When you see these symptoms, the situation is serious, and immediate medical intervention is usually required:

• Rapid vital signs: A fast pulse (tachycardia) or rapid breathing (tachypnea), even when your loved one is at rest;
• Low blood pressure (hypotension): This can be a sign the body is struggling to cope with fluid loss;
• Inability to produce tears or sweat: If they cry, there might be no tears, or their skin might be very dry even in a warm environment. This is a very serious indicator;
• Severe mental status changes: Extreme confusion, profound disorientation, or delirium. They may not recognize familiar people or know where they are;
• Fever: A fever may develop without any other clear sign of infection;
• Poor skin turgor: This is a classic test. Gently pinch the skin on the back of their hand or over their sternum. If it stays “tented” and doesn’t snap back quickly into place, it indicates significant fluid loss.

Reading Between the Lines: Environmental and Staff-Related Clues

Sometimes, the clues aren’t just about your loved one’s physical symptoms. The environment and staff behavior can also tell you a lot about the facility’s commitment to hydration:

• Water accessibility: Are water pitchers consistently empty, placed out of reach, or do they look untouched visit after visit?
• Fluid offering practices: Do staff regularly offer fluids to residents, not just at mealtimes, but also with medications, during activities, or simply throughout the day?
• Assistance with drinking: For residents who need help, are staff members actively and patiently assisting them to drink, and doing so frequently enough?
• Unexplained weight loss: Rapid or noticeable weight loss over a short period can sometimes be linked to chronic underhydration;
• Staff demeanor and knowledge: Do staff seem rushed and dismissive if you ask about fluid intake? Are they unable to tell you how much your loved one has had to drink that day? This can indicate systemic issues. Different staff members may also have varying abilities to recognize dehydration. While Registered Nurses (RNs) typically have more extensive training, Certified Nursing Assistants (CNAs), who provide most direct care, may sometimes miss subtler signs if not adequately trained or supervised.

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Your Legal Rights and Nursing Home Responsibilities in South Carolina

Federal Law: The Nursing Home Reform Act

The federal government set a baseline standard for care in nursing homes nationwide with the passage of the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87), often called the Nursing Home Reform Act.

This act mandates that nursing homes receiving Medicare or Medicaid funding (which is most of them) must provide care and services to enable residents to “attain or maintain the highest practicable physical, mental, and psychosocial well-being.” This broad mandate definitely covers providing sufficient fluids. Specifically, federal regulations like 42 C.F.R. § 483.25(g) address nutrition and hydration directly, requiring facilities to provide sufficient fluid intake to maintain proper hydration and health for each resident.

South Carolina’s Laws

South Carolina has its own robust laws designed to protect vulnerable adults, including those in nursing homes. The key piece of legislation here is the South Carolina Omnibus Adult Protection Act (S.C. Code Ann. § 43-35-5 et seq.).

This Act defines “neglect” clearly. It includes the failure of a caregiver (which includes nursing home staff and the facility itself) to provide the care, goods, or services necessary to maintain the health or safety of a vulnerable adult. Failing to ensure adequate hydration, leading to health complications, falls squarely within this definition of neglect.

Additionally, the South Carolina Department of Health and Environmental Control (DHEC) sets forth specific regulations for the licensing and operation of nursing homes. These regulations detail standards of care that facilities must meet, and these standards invariably include requirements related to resident nutrition and hydration.

“Standard of Care” and “Negligence”

When we talk about legal responsibility, two terms are central: “standard of care” and “negligence.”

• Standard of Care: This refers to the level of attention and competence that a reasonably careful and sensible nursing home and its staff would provide under similar circumstances. It’s not about demanding perfection, but it is about expecting a professional level of diligence and attentiveness to resident needs, including hydration.
• Negligence: Legally, negligence occurs when a nursing home (or its employees) fails to meet this accepted standard of care, and that failure directly causes harm, injury, or a worsening of condition to a resident.

If a nursing home resident suffers dehydration, and it can be shown that this resulted from staff inattention, insufficient staffing, poor facility policies, or a failure to follow established hydration protocols, that’s a breach of the standard of care. If that breach directly caused harm – such as a UTI, kidney damage, a fall due to dizziness, or worsened cognitive state – then it constitutes negligence, and the facility can be held liable.

Enough is Enough: Steps to Take if You Suspect Dehydration Neglect in a Nursing Home

Act Fast – Your Loved One’s Health is on the Line

• Document meticulously: Start a detailed log immediately. Note dates, times, specific symptoms you observe, any complaints your loved one makes, who you spoke with at the facility (names and titles), and what they said or did. Take photos if they are relevant (e.g., of untouched water pitchers, uneaten food if it relates to fluid intake with meals). This documentation is invaluable;
• Communicate assertively (but calmly): Request an immediate meeting with the Director of Nursing and, if necessary, the facility administrator. Don’t just make vague complaints. Present your documented concerns and observations clearly and directly. Ask pointed questions about their hydration protocols and your loved one’s specific fluid intake records;
• Demand medical attention: Insist that your loved one be thoroughly evaluated by a doctor – preferably their own primary care physician if possible, or at least the facility’s medical director – to specifically check for dehydration and any related complications. Request copies of all medical reports and lab results.

Escalate If Necessary – Don’t Take “No” or “We’re Handling It” at Face Value

If the facility is dismissive, doesn’t provide satisfactory answers, or if you don’t see immediate and significant improvements in care and your loved one’s condition, you need to escalate.

• Contact the South Carolina Long-Term Care Ombudsman Program: Ombudsmen are advocates for nursing home residents. They can help mediate disputes, investigate complaints, and provide information about resident rights. You can find their contact information through the South Carolina Lieutenant Governor’s Office on Aging;
• File a formal complaint with DHEC: The South Carolina Department of Health and Environmental Control is the state agency responsible for licensing and regulating nursing homes. They investigate complaints of neglect and abuse. Filing a formal complaint can trigger an official investigation into the facility’s practices.

Know When to Bring in Legal Reinforcements

Sometimes, despite your best efforts, the facility fails to rectify the situation, or the harm caused by dehydration is already severe. This is when you should consider legal action.

It’s time to call a lawyer if:

• The nursing home consistently dismisses your concerns or fails to make meaningful, lasting improvements in care;
• Your loved one has already suffered serious harm, such as hospitalization, a significant decline in health, or lasting complications due to dehydration that you believe was preventable;
• You feel overwhelmed and unsure how to navigate the system to get justice and ensure your loved one’s safety.

The Hughey Law Firm understands the complexities of nursing home neglect cases. Our “no win, no fee” promise means you don’t have to worry about upfront legal costs. We are here to assess your situation and discuss your options.

Secure Justice with Hughey Law Firm

Don’t let nursing home neglect go unchallenged. If dehydration has harmed someone you care about, it’s time to seek justice and explore your legal options. Our Charleston personal injury attorneys are here to help.

Contact the Hughey Law Firm today at (843) 881-8644 for a confidential, no-cost consultation. Let us stand up for their rights and fight for the compensation they deserve.

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Nathan Hughey

Nathan Hughey, an attorney and fourth-generation South Carolinian, founded Hughey Law Firm in 2007. Before that, he spent five years defending nursing homes and insurance companies. Leveraging his experience, he now advocates for those injured or wronged by such entities, securing over $290 million in verdicts and settlements.