It didn't take long for Jonathan Rosenfeld to grab recent headlines from La Salle County and post them on his Web site: "La Salle County nursing home cited for failing to protect residents from sex abuse."

The Illinois Department of Public Health recently released a report that said a male resident molested 10 female residents at the county home during a six-month period this year and staff did not do enough to protect the victims. The male resident has been removed from the home.

Chicago attorney Rosenfeld said he was familiar with the report on the La Salle County home, as his office reviews such reports.

Rosenfeld specializes in lawsuits involving nursing home abuse and he keeps tabs on related issues with his Web site: NursingHomesAbuseBlog.com. He offers advice on a variety of categories that would be relevant to families with loved ones in nursing homes or long-term care facilities, including how to select a nursing home. His advice also includes links to other resources and references.

Rosenfeld, of the firm of Strellis & Field, has handled 30 to 40 cases of nursing home abuse, with nine in progress. Below are some questions and answers he feels relevant. In a recent interview with The Times, he answered the following questions. Also are included are questions he feels relevant to nursing home care.

Q: In a nursing home abuse situation, who is usually the abuser?

A: Most involve residents victimizing residents, rather than staff victimizing residents. Some cases also involve visitors victimizing residents.

Q: What challenge do investigators face in gathering evidence?

A: The victim is usually disabled or suffering from Alzheimer's disease and thus unable to help investigators. In the case of the La Salle County Nursing Home, the Illinois Department of Public Health was fortunate enough victims were able to respond to questioning. The state usually does a good job of investigating. Abuse happens more than people realize.

Q: What is the typical reason abuse goes unchecked?

A: Short staffing. The facility may meet guidelines for proper number of staff, but it may not be what's really enough. It's dollars and cents. If they hire one or two more, they go over budget.

Q: What else creates an environment for abuse?

A: When a facility has young and old residents and the young are permitted to mix freely with the old. Another source of trouble is that a number of registered sex offenders have been found living at nursing homes. Also putting residents at risk are unsupervised visitors.

Q. What are signs of nursing home abuse?

A.Physical, mental and sexual abuse are forms of abuse encountered by nursing home residents across the country.Remember, you know your loved one better than anyone else. If you suspect mistreatment or abuse immediately report the situation to local police and/or ombudsmen. The reality is that most episodes of elder abuse go unreported.

The following situations warrant further investigation:

• Unexplained bruises, cuts, burns, sprains, or fractures.
• Bed sores.
• Frozen joints.
• Unexplained venereal disease or genital infections, vaginal or anal bleeding.
• Bloody clothing.
• Sudden changes in behavior.
• Staff refusing to allow visitors to see resident or delays in allowing visitors to see resident.
• Staff not allowing resident to be alone with visitor.
• Resident being kept in an over-medicated state.
• Loss of resident's possessions.
• Sudden large withdrawals from bank accounts or changes in banking practices.
• Sudden loss of appetite.

Q. Are bedsores an unavoidable part of living in a nursing home?

A. No! Bedsores, also called pressure sores or decubitus ulcers, are preventable — with proper screening, early detection, and staff involvement. Bedsores are a widespread problem in nursing homes and hospitals. The development of bedsores in nursing home patients is really a reflection of poor nursing care than an inevitable part of of the aging process.

Bedsores likely will develop if the nursing home and its staff do not make bedsore prevention a top priority. Nursing homes must do a thorough assessment of residents on admission and on a regular basis during their stay. Following the assessment, the nursing home should develop a comprehensive care plan that specifies what precautionary measures should be in place.

The nursing home plan should include considerations to monitor each resident's hydration, nutrition, and hygiene. Early signs of bedsores should be identified by the nursing home staff and treatments should implemented. Unattended, bedsores can quickly become infected leading to sepsis, limb amputation and even death.

As part of nursing home's system of bedsore prevention, nursing home residents (particularly the bed-bound) should be repositioned every two hours and ensuring proper hygiene. Pressure relieving mattresses should be implemented as a preventative measure. While bedsore prevention plans are great in theory, the most important part of bedsore prevention and treatment ultimately relies on the skill and dedication of the staff. Do not let a nursing home or hospital tell you your loved one's bedsore was unpreventable!

Q: What should relatives do if they suspect their loved one in a nursing home has been abused?

A: Contact police, because police are the ones qualified to do criminal investigation. Listen closely to what loved ones say. Look for physical signs.Counseling should take place if needed. One of the worst things to do is to pretend nothing happened.

Q. What should families do to prove mistreatment?

A.When you become aware of mistreatment ... it is important to get your loved one the medical treatment they need and then get into "fact-collection mode." ... Collect information about the incident, acts of the nursing home staff and medical condition of your loved one.

Don"t assume you will remember all facts regarding the incident. As time goes on, your memory will begin to fade.The following information will prove to be valuable:

• Photographs of the physical injuries themselves, the area where the incident took place and if possible, the people involved.
• Write down as much information about the incident or events as you can remember. Write some more. Details can be particularly helpful ... Concentrate on: names, dates, room numbers, names of facilities and medication dosages (if relevant).
• The medical chart from a nursing home and / or hospital is crucial to determining what a facility may have done or failed to do that resulted in injury or death.
• Chronology: It is important get the correct names and general dates of admission at health-care facilities. The names of doctors who provided medical can be helpful as well.
• Other Relevant documents: Health-care power of attorney, wills, death certificates, preinjury photographs, autopsy reports and nursing home inspection reports all can be helpful.

Q. Who regulates nursing homes?

A. In most states, nursing homes are regulated by a combination of state (Department of Health) and federal authorities (U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services). Each agency has its own regulations that control all aspects of the nursing home including: resident care, staffing, policies and procedures and medical equipment.

Because nursing homes are responsible for complying with state and federal regulations, agents from either agency conduct inspections of the facility to assure compliance with the regulations. These inspections are called 'surveys' and are generally done unannounced at least one time per year. Surveys may be conducted more frequently at facilities with a history of prior violations or in response to a complaint regarding resident care.

After each survey a report is completed regarding the facilities compliance with applicable regulations. If the findings do not immediately threaten patient safety, nursing home administrators will have an opportunity to review the survey findings and propose a 'plan of correction'. If however, surveyors find conditions that pose a threat to patient safety, they have the ability to impose a variety of penalties including: fines, appointed facility supervisors, suspension of new resident admissions or license suspension.