You are the ombudsman for a large, public nursing home. A patient's family comes to you with complaints that their 85-year-old mother (Millie Sweet) is being mistreated by several of the nursing assistants assigned to her floor. Their mother is incontinent. They have often found her dirty, sitting in her own urine. When questioned, their mother says, "Jeanie (one of the nursing assistants) says I do this intentionally. She makes me sit in my wet diaper to teach me a lesson." Although the family has made a point of providing their mother with new clothes, they have often found their mother dressed in stained clothes that are not hers, with her dress unbuttoned and stockings down around her ankles. Their mother has a colostomy stoma, and the family has often found her bag overflowing. The final straw came when they saw an angry bruise on their mother's cheek. Their mother reported, "They pinch me when I won't eat."

Describe your initial planning for this case, using material in this course and any specialized material you can find online or elsewhere for investigations in emergency rooms or other outpatient settings. Also discuss what pre-conceived ideas one might develop when learning about this scenario without first gathering the facts. What danger does it present?