In West Virginia long-term care settings, family members often notice warning signs like:
- Confusion, increased sleepiness, or agitation that worsens over days
- Low appetite, refusal of meals, or difficulty finishing assisted feedings
- Constipation or urinary changes tied to poor fluid intake
- Pressure injuries that develop or worsen despite “routine repositioning”
- Lab abnormalities related to hydration or nutrition
- Delayed wound healing and frequent infections
Sometimes the facility explains it as an expected progression of illness. But the legal question is different: Did the nursing home respond appropriately once risk signs were present?


