Nursing Homes Abuse Blog - By Jonathan Rosenfeld

There is no free ride.   Nursing home residents (and often their estates) must contribute to the cost of the care.  Before Medicaid coverage kicks in, nursing home residents must use their own assets to satisfy the costs of nursing home bills.  This effectively means that all of the residents income from Social Security, pensions, annuities and other sources must be used before the government will foot the bill for nursing home care.

Nursing home residents are allowed a meager monthly allowance for personal items.   The amount varies by state.  However, most states only allow a resident to keep approximately $30 per month to cover their personal expenses for things like haircuts and toothpaste.

If the nursing home resident has a living spouse the spend-down formula is different.  A spouse living outside of the nursing home and in the general community is called a 'community spouse'.  The community spouse is allowed to keeps a minimum of $1,750 per month an the remainder goes to the nursing home.  The final amount the community spouse may keep is dependent on other factors such as other dependents, heath expenses and living expenses.

It is easy for nursing homes to make sure their residents pay their bills.  If the residents do not pay their bills, "[t]hey can kick you out for nonpayment," says Gene Coffey, a staff attorney for the National Senior Citizens Law Center.

Death a does not wipe out your financial obligations to a nursing home.  Medicaid is entitled to recoup some or all of the deceased nursing home expenses spent from their estate.  The final decision on recovery of nursing home expenses is dependent upon the State.  Some States will postpone collection from widows and dependent or disabled children or exempt them entirely.

To assure they get paid many states put liens on a nursing home residents assets. A lien is a legal right against an asset which is used to secure a loan.  The lien effectively prevents any distribution of assets until the State releases their lien on the asset.

Read more about nursing home bills here.

A client's daughter forwarded this link to me regarding pressure sores (or similarly called pressure ulcer, decubitus ulcer or bed sore). This is a thorough discussion of the subject and is useful to all who have pressure sores or who may be at high risk for developing them. This article appeared on the CNN website.

Bedsores (Pressure sores)
From MayoClinic.com
Special to CNN.com

Bedsores, more accurately called pressure sores or pressure ulcers, are areas of damaged skin and tissue that develop when sustained pressure -- usually from a bed or wheelchair -- cuts off circulation to vulnerable parts of your body, especially the skin on your buttocks, hips and heels. Without adequate blood flow, the affected tissue dies.

Although people living with paralysis are especially at risk, anyone who is bedridden, uses a wheelchair or is unable to change positions without help can develop pressure sores. Pressure sores can develop quickly, progress rapidly and are often difficult to heal. Yet health experts say many of these wounds don't have to occur. Key preventive measures can maintain the skin's integrity and encourage healing. Signs and symptoms

Pressure sores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization dedicated to the prevention and treatment of pressure sores, has defined each stage as follows:

Stage I. Initially, a pressure sore appears as a persistent area of red skin that may itch or hurt and feel warm and spongy or firm to the touch. In blacks, Hispanics and other people with darker skin, the mark may appear to have a blue or purple cast, or look flaky or ashen. Stage I wounds are superficial and go away shortly after the pressure is relieved.

Stage II. At this point, some skin loss has already occurred -- either in the epidermis, the outermost layer of skin, in the dermis, the skin's deeper layer, or in both. The wound is now an open sore that looks like a blister or an abrasion, and the surrounding tissues may show red or purple discoloration. If treated promptly, stage II sores usually heal fairly quickly.

Stage III. By the time a pressure ulcer reaches this stage, it has extended through all the skin layers down to the muscle, damaging or destroying the affected tissue and creating a deep, crater-like wound.

Stage IV. In the most serious and advanced stage, a large-scale loss of skin occurs, along with damage to muscle, bone, and even supporting structures such as tendons and joints. Stage IV wounds are extremely difficult to heal and can lead to lethal infections. If you use a wheelchair, you're most likely to develop a pressure sore on: Your tailbone or buttocks Your shoulder blades and spine The backs of your arms and legs where they rest against the chair When you're bed-bound, pressure sores can occur in any of these areas: The back or sides of your head The rims of your ears Your shoulders or shoulder blades Your hip bones, lower back or tailbone The backs or sides of your knees, heels, ankles and toes.

Causes of Bed Sores

You shift in your chair during meetings, fiddle with the radio when driving, turn a dozen times in your sleep. Every day, without thinking, you make hundreds of subtle postural adjustments that help stave off problems arising from inactivity. But for people immobilized by paralysis, injury or illness, those problems -- including pressure sores -- are a constant threat. Pressure sores usually result from sustained pressure on your body. They're especially common in areas that aren't well padded with muscle or fat and that lie just over a bone, such as your spine, tailbone (coccyx), shoulder blades, hips, heels and elbows.

Because your skin and the underlying tissues are trapped between bone and a surface such as a wheelchair or bed, blood flow is restricted. This deprives tissue of oxygen and other nutrients, and irreversible damage and tissue death can occur. Though the affected tissue may die in as little as 12 hours, the injury may not be apparent for days or even weeks. In some cases, the pressure that cuts off circulation comes from unlikely sources: the rivets and thick seams in jeans, crumbs in your bed, wrinkled clothing or sheets, a chair whose tilt is slightly off -- even perspiration, which can soften skin, making it more vulnerable to injury.

Other causes of pressure sores include: Friction. Frequent shifts in position are the key to preventing pressure sores. Yet the friction that occurs when you simply turn from side to side can damage your skin, making it more susceptible to pressure sores. Shear. This occurs when your skin moves in one direction, and the underlying bone moves in another. Sliding down in a bed or chair or raising the head of your bed more than 30 degrees is especially likely to cause shearing, which stretches and tears cell walls and tiny blood vessels. Especially affected are areas such as your tailbone where skin is already thin and fragile.

Resource:

Bed Sore FAQ

Nursing Home Injury Laws: Bed Sores, Pressure Sores, Decubitus Ulcers, Pressure Ulcers

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The Robert Wood Johnson Foundation commissioned a study conducted by Dr. Bill Thomas to look into alternatives to traditional nursing homes.  The results of the study suggest a viable alternative to traditionally large nursing home facilities may be a home-like facility with 10-12 people. 

The foundation has coined the term 'Green Houses' to describe the new facilities.  Currently, there are 40 Green Houses in operation.  If the facilities are feasible and the residents are happy, the foundation plans to open the Green Houses in every state.

Currently the nursing home industry in in crisis.  According to an AARP poll, 99% of people do not want to be in a nursing home during their senior years.  Even though the elderly population is growing quickly, there are vacancies in many nursing homes because people are put off by the prospect of being warehoused as they age.

Read the full article here.

A 44-year old woman was raped in Kent Nursing Home in Seattle.  The victim was particularly vulnerable with mental and physical impairments.  The rape was not discovered until the woman had a miscarriage and DNA testing confirmed that the act was done by an employee of the nursing home.

'We entrust caregivers for dependent adults with tremendous responsibility for the health and well-being of the patient,' said Prosecutor Dan Satterberg. 

Long-term facilities, hospitals, and nursing homes have a duty to provide a safe facility for all residents and employees.   Part of providing a safe facility requires a full criminal background check for all employees.  The background check also involves checking references. 

Most instances of physical abuse are preventable.  Had a facility performed an adequate search, they would have discovered the employees criminal propensities.

Read the full article here.
Watch the news video of this story here.

Old?  Weak? Tired? Have dementia?  The answer to these ailments in some nursing homes is to prescribe antipsychotic drugs to subdue any signs of energy and life left in residents suffering from Alzheimer's and other forms of dementia.  A whopping one-third of all nursing home residents are prescribed antipsychotic drugs such as: Risperdal, Seroquel and Zyprexa.

Prescription of antipsychotic drugs is big business for their makers.  Sales of Risperdal, Seroquel and Zyprexa have more than tripled from 2000 to 2007.  Dispensation of the drugs is also often profitable for the facilities where the patients reside.  Every time medication is given, it is an opportunity for a nursing home to charge.  Most often the charges are tacked onto the Medicare and Medicaid tab.

Use of antipsychotic drugs continues despite recent studies that have demonstrated their ineffectiveness in Alzheimer's patients with aggressiveness and delusions.  The wide spread use of antipsychotic drugs covers up the fact that most facilities are understaffed.  It is far easier to have a patient down a couple of pills than to provide skilled nurses, psychiatrists and therapists to treat their underlying needs.

Read the full New York Times article on overuse of medication in dementia here.

The National Fire Center, reports an annual average of 2 million fires in the United States. Those fires resulted in an annual average in excess of 27,000 civilian injuries, more than 4,000 deaths. 

Nursing home residents may sustain burns while at a nursing home facility.  Common situations involving residents sustaining burns include:

• Baths- Staff failing to monitor the water temperature
• Smoking- Smoking especially around oxygen tanks can be disastrous
• Lighters- Senile patients playing with lighters
• Fires in the nursing home.  Often nursing homes do not have proper alarms or fire-sprinklers
• Electric blankets- Staff failing to monitor patients who may not be able to detect temperature

Nursing home residents who sustain burns need focused care from experts to implement a plan to deal with the physical and psychological affects.  Burns sustained by the elderly are especially difficult to treat and are commonly accompanied by infection and bedsores.

Medication errors are considered to be any preventable event that may cause or lead to inappropriate medication use or harm to a patient. Since 2000, the Food and Drug Administration (FDA) has received more than 95,000 reports of medication errors. FDA reviews reports that come to MedWatch, the agency's adverse event reporting program.  (Source: FDA website)

The FDA relies on a voluntary reporting for incidents involving medication errors.  The actual number of incidents involving errors in the misadministration of medication to be much higher. The term 'medication error' may describe situations involving: physician malpractice, inadequate facility policies and procedures, faulty charting, order miscommunication, inadequate product labeling, faulty packaging, under-staffing and failure of a nursing home or hospital to monitor residents.

The American Hospital Association lists the following as some common types of medication errors:

• incomplete patient information (not knowing about patients' allergies, other medicines they are taking, previous diagnoses, and lab results, for example);
• unavailable drug information (such as lack of up-to-date warnings);
• miscommunication of drug orders, which can involve poor handwriting, confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations;
• lack of appropriate labeling as a drug is prepared and repackaged into smaller units; and
• environmental factors, such as lighting, heat, noise, and interruptions, that can distract health professionals from their medical tasks.

Similarly, incidents of medication error may occur when nursing home staff withhold medication or over-medicate residents.  There are incidents where nursing homes intentionally over-medicate a large percentage of their residents in order to keep them complacent and quiet, rather than providing them with the necessary care.

Victims of medication errors have rights.  If you believe a family member or friend has suffered an injury due to a medication error contact the nursing home monitoring authorities in your area.

Definition: A traumatic brain injury (TBI) is a blow to the head that results in a disruption of the normal brain functioning. TBI's may range from a brief change in cognitive functioning to an extended period of unconsciousness. (Source: National Center for Injury Prevention and Control) TBI's are some of the more common injuries sustained by nursing home residents.  TBI's are most common in the elderly population. 

Facts: How common are TBI's:

• 1.4 million American have a TBI each year
• 52,000 deaths per year
• 235,000 hospitalizations
• 1.1 million emergency room treatments

It is a surprise to most people that people 75 and older compose the largest group of TBI patients.  Further, most TBI's result from falls or physical abuse.  (Falls and nursing home abuse)

Consequences:  It is very difficult to measure the consequence / fallout from TBI's.  TBI's have very different symptoms in every person.  While some people who may have a TBI and be able to function, other may suffer from significant cognitive and psychological impairment.  A TBI may effect sensory motor, and automatic functions.  While most of the effects of a TBI may be apparent within a day or two from the initial trauma, many long-term effect do not become apparent until long after the traumatic event.

Treatment: Many elderly who suffer from TBI's require extensive rehabilitation and physical therapy.  The cost of the rehab is significant-- some treatments costs are projected to exceed a million dollar.  The most important treatment is diagnosis.  All treatments are most affective if implemented soon after the initial injury.  In addition to physical therapists and physicians, neuropsychologists are very important in developing a care plan for TBI patients.

For additional information on TBI's look here.

Taking Note, a financial blogging group, provides further evidence that big business is putting its desires for quick profits over the care of nursing home residents.  The nursing home population is exploding.  Big business is recognizing the opportunity to profit off this fact and is jumping in the nursing home industry.  There are no laws controlling ownership of nursing homes in the United States making transition of ownership from an experienced owner to a large corporation easy.

Maggie Mahar, the articles author, skillfully calculates that roughly 6% of the 2 trillion dollar United States annual health care budget is spent on nursing homes.  The percentage of the health care budget is likely to increase.  Citing a Genworth Financial survey, the average annual cost for a private room in a nursing home hit  $76,460, or $209 per day this year—a 17 percent increase over the $65,185 cost in 2004.

The Center for Disease Control notes that more than two-thirds of the nation’s nearly 16,000 nursing homes were in the hands of private investors. The new owners include prominent private equity firms like Warburg Pincus and the Carlyle Group. The remaining one-third were owned either by the government or by non-profit organizations.

Ms. Mahar cites to a New York Times story that examined more than 1,200 nursing homes purchased by large private investment groups since 2000—plus more than 14,000 other homes—reporters compared investor-owned homes against national averages in multiple categories.

As corporations enter the 'nursing home industry', there are indications that patient care is deteriorating. The New York Times article showed the ratio of RNs to nursing home residents was significantly higher at the investor-owned homes (20:1) than the national average (13:1), as was the share of long-term residents who suffered from health deficiencies, anxiety and depression, or  needed more help with daily activities such as simply moving around their rooms.  In the investor-owned homes, patients were deteriorating.

A recent NPR radio program discusses bed rail safety in nursing homes.  The increased demand for hospital beds in nursing homes, hospitals, hospice programs, and in home use has resulted in a shortage of certain bed parts.  For example, mattresses may be improperly sized to the type of beds.  Using improperly sized mattresses may result in gaps between the end of the mattress and the bed rails.  The gaps allow patients to get wedges between the mattress and rail.  The entrapment may result in suffocation, falls, lacerations or even death.

Listen to the full discussion here.

Bedrails are the most common type of physical restraint used in nursing homes today.  Bedrails were once only associated with confining residents to their bed.  Today, new bedrail designs, have been developed in order to assist residents get into and out of bed. 

Even with new designs, bedrails commonly cause falls and entrapment, which may result in fractures or even death.  In order to help identify potential problems with bedrails, the FDA has identified seven 'entrapment zones.'  The most common reasons, residents attempt to leave their beds are as follows:

• Agitation
• Delirium
• Need to use bathroom
• Pain / discomfort
• Hunger / thirst
• Sleep walking
• Difficultly breathing while lying down
• Boredom

Nursing home residents with cognitive impairment are the most likely group to be injured in an incident involving bedrails.  Nonetheless, a complete collaboration with many different departments within a nursing home is imperative in order to provide a safe and restful nights sleep for all.  Simple programs such as: implementation of scheduled toileting, administration of increased pain medication prior to bed and identification of residents with delirium can be helpful in preventing bedrail injuries.

The biggest predictor in determining resident care is the owner of the nursing home according to the Salt Lake Tribune.  Of 91, Utah Nursing Homes studied, the article detailed how, many problems start at the top and ‘trickle down to the lax administrators and nursing directors,’

Majestic Care, the owner of several Utah Nursing Homes had repeatedly scored low during state inspections.  The owner of Majestic Care was difficult to discover.  Once a nursing home receives a poor inspection score, owners may change the name of the facility in order to deceive potential residents and avoid ridicule. While most nursing homes scored well in inspections regarding of compliance, about one quarter of the facilities had a ‘dismal track record loaded with medical errors, neglect and mismanagement.’  

Tracking the owners of nursing home facilities proved difficult.  Names of problematic facilities are quickly changed making discovery of the current nursing home owners difficult if not impossible.

Trying to find the name of an Illinois Nursing Home Owner?  Look here.

Mother Jones, the independent, non-profit, investigative authority recently addressed arbitration clauses in nursing home contracts.  The blog entry addresses how nursing homes take advantage of unsuspecting elderly in order for them to 'sign away' their right to a jury trial.  The article details Ken Conner, congressional testimony regarding arbitration clauses.  Mr. Conner testified:

  "All too often, the story is the same: avoidable pressure ulcers (bed sores) penetrating to the bone;  wounds with dirty bandages that are infected and foul smelling; patients languishing in urine and feces for hours on end; hollow-eyed residents suffering from avoidable malnutrition, unable to ask for help because their tongues are parched and swollen from preventable dehydration; dirty catheters clogged with crystalline sediment and  yellow-green urine in the bag."

Contact your congressman to tell him or her to vote to ban all mandatory arbitration clauses in nursing home cases.

I received several responses from blog readers regarding yesterday's post questioning the need to have a link to a 'You Tube' video demonstrating the catheterization process.  If I offended any of our subscribers, I apologize. However, I will not apologize for bringing to light incidents of abuse and neglect involving the elderly.

Photographic evidence is one of the most important tools in proving abuse and neglect involving nursing homes. It is one thing to see a mention of bedsores, bruising or broken bones in a stack of medical records. It is quite another to see the actual photographs.

I advise people who may suspect  nursing home abuse to document all aspects of their injuries via photographs. How else can other people appreciate the extent of the injury or the disability you face without viewing the photos?

Do not take 'no' for an answer if your loved one wishes to be photographed or videotaped. There is no legal basis for the staff at a nursing home or hospital to deny a resident's / patient's right to be photographed. If need be, get a judge to order the photographs to be taken.

For example, cases involving bedsores or pressure ulcers in hospitals, nursing homes, and assisted living situations, the bedsores may develop quickly. It is important to document the bedsores progression from both a patient and facility prospective. Just as a photo may demonstrate neglect, it may conversely prove otherwise if used by a nursing home to refute an allegation of neglect.

It is advised to accurately date all photographs and document the photographers to assure accuracy and admissibility in a court setting. Moreover, use of a daily newspaper to verify the accurate date is advisable. Below are some common examples of nursing home neglect captured by camera.  Lawyers at Stark & Stark a law firm with offices New Jersey have already addressed the issue of photographic evidence in nursing home litigation. Well done.

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"How do you know if the nursing home is providing the necessary care to my loved one?"

This question gets asked repeatedly by families who have a relative in a nursing home. One of the first places to begin an investigation into whether the resident is getting the proper level of care in a nursing home is by looking at documents related to the Resident Assessment Instrument (RAI).

Within 14 days of admission, new nursing home residents must be evaluated by the nursing home staff for the purpose of conducting a RAI under the Nursing Home Reform Act of 1987 (contained in the Omnibus Budget Reconciliation Act, OBRA 1987) and specifically codified at 42 CFR 483.20 (b)(1)(i)-(F272).

The RAI has three elements: MDS- minimum data set, RAPS- resident assessment protocols and utilization guidelines. The acronyms are confusing, however each element of the assessment is intended to provide a customized care plan for each nursing home resident. Each area has specified criteria for the nursing home staff to address when making their assesment. It is up to the staff to address other areas that are relevant to individual resident-- regardless of their omission from the RAI. Families of the new residents should actively participate in this process.

The first step in conducting the RAI is the MRS. The MDS (Minimum Date Set) is a set of screening items that forms the foundation of all long-term care residents at Medicare and Medicaid certified facilities. This is a standardized list to allow facilities a consistent ‘measuring stick’ to analyze resident improvement or deterioration while at the facility and to help new facilities or agencies get a quick analysis of the patient.

A completed MDS is an extremely valuable tool in determining whether the needs of a nursing home resident are met. An MDS is a legal document, which must be signed by all health care professionals who assist in completing it. The completed MDS is also significant in that it is used for Medicare and Medicaid billing. Its accuracy for both patient needs and for billing purposes is essential. The MDS items are detailed below:

•  Identification and background information
• Cognitive patterns
• Communication / hearing patterns
• Vision patterns
• Mood and behavior patterns
• Psychological well being
• Physical functioning and structural problems
• Continence in the last 14 days
• Disease diagnoses
• Health Conditions
• Oral / nutritional status
• Oral / dental status
• Skin Condition
• Activity pursuit patterns
• Medications
• Special treatments and procedures
• Discharge potential and overall status
• Signature and attestation
• State defined section
• Required for Medicare assessments
• Medications
• Resident Assessment Protocol (RAP) study
  

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One word--'No'

As a lawyer who makes a living representing plaintiffs in personal injury related matters, my suggestion to demand a right to a jury trial probably comes at no surprise.  Self-serving issues aside, our jury system (in the Civil setting) a place for those who have been wronged to obtain fair compensation for their injuries.  Juries are composed of people from the plaintiff's community who make the decision of who get what and how much they are getting.  The jury's award must be unanimous. 

Does the jury always make the 'right' decision?  No.  Does a jury always make a rational decision?  No.
The jury system remains in place because there is no better or fairer way of redressing fault than through a jury trial.  Twelve people must listen to the evidence, sort through the witness testimony and make tough decisions that have incredible importance on the parties lives. 

In an effort to streamline the injury claim process and remove some 'juror uncertainty', nursing home owners have started to encourage residents to sign binding arbitration clauses into contracts.   The Wall Street Journal documented how the practice is becoming more common in the nursing home industry.  Unfortunately, as the article points out, many new nursing home residents who are signing these agreements are in positions of weakness at the time the clauses are executed.  Many of the people who are signing these clauses may be in weaken physical state or be in the beginning stages of dementia.

Nonetheless, the binding arbitration clauses appear to have some benefits for the nursing home industry.  As the chart below, also from The Wall Street Journal demonstrates, the number of nursing home complaints has risen while the money paid out per claim has declined.

The other day I posted regarding the violations nursing home inspectors commonly miss.  In defense of the likely overworked and underpaid inspectors- -their job its difficult.  They are expected to uncover nursing home safety violations and neglect at many different facilities in a single visit.  I received several messages from subscribers to our blog voicing concern over the inherent inadequacy in the inspection system.

I came across this article which details a potential solution to this problem.  I was mighty impressed with the simplicity of this idea.  For states facing budget problems and in the midst of nursing home inspector shortage this is a great solution.  The program allows nursing home residents to develop a relationship with the ombudsmen and provides the unique opportunity to monitor facilities on a daily or weekly basis.  Well done!

More than 20 years the Nursing Home Reform Act was passed to protect residents of nursing homes.  Has the law helped?  Of course it sets standards for the care and treatment of nursing home residents.  However, as the Act ages, nursing homes and the companies that own and operate them have become increasingly sophisticated in ways to meet the standards, yet still skimp on the level of care required to properly tend to many residents needs.

A new bill in the Senate Finance Committee, the Nursing Home Transparency and Improvement Act (S2641), would overhaul current nursing home standards.  For example, the new bill would require nursing homes to: clearly state ownership information, standardize complaint forms, improve reporting on staffing information, and replace some self-reported information with independent audits. 

The new bill would make selection of a nursing home easier for elderly and their families.  Families  would know who the owner of a facility is and have access to information on its staff.  Under the current system many nursing homes hide ownership information in order to make bringing a complaint or filing a lawsuit as difficult as possible. 

The bill would also give those responsible for enforcement of the law more muscle.  The bills sponsors, Senator Charles Grassley and Senator Herb Kohl intend the fines  and penalties for failure to comply with the laws be strong enough to deter the behavior as opposed to the cost of doing business.

I encourage you to contact your congressman using the this link and ask them to vote 'yes'.

Falls in nursing homes may be the largest heath threat to the elderly.  Older people tend to fall more frequently than their younger counterparts.  However, when an older person falls they are substantially more likely to become injured than a younger person.  Some startling statistics from the Center for Disease Control demonstrate the obvious: falls in nursing homes are widespread and have a devastating impact on the residents.

• About 1800 people die each year due to falls in nursing homes
• 10 to 20% of nursing home falls result in serious injury, 2 - 6% of falls result in fractured bones
• 3 out of 4 people living in a nursing home will fall this year
• Most people are 'repetitive fallers'- After a first fall, there is a substantial likelihood that you will fall again
• Most falls go unreported

Falls in nursing homes occur for a variety of reasons.  Some of the more common causes for falls  are:

• Muscle weakness and walking or gait problems. (24% nursing home falls)
• Hazards in the nursing home- wet floors, poor lighting, improper be heights, improperly maintained wheelchairs, equipment left out of place (16 - 27% nursing home falls)
• Medications.  Drugs that effect the central nervous system, such as sedatives and anti-anxiety drugs (psychoactive drugs)
  
• Improperly fitting shoes or incorrect walking aids
• Frequent use of restraints

The prevention of falls requires a team approach.  All health care professionals in the nursing home setting must work together to help encourage nursing home safety.  Additionally, nursing homes should do the following:

• Conduct a fall-risk assessment for every resident to determine who may be at risk for falls.  This puts the staff on notice as to who may need special attention.
• Install safety devices such as grab bars, adjustable height beds and handrails
• Review all prescribed medications to assess what residents may be a fall risk due to the nature of the medication
• Install alarms on on beds and chairs for residents who are at a particularly high fall risk.
• Remove clutter from walkways