Nursing Homes Abuse Blog - By Jonathan Rosenfeld

The Chicago area has been struck by a snap of arctic weather lately.  It’s the kind of weather that quickly brings a chill to every part of your body regardless of how quickly you can do what needs to be done and get back to a warm area. 

When I read news clippings about a downstate nursing home patient who wandered from a facility into these cruel temperatures, I couldn't help but cringe as I knew more bad news would follow.

Sadly, I was correct. 

The body of the 75-year-old nursing home patient, identified as Aubrey Giles, was found in a creek located just a block away from Midwest Rehabilitation and Respiratory Care in Belleville, IL.  The elements were simply too much for that man to bear, and a medical examiner has ruled Mr. Giles died from exposure-related hypothermia.

In response to this unfortunate incident, officials from the Illinois Department of Heath have descended upon the Southern Illinois Nursing Home to begin an investigation into matter.  Much of the investigation will focus upon Mr. Giles' care plan created by the facility to best serve the his needs. 

Because many Alzheimer’s and dementia patients are considered to be elopement risks, I presume the state’s investigation will closely review what type of safeguards were ordered under the care plan for this patient vs. the safeguards (such as door alarms, wanderguards and gps tracking bracelets) that were actually in place at the time Mr. Giles wandered from the facility.  In  addition to safeguards, I would anticipate most of the staff on duty at the time of Mr. Giles incident would be questioned about their knowledge of his past behavior in addition to the circumstances of the day in question.

While wandering safeguards will indeed be reviewed, according to news reports surrounding this incident, the timeliness of the facilities notification of officials following the known departure of Mr. Giles’ departure from the facility appears to be within the boundries of the law.  Amazingly, while officials from Midwest Rehabilitation discovered Mr. Giles missing at three in the afternoon--- it was not until 7:30 that evening that the facility notified Department of Health officials.  Yet, this scheduling is completely legal.

Moreover, despite the fact that nursing home workers knew their patient with diminished capacities went into the frigid elements, no local police departments were contacted to help in the search for this missing patient-- again completely legal under the present laws.

Situations such as this shout the need for state lawmakers to begin to reevaluate the nursing home laws applicable to the tens of thousands vulnerable patients in Illinois whom are completely reliant on facilities for every part of their subsistence.  I find that fact that a nursing  home can use their own methods to locate a missing patient for 23-hours after they go missing downright shocking.  If a similar incident were to occur with a child leaving his home, I have little doubt the the public outcry over such an incident would be deafening. 

Related Nursing Homes Abuse Blog Entries:

Investigation Initiated After Suspicious Nursing Home Death, Involving Patient Wandering and Drowning

Too Little, Too Late. Nursing Home Submits Corrective Plan After Disabled Patient Wanders From Facility To His Death

State Fines Nursing Home Where Patients Drowns In Puddle In Front Of Facility

Lack Of Door Alarms Allows Assisted Living Patient To Wander To Her Death

After two hours of deliberations a Kentucky jury has awarded a former nursing home patient more than $1 million in damages for injuries she sustained while a patient at the facility.  The nursing home negligence lawsuit alleged that Cambridge Place Nursing Home in Lexington, KY was negligent in looking after an Alzheimer's patient who managed to gain access to an equipment storage room without the knowledge of staff at the facility.  

Ultimately, the woman sustained multiple injuries as a result of a fall she sustained in the restricted area including: broken facial bones, bleeding in her brain and multiple cuts on her face that required hospitalization.

Interestingly, the incident was investigated by a state adult-protection worker who determined that the woman's fall deserved to be evaluated for possible sanctions against the facility considering the severity of her injuries and the fact that she was a victim of caretaker neglect whom had been exposed to an extreme safety risk.  Yet, the Kentucky Attorney General declined to prosecute the matter as the injuries were deemed accidental.

Given the size of this verdict, I guess that the people sitting on this jury sided with the opinion from the adult protection worker?  

Post-incident investigations

The timeliness of an investigation by regulatory agencies can prove to be pivotal in determining both how an incident occurred and the role the facility may have played.  Unlike families or attorneys hired by families--- state regulatory workers--- and even law enforcement personnel have the ability to investigate the circumstances following the discovery of a concerning situation. The investigations can provide families with the answers they frequently seek concerning how and why an incident occurred.

Additionally, should the family choose to pursue the case civilly, the investigation can be extremely helpful in prosecuting the case because many of the details contained in the investigative report can be used to establish liability and damages.  As a nursing home lawyer, I always suggest that families contact the department of health within their state or similar regulatory agency as soon as feasible following an incident so a thorough investigation can be done while the event may be fresh in the minds of witnesses and staff.

Related Nursing Homes Abuse Blog Entries:

Alzheimer's Patient Fractures Her Neck As She Attempts To Crawl Out Of Window

Another Example Of Nursing Home Negligence: Disabled Patient Falls Down Unsecured Stairway

Rapid Decline For Elderly Nursing Home Patients Following Fall-Related Injuries

California Nursing Home's Failure To Provide Fall-Prevention Safeguards Results In A Substantial Fine

All too often, nursing home residents with Alzheimer’s and dementia are overlooked and over-medicated. Perhaps this arises from serious miscommunications, or - more likely - a deep misunderstanding from staff.

What makes the situation so tragic is that these are the very patients who truly need the most sensitive care. Luckily, a nursing home chain in Minnesota has caught on to this fact, and is now trying to effect a national change.

At the “Awakenings” program in 15 Ecumen nursing homes, staff focus on the “personal” aspects of relationships with Alzheimer’s and dementia patients - not just the pharmacological.

“It’s a person-centered model,” said Awakenings’ Executive Director Janet Green. “It’s added focus and time. We think it’s going to change statewide and nationwide how we care for patients with Alzheimer’s and dementia.”

Staff at Ecumen homes are trained to pay great attention to the smaller details of patients’ lives, such as: What time does the patient like to get up in the morning? Does the patient like to have coffee before breakfast? And on what day does the patient enjoy getting her hair done?

“A lot of it is little things,” said Green. “We can’t bring their memories back, but we can bring back the quality of life.”

The first, and primary goal of Awakenings is to wean patients off of their psychotropic medications - a challenging task for any health care provider. More than a quarter of all nursing home patients receive some kind of psychotropic drug, and the drugs can be notoriously hard to kick.

Still, at the Scenic Shores Nursing Home in Two Harbors, MN, Ecumen persisted with its goal - and received astonishing results.

“In six months, the home eliminated the use of antipsychotic drugs among all residents, and decreased their use of antidepressants by 30 - 50 percent,” a recent Ecumen report said. “As a result, many residents were literally ‘awakened’ to a fuller life. What was once a quiet nursing home is now a much more bustling, vital community.”

For Terri Jernberg, whose father George has dementia, the changes she witnessed in Ecumen’s Emmanuel Nursing Home were dramatic.

“He’s totally transformed, and the change has been unbelieveable,” said Jernberg, in a recent news article. “My dad has turned around. It’s like he’s truly awoken from a sleep.”

Awakenings began in 2009, after Ecumen received a $3.8 million grant from the state.

Related:

NYT - “Clearing the Fog in Nursing Homes”

“A Drug-Free Approach to Alzheimer’s Care”

“Antipsychotic Drug Use Among Elderly Nursing Home Residents in the U.S.”

After just two hours of deliberation, a West Virginia jury has awarded a family of a deceased woman $91.5 million in damages against Heartland of Charleston, a Manor Care facility.  The verdict is comprised of $11.5 million in compensatory damages and $80 million in punitive damages against the facility.  The nursing home lawsuit alleged that Heartland's failure to provide life's elemental needs--- food and water-- contributed to her death just weeks after her initial admission.

Allegations of nursing home neglect

Like many families coping with a family member's declining health, Tom Douglas knew it was time for his mother needed additional care that a skilled nursing facility could allegedly provide.  After recognizing that he was having difficulty caring for his mother at home, he sought out a facility that was uniquely equipped to care for her various ailments including: Alzheimer's, Parkinson's and dementia,

While he waiting for space to open at an Alzheimer's facility, he temporarily placed his mother at a facility for which he intended to be a short term stay.  In September, 2009 Tom placed his 87-year-old mother, Dorothy Douglas, into Heartland of Charleston for a short-term admission.

Within three weeks, Ms. Douglas' physical and emotional condition rapidly declined.  During her stay she was transformed from a woman who was capable of walking, talking and generally recognizing her family to a shadow of herself. 

By the time space had become available at the facility Ms. Douglas' family had selected for her care, she had lost 15 pounds and was on the brink of death.  In fact, a day after her transfer Ms. Douglas was taken to a nearby hospital where she died.

Damages intended to punish the facility

Like some states, West Virginia allows families to recover both compensatory damages and punitive damages against nursing homes and other medical facilities responsible for the injury or death of a family member.  In this case, lawyers for the family argued that Manor Care's under-staffing and high staff turnover were the underlying reasons for Ms. Douglas' rapid decline and eventual death.

According to news reports of the trial, former Heartland workers testified that it was physically impossible for them to care for their patients due to their extraordinary workloads.  Similarly, documents produced by Heartland demonstrated that staff turnover was 112% during the year Ms. Douglas was at the facility.

My take

At some point, even the largest corporations need to take notice of the fallout from their actions.  As the largest (and likely most profitable) nursing home operator, Manor Care needs to acknowledge that there are consequences for their actions. 

Even as the the giant of the nursing home industry, ($4 billion in annual revenue and more than $8 billion in assets), when verdicts this size come down, the company surely must taken notice.  Surely, verdicts such as this send a message to the decision makers that inadequate care is simply not acceptable.  Even when the human impact of their poor care is removed from the equation, poor care is simply bad business.

Related:

Care home's neglect was fatal, lawyers argue Charleston Gazette, by Zac Taylor, July 26, 2011

Heartland must pay $91.5M in fatal neglect case Charleston Gazette, by Zac Taylor, August 5, 2011

What's In A Name? Are Large Nursing Home Chains Intentionally Attempting To Deceive The Public When It Comes To Corporate Ownership?

Nursing Home Negligence Lawsuit Filed After Man Wandered From West Virginia Facility

Nursing aide to be charged with injury: kxan.com

Frustration is likely to blame for an episode of elder abuse at a Texas nursing home where a CNA attacked an Alzheimer's patient she was trying to get dressed.  Staff members at Wesleyan Nursing Home, notified nursing home administrators when they saw the CNA grab the patient and put him in a 'head lock' after he was slow to follow instructions.

Though the patient did not sustain injuries that are permanent in nature, the CNA was fired from her position and will face criminal charges of: injury to the elderly and disabled reckless bodily injury.

Caring For Patients With Alzheimer's

Ok, let's face it.  When it comes to being a caregiver for a person-- old or young-- it can be difficult, sometimes thankless work.  When it comes to caring for a person with dementia or Alzheimer's it really takes a special--- and incredibly patient-- person.  Unlike other patients who may be re-directed to the task at hand, caregivers for patients with Alzheimer's may simply have to wait until the person is ready to do what ever the task may be. 

Too often, a poorly trained or unsuitable caregiver may snap in frustration and take out their anger on the patient for who they are responsible for caring.  Recognizing that combativeness is part of the disease, is important for all caregivers to acknowledge. 

When selecting a nursing home for a patient with Alzheimer's, families should ask the facility the following questions:

• How many Alzheimer's patients do you have?
• Have staff received any specialized Alzheimer's training?
• Are staffing levels increased for Alzheimer's patients?
• Do you have a plan for when patients become combative?

Wandering in a potentially deadly problem for nursing home patients with dementia and other medical conditions that make them unable to appreciate the dangers around them. 

While not a common problem, wandering from nursing homes puts particularly vulnerable patients at risk for harming themselves when they find themselves in the outside world with no one to look after them.

Just 200 feet from the doors to the nursing home where she was a patient, a 92-year woman left the facility without the knowledge of the facility staff and managed to fall into a shallow puddle nearby and drown.  Authorities from the North Carolina Division of Health Service Regulation have issued a $20,000 fine against, Bradford Village of Kernersville, the facility that was to be supervising the woman.

In the course of the agencies investigation, it was determined that the facility made numerous errors when it came to ensuring the safety of the woman.  In particular, the investigation revealed:

• The staff at the facility failed to conduct regular inspections of the woman's room to help track her whereabouts.
• Numerous code violations regarding errors made the physical environment, personal care and supervised.
• Door alarms at the facility were de-activated to allow staff to easily exit the facility to smoke cigarettes.
• Supervisors at the facility unaware of safety protocols.
• Staff failing to appreciate the fact that the woman suggested that she wanted to leave the facility earlier in the evening

Certainly, tragedies such as this, are reminder of the necessity of all facilities that care for patients who have dementia or other medical conditions that make them unable to appreciate their surrounding dangers. 

Having worked on a number of nursing home wandering cases, I always encourage families to report the situation to the state department of health so an into the incident can be investigated in a timely manner. 

Given the fact that many nursing homes have extraordinarily high staff turnover rates, conducting a timely investigation and obtaining statements from staff is especially important.  Frequently, I cite these early investigations as a primary reason why some cases can be resolved early on as opposed to protracted litigation.

Related:

Hypothermia Confirmed As Cause Of Death In Nursing Home Wandering Case

$821,000 Awarded To Family Of Deceased Assisted Living Patient Who Wandered From Facility

Wrongful Death Lawsuit Ensues After Nursing Home Patient Is Struck By A Freight Train

Chicago Nursing Home Cited For Multiple Violations Following Drowning Death Of Patient

Authorities in Missouri are looking for answers regarding how and why an Alzheimer's patient at Springfield Skilled Care Center fractured her neck.  Police were summoned the the Missouri nursing home after the staff at the facility discovered the patients dead body on the ground outside of the facility.

A preliminary autopsy demonstrated that the patient suffered from a fractured neck that apparently happened as the woman was wrangling her way through a window to the outdoors.

As inspectors examine the circumstances surrounding this incident, news reports verify that Springfield Skilled Care Center has had troubles in the past.  With a one out of five star health inspection rating, Springfield has had troubles relating to its 'special care unit' for patients with Alzheimer's and dementia when doors wouldn't open after fire alarms were activated.

In response to situations such as this, some facilities that cater to patients with Alzheimer's have implemented the use of specialized safety devices such as: window and door alarms and specialized hardware to prevent patients from leaving the facility without the knowledge of the staff.

Related:

Nursing Home Cited For Mistreatment Of Resident Following Investigation Of Resident's Fractured Neck

Fall Leaves Dementia Patient With Broken Neck At Assisted Living Facility

"Escape Plan" Tragedy At Chicago Nursing Home

Who doesn’t remember the shock of their first time at the circus when the fire-eater or knife-swallower made their way to center ring to perform their stunts?  Surely, even when these trained performers make their way into the big top, there is always a risk of danger.

Certainly, not to make light out of a serious issue, there are similar swallowing-related dangers facing patients who may not be able to appreciate the dangers.  I have worked on a number of cases involving disabled patients who have swallowed foreign objects during admissions to nursing homes, hospitals and group homes. 

Most of these foreign-object cases involve patients with Alzheimer’s and other psychiatric conditions who remain unable to appreciate the dangers associated with swallowing materials that may be on hand in their rooms.

Commonly encountered swallowed foreign objects including:

• Plastic knives and forks
• Food packaging
• Sterile gloves
• Pens
• Toothbrushes
• Coins
• Razorblades
• Dental implants / dentures

What makes many of the foreign object ingestion cases particularly horrific for the patient is the fact that many of the foreign objects are extremely dangerous is the fact that many objects go undetected by staff until a problem manifests itself in the form of a severe medical complication -- such as choking or internal bleeding.

Given the prevalence in ingesting foreign materials or objects amongst Alzheimer’s, dementia and psychiatric patients, facilities need to be mindful of this real tendency and take steps toward minimizing the chances a patient can access these materials:

• Facilities should take steps towards identifying which patients have a history of ingesting foreign materials
• Medical devices should be kept under locked conditions
• Staff should remove non-edible food wrappers and coverings from meals prior to serving staff
• Staff should supervise patients with a swallowing proclivity

Due to the fact that many of these patients are simply unable to perceive the dangers associated with ingesting foreign objects, facilities need to be mindful of the inherent risks associated with keeping materials accessible to their patients and implement safeguards to prevent patients susceptible to this type of behavior from accessing materials.

Resources:

Intentional Swallowing of Foreign Bodies and Its Impact on the Cost of Health Care, Science Daily, November 4, 2010

Foreign body aspiration in dentistry- a review (PDF) The Journal Of The American Dental Association 1996;127;1224-1229 by SM Cameron, WL Whitlock and MS Tabor

CT Features of Esophageal Emergencies (PDF) Radiographics by Catherine A. Young, MD, JD • Christine O. Menias, MD • Sanjeev Bhalla, MD • Srinivasa R. Prasad, MD (2008)

I've seen a significant number of cases where an Alzheimer's patient gets admitted to a nursing home or assisted living facility only to have their health rapidly decline within a brief period.  In several cases, I've seen patients deteriorate so significantly that within a few weeks of their admission they needed to be rushed to a hospital due to rapid weight-loss and dehydration.  

The event likely leads to a hospitals request that a feeding tube be surgically implanted in patient to provide life sustaining nutrients.  Unfortunately, further complications typically arise with the use of the feeding tube adding further problems to a typically messy situation.

A recent New York Times article, "Feeding Dementia Patients With Dignity" reinforced the obvious, feeding patients with dementia and Alzheimer's is difficult and time consuming. Moreover, the alternative in installing a feeding tube can lead to anger in the patient and negatively impacts the patients quality of life.

I highly recommend that all family and caregivers of Alzheimer's patients check out this article authored by Roni Caryn Rabin that chronicles some of the problems encountered by the more than 5 million people suffering from Alzheimer's disease and specifically-- feeding. 

If there's one message I was left with after reading the article, it is that Alzheimer's patients require a great deal of patience during mealtimes in order for them to really flourish.  Ms. Rabin's article describes how a husband spends more than 45 minutes feeding his wife at every meal in order for her to to physically get enough food without physically or emotionally stressing her.

Certainly, nursing homes and assisted living facilities need to be mindful of the patients nutritional needs and provide the staffing levels for all patients to live with the highest feasible quality of life. 

Related:

Nursing Home Staff Must Pay Special Attention To Avoid Complications When Caring For Patients Dependent On Feeding Tubes

Feeding Tubes May Be Over-Used In Dementia Patients

Feeding Tube Mishap Results In Patient Death & Large Nursing Home Fine

Despite the glimpse of warmer temperatures that are (hopefully) around the corner, many nursing homes and long-term care facilities have their heating systems working at full force.  Unfortunately, many of these facilities were constructed at a time when radiant heating systems were state of the art.

The danger radiators and portable heating units pose to disabled nursing home patients may seem like somewhat of an alarmist attitude, but the reality is that anything can pose a danger to people who may be unable to appreciate danger to themselves or others.  

A radiator in a Minnesota nursing home patient's room turned deadly when the man 'wedged' his foot between his bed and the radiator.  The man suffered second and third degree burns to his legs.  Four weeks later, the man died from complications related to the burns.

An investigation in the incident, which occurred at Redeemer Health and Rehab, determined the facility was negligent in its care of this dementia patient because the facility knew that this man was prone to do this.  In fact, the nursing home had noted that the man had a similar episode of wedging his feet between the radiator shortly before this incident occurred.

As a lawyer who has represented burn victims, I can personally attest to the horrific pain these victims experience while undergoing burn treatments.  Many burn patients require skin grafts and other painful surgeries to heal the wound and reduce the risk of infection.  In this respect, it always aggravates me when I hear of a person who needlessly suffered a burn injury because the toll the injury takes on the individual.

Read more about this burn to a nursing home patient here.

Related Nursing Homes Abuse Blog Entries:

Resident Who Smoked & Used Oxygen Suspected Of Causing Fire At Assisted Living Facility

Nursing Home Patient Sustains Serious Burns After Smoking In His Bed

Cigarette Lighter Mishap Results In Severe Burns To Nursing Home Patient

Is it fair to expect an assisted living facility-- loosely regulated entities that help residents with daily living activities to care for a person with Alzheimer's?  

Assisted living facilities (ALF's) are intended to provide a semi-structured environment to (primarily) elderly group.  Meals are prepared and staff are intended to provide residents with daily living activities.  Unlike nursing homes, ALF's are not intended to provide skilled nursing care.

In the case of Alzheimer's patients, many ALF's accept these people despite the fact that many offer no specialized care for them.  Is this a case of corporate greed putting its quest for profits ahead of providing necessary care to its residents?

In the case of Ruby Larson (an Alzheimer's patient), I think the answer is a resounding 'yes'.  On July 23, 2007 Larson wandered from Pheasant Pointe Retirement and Assisted Living Residence-- never to be heard from again.  Last year a judge declared Larson to be legally dead as the search for her was fruitless.

Ms. Larson, 75, was admitted to Pheasant Pointe in May, 2007 suffering from dementia, memory loss, and disorientation.  During the three months Larson was a patient at Pheasant Pointe, she wandered from the facility three separate times.

Larson's family filed a lawsuit against Pheasant Point and its parent company, Spectrum Retirement Communities of Oregon claiming the staff failed to properly supervise Larson and that the companies should have known that Ms. Larson required care only a specialized Alzheimer's care unit could provide.

Unfortunately, Alzheimer's patients may encounter many problems while living in an assisted living environment.  Of course, depending on the individual facility, the levels of care may be different.  But most ALF's are horribly ill-equipped to care for Alzheimer's patient who typically require great care with meals, getting about, re-direction, medication as well as maximum assistance with daily living.

If a facility is unable to provide the level of care required, the facility should advise the family.  Too often, ALF's never mention to the family that their loved one may be better off in a nursing home or alternative facility that specialized in Alzheimer's care.  

Read more about this lawsuit against an assisted living facility here. 

Related Nursing Homes Abuse Blog Entries

The Truth Revealed: Nursing Home Tries To Cover-up Fact That Resident Choked To Death On Tuna Sandwich 

Nursing Homes For Alzheimer's Patients. What To Look For?

Woman Dies From Hypothermia After Wandering From Assisted Living Facility 

As an injury lawyer who frequently handles nursing home negligence matters, I find myself regularly thinking 'what happened to plain old common sense'?  I mean, you can train the nurses, physicians, maintenance workers and administrators til' you're blue in the face-- yet most of the commonly encountered nursing home problems could easily be avoided with plain old common sense.  

Want an example?  How does checking on the temperature of food before feeding a disabled person? Is that too much to ask? 

Along those lines, homicide charges were filed against Alador Thompson, an employee of Cambridge-Brightfield Assisted Living Facility in Hatfield, PA.  The charges are related to an October 8th incident in which Thompson poured scalding oatmeal into the mouth of an Alzheimer's patient she was responsible for feeding.  The oatmeal caused the resident to suffer burns to his lips, tongue, and the inside of his mouth.

The resident was taken to a local hospital for burn treatment.  After three days of hospitalization, the resident was returned to Cambridge where he apparently stopped eating and died.

On August 5th Thompson will be arraigned on charges related to involuntary manslaughter and neglect of a care dependent person. 

Hey district attorney, can I make a suggestion?  How about filing similar charges against the administrator of the facility for accepting this poor man back at the facility and allowing him to starve to death following the obviously severe burns he suffered on hands of your employee? 

Read more about this case of severe neglect at a Pennsylvania assisted living facility here.

Related Nursing Homes Abuse Blog Posts

Ohio Nurse Sentenced To 12 and 1/2 Years For Sexually Abusing 100 Nursing Home Residents

Guilty Plea From Nurse Accused Of Abusing Tennessee Nursing Home Resident

Nursing Home Resident Chokes To Death On Dinner

Tonight HBO will premiere the four-part documentary "The Alzheimer's Project". The scheduled segments include: "The Memory Loss Tapes" (debuting May 10), which provides an up-close and personal look at seven individuals living with Alzheimer's, across the full spectrum of the progression of the disease. "Momentum In Science" (May 11 and 12) is a two-part state-of-the-science film that takes viewers inside the laboratories and clinics of 25 leading scientists and physicians, revealing some of the most cutting-edge research advances. "'Grandpa, Do You Know Who I Am?' with Maria Shriver" (May 11) captures what it means to be a child or grandchild of one with Alzheimer's, while "Caregivers" (May 12) highlights the sacrifices and successes of people who experience their loved one's descent into dementia.

I look forward to tuning in.  Please let me know what you think of the program.

An 87-year-old nursing home resident recently died from injuries sustained in a hit and run auto accident that occurred Friday night.  Several people in the area made 911 calls to the local police department that a car versus pedestrian crash occurred in front of the the Good Samaritan Skilled Nursing & Rehabilitation Center where the woman was a resident.  

The woman's family claimed they recently convinced her to check into the nursing home due to declining health.  Nonetheless, her family believes her unhappiness at the facility lead her escape attempt.  "She was unhappy being in the nursing home.  I think she planned her escape well and anticipated going home," said her daughter Linda Meldrum.

While the circumstances leading to the woman's escape and death are under investigation, the woman's daughter points to under staffing as the predominate cause.  "There was a security  door in her room that she was able to disable at 87-years-old  They appear to be very short staffed at night. We were told there was a loud alarm going off but no one went looking to see what was going on"

The Good Samaritan Nursing facility released the following statement regarding the incident:

An unfortunate incident has taken place in which one of our residents was struck by an unidentified vehicle on Detroit Road during the evening of March 13, 2009. This was a "hit and run" incident where the driver left the scene. Good Samaritan urges anyone with any information regarding this incident to immediately report it to the Avon Police Department at 440-934-1234. Out of respect for the privacy of the resident and their family, we cannot share any further information, other than to note that all of the other residents of our health care center are safe. Good Samaritan appreciates the well-wishes and condolences of the community and hopes that the driver involved in this incident will be found quickly.

Read more about this case of elopement in an Ohio nursing home here.

Nursing Home Residents Who Elope

Nursing homes have a duty to protect their residents not just from harm from outside sources, but also from themselves.  In order to minimize the risk of residents eloping, facilities should take the following precautions:

• Install technology updates (such as automatic locks and alarms) to their facilities that to help contain residents with a propensity to wander.
• Train staff to identify residents who are likely to wander from the facility and how to search for missing residents.
• Provide adequate staffing levels to look after residents.  Many of the wandering incidents occur during 'off' hours when the facility is minimally staffed.
• Establish plans to help look for missing residents

Wrestling legend Verne Gagne, a former professional wrestler, still has some of his moves that made for a successful career in college wrestling, professional wrestling and professional football.  Unfortunately, the wrestling moves have no place in an Alzheimer's unit at Friendship Village Nursing Home.  Recently, Gagne threw down his roommate, Helmut Gutman, resulting in a broken leg and closed-closed head injury.  Several days later, Gutman died from complications related to his injuries.

This incident demonstrates the necessity of nursing home staff to closely monitor Alzheimer's and dementia patients and potentially intervene if the residents pose harm to themselves or others.  It is common for many people suffering from late stage Alzheimer's to act violently and out of character as their disease progresses.  Nursing home employees should quickly intervene when they see a resident begin acting more aggressively and redirect the person even isolate them temporarily.

The failure of a Pennsylvania hospital to take basic steps to protect its patients may have cost a dementia patient her life.  89-year-old Rose Lee Diggs was admitted to UPMC Montefiore for multiple deficiencies during the investigation of her death.  Although Diggs was transferred from a nursing home that warned the hospital of her propensity to wander, staff at the hospital failed to take any preventative measures to assure Diggs safety in their facility.

Five days after Diggs admission to UPMC she was found dead on the hospital roof in her hospital gown and slippers in 20-degree temperatures.  The Pennsylvania Department of Health determined Diggs was able to access the rooftop through a mechanical room with a broken lock.  The last recorded sighting of Diggs by hospital staff was more than 13 hours before her body was discovered. 

The health department's investigation into the death determined the hospital acted improperly when it:

• Failed to assess patients safe care needs
• Failed to take any steps to address wandering behavior- despite the nursing home advised them of this tendency
• Failed to maintain a safe hospital environment

Following the health department's report, the hospital developed a plan of correction to address the deficiencies.  Among the new programs initiated: a 'Condition L' plan that causes all hospital employees to help in a coordinated search for missing residents, geriatric or psychiatric nurses are to conduct specific assessments of each patients propensity to wander and a policy to inspect doors leading to outside areas.

The family of Diggs is planning to pursue a civil case against the hospital for their negligent care that caused or contributed to her death.  This matter highlights the importance of investigations by health departments into situations involving negligent care in hospitals and nursing homes.  Frequently, the information obtained by investigators can be helpful in the course of litigation as witness statements and other valuable information is captured shortly after the incident took place.

Related article

State cites UPMC for patient's death on roof

The North Carolina Department of Health and Human Services has issued a report very critical of the nursing care provided to an Alzheimer's patient who recently died from injuries she sustained from a fall.  The report follows an extensive investigation of the nursing practices at Five Oaks Manor Nursing Home.  The resident at issue is 87-year-old Annie Bell Scarboro who died from head injuries related to a fall from a loading dock off the kitchen.

The state's report indicates that on December 18th, Scarboro managed to wheel herself in her 'merry walker' through three sets of unlocked doors to the outside area without the staff's knowledge.  The report also indicates there were no door alarms on any doors-- including the one leading to the outside area where Scarboro died.

This incident follows similar wandering episodes Scarboro had while a resident at the facility.  On May 22, 2008, managed to escape through the exact same doors she managed to navigate through prior to her death.

The state's report into this nursing home death, concluded the facility failed to comply with 483.25(h) Accidents and Supervision, the facility failed to "ensure that the resident environment remains free from accident hazards as is possible; and each resident receives adequate supervision and assistance devices to prevent accidents."

Among the 'assistance devices' ordered to be implemented at the nursing home, by state authorities is the installation of a Mag-Lock and Accutech alarm system.  The Mag-Lock / Accutech system automatically locks doors as an Alzheimer's resident approaches the area with a special bracelet that activates the system. 

While a sophisticated alarm system would have prevented this nursing home death.  The sad reality is that this incident should have been prevented. Had the facility followed basic safety measures for Alzheimer's patients-- staff supervision and locks on doors-- there is little doubt this death could have been prevented.

Read more about this report of nursing home negligence here.

View a complete copy of the investigative report of this incident here.

Related: Nursing Home Injury Laws: North Carolina

The family of Mabel Montgomery is bringing a wrongful death lawsuit against the assisted living facility where she lived, Juniper House.  The lawsuit alleges that Ms. Montgomery left Juniper House through a fire exit and fell.  The fall resulted in a fracture of Ms. Montgomery's neck and traumatic brain injury.  The injuries from the fall ultimately lead to the woman's death.

The lawsuit further alleges that the Oregon Assisted Living Facility knew that Ms. Montgomery had dementia and had a propensity to leave or wander from the facility.  The staff at Juniper House apparently went so far as to assure the victim's family that the fire doors were secured in a way to prevent residents from easily opening them.

Understaffing is the real culprit here.  Too often the simplest preventative measures could stop dangerous situations from occurring.  I would be interested to see what time of day this incident occurred as how many staff were working at the time.  My guess is that this incident occurred at a time when staffing was at a minimum.

The following is a recent article I authored for the Senior Home Care Blog.  Senior Home Care Blog is a valuable source of information for caregivers to people who suffer from Alzheimer's, stroke, MS and other brain impairing conditions.  I highly reccommend this blog as a great resource to all home care providers and nursing home staff.

At some point, most Alzheimer’s patients will spend time in a nursing home or assisted living facility.  Whether, the stay is a temporary or permanent in nature, the special needs of Alzheimer’s patients must be recognized and evaluated before the person is placed into a nursing home environment.  There are no specific nursing home regulations in place for people with Alzheimer’s and dementia.  Consequently, the burden of selecting an appropriate facility falls squarely on the shoulders of the family or close friends.  The following is general ‘game plan’ that can be used by families of people with Alzheimer’s, dementia or traumatic brain injury to aid in the selection of a temporary or permanent nursing home.

Before any change in living arrangements is contemplated, a complete physical and mental assessment of you loved one should be completed.  A candid discussion of the individuals needs should be done in the presence of the family and caregivers.  Try to decide what the person is really capable of an in what areas the person needs assistance. Honesty is crucial.  An open and honest discussion will help with the selection of a facility, but will also help the staff at the facility a baseline get an idea of your loved one’s needs. 

 Initial selection of a nursing home or long-term care facility for an Alzheimer’s patient is no different from the selection of a nursing home for a non-Alzheimer’s patient.  The first step is to do some research about the facilities via friends or on the internet. I suggest the Medicare website (http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteria.asp?version=default&browser=Safari%7C2%7CMacOSX&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True) as a starting point.  You can see on-line where the facilities are located and what services they offer.

 After conducting some initial fact gathering about the facilities, a visit to the facility is a must.  Do not risk the safety and happiness of your loved one at a facility without physically visiting the facility. Before deciding on a facility at least two visits are in order.  The first visit should be a scheduled visit to get a tour from the staff.  If the initial visit passes muster, a second unannounced visit should be made.  The second visit will likely be more telling than a carefully coordinately tour.  Do not hesitate to talk with the staff during your visits.  You can learn a lot about the facility depending on their attitude and demeanor.  Unhappy staff is usually indicative of unhappy residents.

 Unlike most nursing homes that care for the elderly, nursing homes that care for Alzheimer’s patients and those suffering from a brain injury needs to take precaution to reduce the risk of residents harming themselves and others.  Nursing homes for Alzheimer’s patients should have specialized design considerations to help ensure the individual’s safety and happiness.  Facilities should:

-       Place restrictions on in-and-out privileges for residents.  Safeguards to prevent elopement (http://www.nursinghomesabuseblog.com/2008/07/articles/elopement-wandering/elopement/) and wandering (http://www.nursinghomesabuseblog.com/2008/07/articles/elopement-wandering/wandering/)—common sources of injury to Alzheimer’s residents.

-       Require each visitor to sign in.  Mentally impaired residents are disproportionately physically and sexually abused compared with the general nursing home population.

-       Bracelets and alarms.  Does the facility have a tracking system or alarm for residents who have a tendency to wander?  Depending on the mobility of the individual, a surveillance bracelet should be used to keep track of the person.

-       The facility should have clearly marked walkways inside and outsides the facilities. The walkways should be well lit, have directional signage with diagrams as opposed to written diagrams.

-       Have a circular configuration. Alzheimer’s patients get particularly frustrated when encountered by dead-ends and right angles.

Staffing Is The #1 Consideration

‘Does the facility regularly handle people with Alzheimer’s?’  This is an important question to ask, because the most important factor in your loved ones happiness and safety will be dependent on how much experience the facility has in dealing with Alzheimer’s patients.  Seek out a facility that focuses exclusively on Alzheimer’s care or has a specialized unit for residents with Alzheimer’s. If the facility houses both Alzheimer’s and non-Alzheimer’s patients, precautions should be in place to control both groups access to the other.  Though it may seem segregationalist, depending on the level of functionality, most Alzheimer’s patients should be kept together for their own safety.

 Most incidents involving nursing home injury occur due to staffing problems.  Don’t be afraid to ask some or all of the following:

-       Does the facility require / provide any specialized Alzheimer’s training for the staff?

-       Does the facility do backgrounds checks on all employees?

-       What is the policy for alerting a family member to an incident?

-       What is the policy for physical and / or drug restraints?

-       What is the facilities toileting policy? Are diapers changed regularly or does the facility only change on a schedule?

-       How does the facility ensure that resident’s eat?  Do they have staff to monitor what is and is not eaten?

-       What is the resident / staff ratio?  A general rule is 1:6 for staffing during the day.

Jonathan Rosenfeld is a lawyer in Chicago that concentrates his practice in representation of victims of nursing home abuse and neglect throughout the country.  Jonathan author’s the Nursing Homes Abuse Blog.  The blog contains information useful to families of nursing home residents and attempts to answer many frequently encountered questions regarding nursing homes and assisted living facilities. Jonathan is available to discuss all aspects of nursing home care.  You may reach him at Jonathan@rosenfeldinjurylawyers.com or toll-free (888) 424-5757.

A mentally and physically disabled woman walked out of an Maple Crest Manor, an assisted living facility in St. Louis, MO,  and unknown to the facility boarded a bus to Chicago, IL.  The woman left the assisted living facility for what the staff suspected would be 'a long walk'.  After several hours passed without sight of the woman, the facility contacted the woman's legal guardian who then alerted police.

Chicago police called local Missouri authorities after finding the woman's name on the national database for missing and endangered people.  The woman was brought by authorities safely back to the facility in St. Louis.  No charges were filed against the assisted living facility or the legal guardian.  

Authorities report the woman has the mental capacity of a 7-year-old.  This begs the question: Would you let your 7-year-old walk around unsupervised?  Clearly, this incident should have been prevented with the adoption of a more restrictive leave policy for residents.  

Read the full story regarding this incident involving elopement at an assisted living facility here.

This report of an Alzheimer's patient who was sexually assaulted by her co-resident (a registered sex offender) demonstrates the extreme vulnerability of nursing home residents with dementia and Alzheimer's.  Nursing home's must take extra precautions when handling Alzheimer's patients.  Unlike most nursing home residents, who are capable of most daily living needs, many with Alzheimer's are completely dependent on the nursing home staff for every need- feeding, bathing, medication and toileting.

What makes this story particularly disturbing is that the 'victim' of the sexual assault is probably incapable of identifying the perpetrator.  Consequently, there is a chance that this individual could commit a similar crime again against another nursing home resident.  Nursing homes must begin to take precautions to protect their residents.