While we frequently discuss the internal threats to patients at nursing homes or assisted living facilities-- such as through falls or food poisoning, more attention needs to be put upon the inherent safety threats posed to residents when they 'wander' or 'elope' from the safety of the facility as these threats may not always be deemed valid.

When discussing situations involving patient elopement, the circumstance commonly involves a patient who lacks the capacity to truly comprehend the ramifications of their actions.  Unlike a patient who may be unhappy with their situation or living arrangements at a nursing home or assisted living facility and seeks to 'escape' back to the life they once knew, the most concerning cases of patient elopement / wandering involve patients who lack the cognitive ability to make decisions for themselves. 

Individuals plagued with Alzheimer's and other types of memory loss are perhaps the biggest risks when it comes to categories of patients who are "elopement risks".  Identifying patients who pose a risk of eloping from the facility is indeed one of the most important factors in preventing these situations from occurring in the first place.  Once the risk has been identified, facilities can then implement both physical safeguards and behavior modifications to help prevent incidents of elopement from occurring.

I was again reminded about the dangers related to patient elopement when I read about an incident involving a patient who eloped from an assisted living facility in New Jersey and was struck by a car and killed as she was crossing the highway adjacent to the facility.  According to news reports of the incident, the woman suffered from schizophrenia, psychosis, both short-term and long-term memory loss and was known to was identified as being an 'elopement risk' by the facility.

Believing that this incident should have been avoidable with proper care, the family of the deceased resident has initiated a lawsuit against both the ALF, Brandywine Assisted Living, and the company's CEO.

From a legal perspective, if the circumstances prove to be correct, this facility obviously breached its duty of care in looking after this vulnerable patient.  Particularly with the advancements in technology being made with both GPS locating technology and other devises to notify staff when a patient is attempting to leave a facility, incidents such as this really need not occur.

Related Nursing Homes Abuse Blog Entries:

Man Wanders From Illinois Nursing Home With Dangerous Track Record Of Patient Care

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

The fact that most nursing home patients are cared for by a series of caregivers throughout the course of the day further solidifies the concept that when problems do arise is usually means that errors were made not just on the part of one or two caregivers, but likely a team of 4, 5 or 6 individuals who may have provides some form of care-- and are similarly responsible for reporting complications and other problems to a supervisor or physician.

Consequently, when errors are discovered at skilled nursing facilities, the entire staff needs to be re-trained concerning the proper method for caring for their patients.  Particularly after a problem has been identified, I would hope that the facility would work as a team to see that the origins of the original problem get corrected and avoid future complication.

In this light, I was disgusted to hear that just two months after an elderly nursing home patient wandered to his death from Midwest Rehabilitation and Respiratory Care Center in Belleville, IL --- another patient managed to wander from the facility without the knowledge of staff.  Happily, this wandering incident has a different conclusion than its predecessor as the resident was safely located approximately two hours after his suspected disappearance. 

Compared with the January wandering incident there was a significant delay notifying police of the circumstance, this time staff at Midwest Rehab immediately alerted the Belleville Police Department after realizing that the 58-year-old patient had wandered from the facility.

Nonetheless, given the similarities between these incidents and the fact that they occurred within such a short time frame of one another, it is obviously clear that the hyper-scrutiny and sanctions imposed against the facility have done little to improve the safety of patients.

Perhaps this incident will convince public health officials that more significant sanctions need to be placed upon this facility in order to protect current patients from further harm from obviously defective situations.

Related Nursing Homes Abuse Blog Entries:

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

State Steps In After Second Episode Involving Patient Elopement At Same Facility

History Of Errors Discovered At Illinois Nursing Home Where Patient Wandered To His Death

Now, following an investigation by officials from the State of Illinois Department of Health, it appears that the man had prior episodes of attempting to leave the facility-- yet the facility failed to take the necessary steps to prevent the situation from occurring again.

A recent article in the Belleville News-Democrat by Kevin Bersett, “State: Belleville nursing home negligent” discussed the utter lack of safeguards in place at the facility intended to protect patients such as this man. When interviewed by state officials, nursing home employees conceded that they never heard any door or window alarm (to alert them that a patient had left the facility) on the day of the man’s disappearance. Further, staff was aware that the man should be wearing a monitoring device—yet staff allowed the man to remove the device.

All told, the state officials dispensed eight citations to Midwest Rehab concerning negligent care in the manner the facility handled both the care of the patient who recently wandered from the facility as well as for other issues identified during the inspection.

Officials were so concerned about the lack of wandering safeguards they issued considered the situation to pose an ‘immediate jeporardy’ to the patients at the facility and ordered the following corrective measures be implemented on the spot:

The surveyor confirmed through interview, record review and observation that the Facility took the following actions required attention to remove the Immediacy:

1. On 1/15/12, the facility conducted individual in-service training for all staff. All staff were in-services on the following policies and protocol: Elopements, Wandering Residents, Missing Residents, Head Checks and Drills, Elopement Drills, Door Alarms, Behavior Tracking, Tracking Sheets, Residents Currently on Tracking and/or (patient monitoring device) and the (patient monitoring device) System Policy.

2. On 1/16/12, the facility reassessed all current residents in the facility to determine wandering risk status. Following this, all high risk residents care plans were reviewed and changes made as necessary.

3. On 1/16/12, a Quality Assurance (QA) Meeting was held and all areas of the facility were reviewed to determine the possible exit route of the missing resident and other possible problem areas that exist. New preventative measures were implemented at that time as needed.

4. On 1/16/12, the QA committee reviewed all related policies and revisions were made as needed.

5. On 1/16/12 and on-going, secondary keyed door alarms were installed on all exit doors accessible to residents.

6. On 1/16/12, all high risk resident's information was placed in a binder at each nursing station and at the front desk. Each binder included the individual residents face sheet, a current picture, room number and specific interventions to be in place.

7. On 1/16/12, Receptionist's hours have been extended and are now from 8:00 AM until 9:00 PM to provide additional monitoring of our main entrance.

8. On 1/16/12 and on-going, all door alarms will be checked by Maintenance daily (Monday-Friday) and by the weekend manager on Saturday and Sunday to ensure they are in proper working order. These checks will be documented at the time they are completed. Batteries will be changed monthly and as needed.

9. On 1/16/12 and on-going, Elopement Drills will be conducted monthly, alternating shifts, and randomly per Director of Nurse's (DON) and/or designee. 10. On 1/16/12 and on-going, Head Check Drills will be conducted monthly, alternating shifts, and randomly per DON and/or designee.

11. On 1/16/12 and on-going, an initial Wandering Assessment will be completed on all new admits on the day of admission, in conjunction with their 14 day assessment, quarterly and PRN. Follow-up will be implemented based on the results of the assessment.

12. On 1/16/12 and on-going, patient monitoring devices will be checked daily by the MDS nurses Monday thru Friday and on the weekend by the weekend manager.

While the above safety measures seem justified, I find it sad that give the inherently basic nature of most measures, these were not implemented without an intervention from officials. In light of this publicized nursing home error and the prospect of facing a civil lawsuit from the deceased man’s family, I hope that this provides enough incentive for management to begin changing the way they operate and start giving patient needs a priority.

Related Nursing Homes Abuse Blog entries:

Illinois Officials Begin Examination of Nursing Home Procedures Following Elopement Of Alzheimer's Patient

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

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

The trial centered around the care--- or perhaps lack thereof-- that a 92-year-old woman received at Pinellas Park Care and Rehabilitation Center during an admission to the facility in 2004.  It was during that admission, that the staff at the facility allowed the woman to wander in her wheelchair to an unsecured stairway where she fell down multiple stairs to her death.

In addition to the oversight in allowing this patient-- with known wandering propensities--- to wander away from a group of patients at the facility, staff failed to notice the woman's whereabouts even though she was equipped with multiple alarms to alert the facility as to her whereabouts.

According to news reports regarding this landmark nursing home verdict, within just an hour of deliberations the jury awarded the woman's estate $60 million in compensatory damages and $140 million in punitive damages.

Given the impressive award, my guess is that the jury became quite angered after hearing about the was that this facility was operated.  Testimony provided by former employees of the nursing home described a facility was was under-staffed and that allowed problems to develop in the past when the patient suffered other falls and injuries at the facility.  

Related Nursing Homes Abuse Blog Entries:

Wheelchair Patient Falls To Death Down Un-secured Staircase In Nursing Home

Staff Need To Protect Disabled Nursing Home Patients As They Transport Them In Wheelchairs

Unattended Nursing Home Patient Falls Down Stairway In Wheelchair

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

While some activities may command supervision from a person specifically trained to care for a particular condition, most daily supervision can be done by any employee that is alert.

With patients who may be at risk for a particular complication, supervision may need to be completed at regularly scheduled intervals or--- in some cases--- constantly.  

Obviously, it is important for nursing home staff to understand the frequency with which patients need to be monitored and staff need to be educated on which patients may need more assistance than others.  

The concept of properly looking after patients was impressed upon me again after I learned more about a recent nursing home tragedy when a nursing home patient wandered to his death.  Weeks after his initial elopement from Falmouth Nursing Home (a nursing home in Kentucky) the body of a 32-year-old patient at the facility was discovered by in the woods by hunters in the area.  

An investigation conducted by state officials determined that the man who eloped suffered from a brain injury and other psychiatric disorders--- yet during the time he eloped from the facility, there was at least a three hour period where no staff checked in on the man.

Though staff may have assumed this man was asleep or resting, this simply is not a satisfactory assumption to make when a patient has a brain injury or other impairments that diminish his ability to function lucidly.  Further, given the man's youth and physical strength, staff surely needs to appreciate the risk of elopement or self injury during periods he was unaccounted for.

In response to this wandering case, staff at this Kentucky nursing home will be educated on monitoring the whereabouts of their patients.  An outside nurse-consultant will help ensure that such policies get implemented properly.

Too bad such planning was never implemented in anticipation of an incident such as what occurred above.  Too little, too late. 

Read more about this nursing home elopement case here.

Related Nursing Homes Abuse Blog Entries:

What good are nursing home fines when they're not enforced?

Another Assisted Living Patients Wanders From Facility To His Death

Hypothermia Confirmed As Cause Of Death In Nursing Home Wandering Case

Nursing Home Patient Dies When Struck By Car In Busy Street. What Was He Doing There?

Criminal charges have been brought against three nursing home workers on duty the night an Alzheimer's patient wandered from Texas nursing home to his death.  The three were employed in various capacities at a facility known as Tumbleweed Nursing Home on the evening of February 3rd of this year.

Surveillance video from the nursing home demonstrated that an Alzheimer's patient that the staff was responsible for supervising wandered without any intervention from the safety of the nursing home into the frigid outside temperatures.  Hours after the patient left the nursing home, he was found dead outside.  An autopsy revealed that the man's death was related to hypothermia.

After evaluating the evidence related to this nursing home death, a Grand Jury determined that there was sufficient evidence for to prosecute the workers on charges related to injury to the elderly, a third-degree felony.

Like other situations involving injuries to a nursing home resident, the family of this deceased nursing home patients may also elect to pursue a civil lawsuit against this facility based upon the negligence in supervising their loved one.  Unlike a criminal case, families in a civil case may recover money damages for the loss of their loved one.  Read more about the criminal charges pending against these nursing home employees here.

Related Nursing Homes Abuse Blog Entries:

Hypothermia Confirmed As Cause Of Death In Nursing Home Wandering Case

Elderly Woman Wanders From Her Convalescent Home To Her Death

Woman Dies From Hypothermia After Wandering From Assisted Living Facility

Alzheimer's Resident Dies Hours After Escaping From Illinois Nursing Home

Then, in the wake widely publicized investigative report from The Miami Herald concerning the lack of investigations into injuries and deaths at assisted living facilities throughout the state, an investigation into the suspicious death was initiated.

The investigation recently completed by the Department of Children & Families cites many errors made by the adult care facility that collectively contributed to Ms. Nava's drowning death in a pond adjacent to the facility.   Despite claims from the facility that all elopement precautions were in place at the time of Ms. Navas' death, state investigators uncovered the following:

• Broken surveillance cameras
• Sleeping staff
• Out of order door alarms
• Unlocked gate leading to a pond

While I'm sure this family is saddened by the blatant safety lapses discovered by state investigators, I hope that the findings bring some closure to this tragedy.  If anything positive can come of this tragedy, I hope that these findings reinforce the need for timely investigations on the part of regulatory authorities.  How many other untold tragedies were perpetuated upon innocent people at this ALF during the three years following Ms. Navas' death?

Related:

Family Sues Florida Nursing Home For Death Of Wandering Resident

Assisted-living facility blamed in woman’s drowning death, Miami Herald, July 16, 2011

Abuse & Cover-Up At Assisted Living Facility Caring For the Disabled

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

I remember the not-so-distant past when my four-year-old son was in his door playing mode. Doors would slam, hardware would break, but my wife and I were grateful as long as he stayed inside.  

Obviously, anyone seeing a toddler running around unchaperoned would (hopefully) call the police and advise them that his parents should be evaluated to see if they are in sound mind to care for their child!

Much like a child, elderly nursing home patients-- with conditions such as Alzheimer's and dementia-- face the same risks when they leave the safety of their facility and enter a world of unknown risks and dangers.  

Yet for some reason, facilities fail to employ the same standards when caring for these exceptionally vulnerable people.  

Another example of a skilled nursing facility failing to look after a patient comes out of Texas, where a patient was found dead hours after leaving the safety of his nursing home.

FOX 34 is reporting that, 71-year-old Willie Byers was found dead just four hours after walking away from Tumbleweed Care Center on February 3rd.  The morning Mr. Byers left the facility was during one of the coldest stretches in the area's history.  No surprise his death was due to hypothermia.

Currently this incident is still under investigation and no formal charges have been brought against the facility.  I hope that the investigation confirms the obvious-- that this facility was not doing an adequate job looking after its patients.

Related

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

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

Assisted Living Facilites Need To Re-Evaluate If They Are Capable Of Caring For Dementia Patients

Nursing Home Injury Laws: Texas

Occasionally, my chart reviews reveal more than I expect when: medication charts reveal that medication was administered for days after my client was transferred to another facility.  Or on one occasion, there were nurses’ notes for hours following a client’s death.

When I see serious charting errors, I makes me question not just the care surrounding a particular incident, but all care at the entire facility.

I applaud a recent case where criminal charges were filed against three nurses aides at a Bronx, NY nursing home who clearly lied about caring for patient who had wandered from the facility. 

After comparing the patient’s chart with a videotape from the facility, it was apparent that three aides at Beth Abraham Health Services lied about caring for the patient whom had already left the facility.

Thankfully, the patient was located safe shortly after a housekeeper at the nursing home reported she was missing to the police.  Nonetheless, the attorney general has filed charges relating to:

• Endangering the welfare of a physically disabled person
• Falsifying medical records
• Willful violations of health law

No word on when these nursing home employees will face their trial, but the facility obviously didn’t think much about the criminal charges—or safety concerns for other patients---- these aides were reinstated after they were initially fired. 

Related:

Three nursing home aides lied about missing schizophrenic patient in wheelchair, NYDailyNews.com, February 24, 2011

Nursing Home Injury Laws: New York

Nursing Home Settles Lawsuit After Fraudulent Records Discovered

Admissions Suspended At An Emeritus Assisted Living Facility Following The Discovery Of: Medication Errors, Bed Sores & Falsified Medical Records

With a known desire to walk, combined with the fact their their mother had dementia, the brothers knew of the importance of keeping close tabs on their mothers whereabouts.  In fact, the brothers purchased a device, known as a WanderGuard, from Sunshine Villa to help the facility keep tabs on their mother's whereabouts.  

Just hours after her admission to the facility, the elderly woman wandered from the facility.  She was found dead, three days later due to hypothermia.

After initiated a wrongful death lawsuit against the facility for their outstandingly neglectful care, the assisted living facility filed a request to have the matter resolved via binding arbitration.  

Recently, Santa Cruz Superior Court Judge Timothy Volkmann denied the assisted living facilities request, holding that due to the fact that the admission contract between the patients family and the facility did not require binding arbitration as claimed by lawyers for the facility.

My condolences go out to this family and I wish them the best in their lawsuit against this facility. 

Related:

Dementia Patient Found In Freezer At Assisted Living Facility: An Isolated Event Or Real Cause For Concern?

State Steps In After Second Episode Involving Patient Elopement At Same Facility

Chicago Nursing Home Lawyer, Jonathan Rosenfeld, Interviewed Regarding Preventing Patients From Wandering

Sunshine Villa, Sued for wrongful death, thwarted in request for arbitration, The Mercury News February 8, 2011 by Jondi Gumez

Ms. Purvis wasn't located until several hours later when staff at the facility found her body close to the door she is believed to have exited from.  Despite efforts to resuscitate her, Ms. Purvis was pronounced dead upon arrival at Moses Cone Hospital.  Her death was primarily related to exposure to the freezing temperatures.

An investigation into the incident is underway by the North Carolina Department of Health and Human Service.  However, at this time, it is apparent that the facilities failure to equip exterior doors with a device known as a door alarm, allowed Ms. Purvis to exit the facility without the knowledge of the staff.  If the investigation by North Carolina Officials confirms the initial situation, it may face up to $20,000 in fines.

Wandering Cases

Wandering cases involving a death or severe injury to a patient at a nursing home or assisted living facility are a real tragedy simply because most cases could have been prevented with relatively basic safeguards.

When it comes to caring for people with dementia, many of which are able-bodied and active, facilities need to accurately asses if their facility is really capable of caring for them in the first place.  In order to provide a safe atmosphere for dementia and Alzheimer patients facilities need to have:

• Door / Window alarms
• Keep dangerous materials safe guarded
• Have a system to track patients whereabouts
• Train staff regarding how to re-direct patients

Related:

Swallowing Foreign Objects Is No Laughing Matter For Dementia Patients In Nursing Homes

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

State Steps In After Second Episode Involving Patient Elopement At Same Facility

Officials investigate death at assisted-living community, by J. Brian Ewing, News-Record, January 8, 2011

The lawsuit, filed by the daughter of the deceased resident, claims that despite multiple assurances from the facility, they failed to supervise and provide necessary safguards to keep the 83-year-old safe.

According to the lawsuit (see PDF version below: Diane Phillips individually and on behalf of the wrongful death benefitiaries of Merle Fall v. Ridgeland Assisted Living LLC and Emeritus Corp.), Ms. Fall was admitteded to Ridgeland on February 25, 2010 with known problems related to Alzheimer's / dementia and a history of wandering from home.

Also at the time of admission, Ms. Phillips was assured by an employee of Ridgeland, Ashley Martin, that the facility was capable of safely caring for her mother and the facility would take the necessary steps to keep her mother safe.

Three days later, Ms. Phillips visited her mother to find her in a filthy condition with dirty clothes and was also informed by Ridgeland staff that her mother attemped to climb out of her second story room.  Again, Ridgeland assured Ms. Philips that it was capable of safely caring for her mother and they would take the necessary safeguards-- such as installation of window locks-- to keep her mother safe.

Depsite the assurances of safety, Merle Fall fell from a second story window on March 6, 2010-- just weeks after her previous attempt to get out of the window.  Ms. Fall sustained mutiple injuries including: a compound fracture of the left ankle and a subdural hematoma.  On March 9, 2010, Ms. Fall died from her injuries at a nearby hospital.

In addition to seeking compsatory damages of atleast $500,000, the Complaint also seeks punitive damages from each defendant for their reckless conduct in failing to take the necessary safeguards to protect an exceptionally vulnerable senior.

The Complaint is filed by my colleage attorney Philip Thomas.  Interestingly, at the time this lawsuit was filed, this Emeritus facility failed to provide Ms. Fall's medical records as they were obligated to do under Mississippi law when presented with a valid request.

Broken Promises

Too often facilities--- nursing homes and assisted living--- put their census numbers ahead of the patient's well-being.  As Philip does a nice job of articulatinging this lawsuit, he specifically names the Emeritus employee who assured the family that their loved one would be well cared for.

Time will tell, but if the allegations made in this complaint prove to be true, there certainly appears to be circumstnaces necessary to incite a jury to award substantial punitive damages due to both the facilities gross negligence and outward assurances.

Related:

Diane Phillips, individually and on behalf of the wrongful death benefitiaries of Merle Fall, deceased v. Ridgeland Assisted Living LLC and Emeritus Corp. (PDF)

Man Falls From Fourth Floor Window To His Death At Alden Nursing Home

Assisted Living Facility Submits Corrective Plan After Dementia Patient Falls From Window

Admissions Suspended At An Emeritus Assisted Living Facility Following The Discovery Of: Medication Errors, Bed Sores & Falsified Medical Records

Rather Than Improve Poorly Performing Nursing Homes, Why Not Just Re-Categorize Them?

Wandering Cases:

Many patients with Alzheimer's and dementia are prone to wander from the facilities--- nursing homes, hospital and assisted living facilities where they reside.  It is the responsibility of the facility to identify people who are prone to wander and implement plans of care to prevent these patients from harming themselves.

Despite the appearance these patients are unhappy with their living arrangements, it is crucial for staff at these facilities to make sure that these patients remain within the safety of the facility.  If a facility can not safely accommodate the needs of the patient, they should suggest that the patient's family locate a suitable living arrangement.

Related:

Ruling against Ore. care facility in woman's death, The Columbian, October 5, 2010

Assisted Living Facilities Need To Re-Evaluate If They Are Capable Of Caring For Dementia Patients

Chicago Nursing Home Lawyer, Jonathan Rosenfeld, Interviewed Regarding Preventing Patients From Wandering

Elderly Woman Wanders From Her Convalescent Home To Her Death

Wandering tragedies such as this are more common than many would like to believe. Many nursing home patients, particularly those suffering from dementia or Alzheimer's, may have a tendency to wander or elope from facilities.  

Consequently, nursing homes should identify those patients who are at risk for wandering and implement necessary safeguards to assure their safety.  Common wandering safeguards include:

• Installing door alarms
• Re-directing patients who have a tendency to wander
• Using lock and other restrictive devices for patients who have a history of wandering
• Adequately staffing facilities so staff can properly keep tabs on patients whereabouts

My colleague David Terry is representing the family in this matter and I am extremely confident that David will get to the heart of the facilities errors as discovery in the lawsuits progresses.

Related:

Sikeston nursing home resident dies from injuries after being hit by train Southeast Missourian, March 19, 2010

Son of woman killed by train files wrongful death lawsuit against nursing home Heartland News, September 21, 2010

Keith Kinder v. Hunter Acres Caring Center, Inc. (PDF)

An episode of a patient wandering from Brentwood Assisted Living facility, would normally not be a particularly noteworthy event--- especially since the eloping woman will hopefully recover from her injuries.  What deservedly brings more attention to this incident is the fact that this was the second patient to wander from this facility this year!

In the most recent occurrence, the Michigan Department of Human Services is investigating the incident in which a 91-year-old woman wandered from the assisted living facility with her walker.  Three days later, the woman was discovered by neighbors in the area at the bottom of a heavily wooded ravine. 

As DHS investigates this incident, just months before the agency investigated a similar incident in which a patients eloped from the facility.  After the agencies investigation, it was revealed that Brentwood: 1) failed to monitor the patient in accordance with their care plan that identified them as being at high risk for eloping and 2) failed to timely notify the patients family of the occurrence.

Patterns of poor care

Of course, episodes of poor care should give rise to concern.  However patterns of poor care really should give rise to alarm both on the part of families who have loved ones at this facility and on the part of the state.

Even though it appears that neither patient involved in these elopement events was injured seriously, I hope that the state recognizes the severity of these lapses in patient care and reprimands the facility accordingly. 

Episodes involving patient elopement and wandering rarely end as well as it did for these patients.  Unfortunately, when patients wander from a nursing home or assisted living facility they are ill-equipped to deal with the world around them.  In our nursing home abuse practice, we have worked on several cases where patients received severe injuries or were killed after they left the safe confines of their facility.

Read more about this case of elopement from an assisted living facility here.

Elopement

Assisted living and nursing home patients with dementia and Alzheimer's are commonly known to elope from their facilities. On admission, the facility should conduct an assessment of the patient (with family if possible) and determine the persons risk level for eloping from the facility.

Once an assessment has been completed, the implementation of simple preventative measures implemented by a facility to assure the patient remains safely at the facility.  Assisted living facilities and nursing homes that care for patients who are at risk for eloping should have the following safeguards in place:

• Door alarms
• Window locks
• Door locks
• Bracelets that track each resident's location
• Hire adequate staff to look after residents
• Have contingent plan to locate patients in the event a resident elopes from the facility

Related Nursing Homes Abuse Blog Entries

Assisted Living Facilities Need To Re-Evaluate If They Are Capable Of Caring For Dementia Patients

Chicago Nursing Home Lawyer, Jonathan Rosenfeld, Interviewed Regarding Preventing Patients From Wandering From Their Facilities

Three Employees At Assisted Living Facility Disciplined For Their Failure To Report Missing Nursing Home Resident

What Can Nursing Homes Learn From Jails?

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

The level of care offered at assisted living facilities simply is not intended to take the place of the skilled nursing care offered in nursing homes.

Unfortunately, I've seen too many assisted living facilities fail to accurately inform families about the limitations in care that they offer.  In most cases, it is up to the assisted living facility to inform families about the type of care they can provide and to do an assessment of each patient's realistic care needs.

I feel strongly that assisted living facilities have an implicit duty to advise families if they can not care for their loved ones.  By accepting and retaining a patient, the facility implies that they are capable of safely caring for the person.

Over the years, I've seen the line distinguishing patients who require skilled nursing care provided in a nursing home vs. non-skilled assistance provided at an assisted living facility get blurry-- very blurry especially with patients who are particularly reliant on facilities for most of their daily living needs.

Many dementia patients require extremely high levels of care, yet many assisted nursing facilities (alf's) insist that they are capable of caring for them. 

The ability of assisted living facilities to care for an dementia patient will likely get called into question after 90-year-old man (with dementia) wandered from a Sierra Oaks Assisted Living facility in Pennsylvania.  Ten days after the man wandered from the facility, police located the man's body.

Could this have happened in a nursing home?

Of course.  Unfortunately, nursing home patients wander from facilities fairly frequently.  However, nursing homes are more likely to have staff in place and specialized equipment than assisted living facilities.

Situations, such as the wandering incident above, really should force families to re-evaluate the best living arrangements for their loved ones.

Related Nursing Homes Abuse Blog Entries:

Woman Dies From Hypothermia After Wandering From Assisted Living Facility

Family Sues Florida Nursing Home For Death Of Wandering Resident

Man Wanders 20 Ft. From Chicago Nursing Home To His Death

How Much Freedom Should Assisted Living Facilities Give The Mentally Disabled?