Nursing Homes Abuse Blog - By Jonathan Rosenfeld

It's no secret that falls in the elderly nursing home population remain one of the largest threats to patients safety and overall well-being.  Recognizing this threat, nursing homes must assess each patient for their potential fall-risk and create a plan of care to reduce the incidence of falls during their stay at the facility. 

While fall precautions may including common sense precautions such as: staff assistance, walkers or modification of bed heights--- new research suggests that nursing homes need to begin evaluate patient's use of common antidepressants known as selective serotonin reuptake inhibitors (SSRI's) which dramatically increase a patient's risk of falling.

A recently published study in the British Journal of Pharmacology conducted by clinicians in the Netherlands followed a group of 248 nursing home patients diagnosed with dementia over a two-year period. 

While nearly all of the patients experienced some type of fall during the course of the study, the study concluded that patients taking SSRI's had a notably higher incidence of falls compared with their peers who were not taking the drug.  Even more alarming, was that fact that researchers determined that patients taking SSRi's (common drugs include: Paxil, Zoloft and Prozac) were three time more likely to suffer a fall-related injury such as a hip fracture, leg fracture, bruise or wound.

Though not the primary focus of the study, an incidental finding was that patients taking SSRI's combined with sedatives and hypnotic drugs-- commonly given to patients to aid with sleep--- resulted in an ever further elevated rate of fall-related injuries.

While the this similar studies will no doubt need to be completed on a broader scale, mounting evidence suggests that all medications prescribed to nursing home patients should be evaluated to determine their necessity.  Further, given the suggestive data from this recent SSRI study, nursing homes need to heighten their focus on patients' medications when tailoring a fall-prevention protocol.

Related:

Study Links Medication Use With Falls

Half Of Nursing Home Residents Wrongly Drugged

Antidepressants may raise fall risk in nursing homes USA Today

Falls in older people: epidemiology, risk factors and strategies for prevention (PDF) LAURENCE Z. RUBENSTEIN Age and Ageing 2006; 35-S2: ii37–ii41 doi:10.1093/ageing/afl084

Without a doubt, one of the most frustrating aspects of litigating cases involving nursing home injuries is that many of them derive from the failure of staff to implement the most common sense safeguards. 

Unlike situations where a facility may be negligent providing poor medical care for a patient (which is plenty disturbing), the emergence of cases involving reckless carelessness is something that I am beginning to see with more frequency as facilities look to stock their facilities with the least qualified staff--- at the lowest concentrations.

I was again reminded that the real tragedy associated with this uptick in poor oversight is the harm imposed on patients living at these facilities--- who are very much reliant upon staff to provide them with their care--  when I read about a recent incident at a New York nursing home in Queens.

According to news reports, a patient at the Margaret Tietz Nursing and Rehabilitation Center in Queens fell to their death when they accessed an unsecured staircase in their wheelchair.  The facility has initiated an investigation into the matter to determine why the door to stairway was left unlocked when it was supposed to be accessible only by a pass-code.

While this incident obviously deserves to be investigated an evaluated to the fullest extent possible, I suggest that the operator of this facility take a step back and look at the quality of the people they have working at their facility and realistically assess why no one corrected this obvious error before a patient was killed.

Related Nursing Homes Abuse Blog Entries:

Nursing Home's Failure To Implement Fall Precautions Results In Death Of Patient

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

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

For a nursing home that claims to treat its residents “with the highest level of the respect,” Lexington of Orland Park seems to have a long way to go, if you’re to believe recent Illinois Health Department surveys.

The surveys, conducted in April of 2011 and December of 2010, point out several serious deficiencies in home that’s supposed to  “provide the most compassionate service possible.”

A recurring theme throughout the surveys was instances of suspicious bruises going unreported. Often, I find that suspicious bruises are a strong indicator of physical abuse.

According to the survey, one 87-year-old resident had four suspicious bruises: one on her face, left cheek, left breast and left thigh. The resident, according to a surveyor, was “not able to describe what happened, and was unable to communicate pain.” Another strong sign of abuse can often be a resident’s reluctance to discuss the abuse, for fear of reprisals from staff.

This incident in and of itself is highly suspect. But several other suspicious factors were noted in the surveys, including:

• Failure to contain an outbreak of scabies in spring 2011, as well as failure to report the outbreak to the local health department. According to the survey, “surveillance information on scabies was lacking and vague.” Staff also failed to wash infected linens properly, and to apply medical creams to affected residents.

• Failure to acknowledge and/or treat late-stage bed sores. According to the April survey, one resident with two open bed sores on his buttocks “screamed out” in the presence of a surveyor that he was “in pain; it hurts; my sore hurts,” while a nurse ignored his cries. The surveyor noted that one bed sore was the size of a silver dollar, while the other was the size of a quarter. The same surveyor also heard a patient say, to a nurse, that “I don’t like you. You hurt me all the time.”

• Frequent instances of knowingly mixing the wrong medications

• Multiple instances of residents sustaining unmonitored, life-threatening falls

On October, 25, 2010 the 278-bed facility was fined $30,000 for “Type A” violations relating to the area of nursing. Medicare, on its “Nursing Home Compare” Web site, gave Lexington only one out of five possible stars.

It’s clear from these reports that there are serious problems at Lexington of Orland Park. If you or a family membered suffered from abuse while a resident at Lexington, you may be entitled to compensation. All of our consultations are free and confidential.

Related Nursing Homes Abuse Blog Entries:

Nursing Home Spotlight: Lexington of Elmhurst

Lexington Care Center Named As Defendant In Case Involving Multiple Falls

Nursing Home Battery Lawsuit Filed In Cook County

65 Illinois Nursing Homes On Second Quarter Violation List

From a liability perspective, nursing home fall cases prove to be far more difficult than they may appear to be at first glance.

While nursing home must assess each patient for their propensity to fall and implement fall preventions accordingly--- for some patients falls may occur even with safeguards in place.

We'll save the discussion on nursing home fall precautions for another day-- but what about how the facility handles the care post-fall?

A fall, like any injury-related incident involving a nursing home patient should be immediately be followed by an accompanying evaluation of the patient to see if the patient requires medical care. Even in circumstances where there may be no apparent injury, the circumstances surrounding the incident should followed up with a corresponding evaluation and re-assessment by the facility to prevent similar incidents from occurring in the future.

While the circumstances surrounding the fall may be important for determining any liability on the part of the facility, I find that the care (or lack thereof) provided by the facility after the fact is too often an afterthought of the facility.

In this sense, I was glad to see nursing home investigators from the Minnesota Health Department Office of Health Facilities Complaints acknowledge the errors the Augustana Heath Care Center made following the fall of a patient from his wheelchair.

In evaluating the incident, it was determined that the facility made errors relating to the patients post-fall care.  In a recently released report, the agency noted that the facility "did not assess, monitor and treat" the man in a timely manner following his fall.

The finding is particularly important because it was revealed that the man's death wouldn't have been avoided even with timely care due to the serenity of his injuries.

In the course of an increasingly hostile nursing home litigation environment, I am seeing poorer and poorer post-fall care provided to patients. It is readily becoming apparent to me that many nursing homes would rather attempt to cover up an incident than acknowledge it's existence and provide necessary care for their patients-- that just may ease their suffering.

For patients, I hope that other states acknowledge the need to provide an evaluation and care for a patient post-fall as it is simply cruel to allow patients to suffer because a facility may be ashamed of its care.  All situations involving the fall of a nursing home patient should be followed by a careful examination by staff who are trained to identify even latent injuries to residents. When an injury is identified, staff should summon the patients doctor or get them to a hospital as soon as feasible. Failure to do so isn't just illegal, it's downright cruel.

Related:

Ohio Jury Awards Family $1 Million In Nursing Home Fall Lawsuit

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

Falls In Nursing Homes Are A Serious Threat To The Safety Of Many Patients

Even Common Falls Put Elderly At Risk For Developing Subdural Hematomas

Sometimes I see news stories with such common fact patterns that I have to look at the date of the report as I frequently ask myself, "didn't I just see this article?"  

Unfortunately, the cycle of negligent nursing home care continues with seemingly never ending cycles of stories about patient injury and death.

And yes, many of these do have an erry resemblance to one another.  If there's one thread of similarity amongst many of these stories, it's that the majority of these occurrences could likely have been avoided with a small dose of adequate judgment.

Amongst the pattern of disturbing care-related problems is when facilities fail to monitor their stairwells. Of course most building codes require facilities to have stairwells in cases of emergency or should the elevators become unusable, but when facilities fail to secure stairwells, there frequently is a tragic outcome.

In this sense, I was saddened to read about a recent stairway fall involving a disabled nursing home patient who died from injuries sustained in the fall.  According to a recent Los Angeles Times blog, the patients family has recently filed a civil lawsuit against the Motion Picture & Television Fund's nursing home's alleging the facility was negligence in allowing the patients access to the stairway where she fell.

The patient identified as 89-year-old Carrie Daley suffered from Alzheimer's and other physical maladies that confined her to a wheelchair.  Ms. Daley's fall resulted in multiple injuries, including a fractured spine, that ultimately contributed to her death shortly following the fall.

Significantly, nursing home falls such as this, are not that unusual at this facility. The Times report that the fund has been cited for similar incidents in the past. The California Department of Public Health fined the facility $10,000 for failing to prevent the falls of an Alzheimer's patient and separate $7,500 fine against the fund for failing to prevent the head injury of another patient at the facility.

Certainly, its safe to say that this facility is not doing an adequate job monitoring the safety of its patients-- from commonly encountered dangers such allowing patients unrestricted access to stairway and failing to engage the locks on wheelchairs.

By the way, speaking of patterns of similar events, here are some recent entries regarding nursing home patients falling down stairways....

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

Wheelchair-Bound Nursing Home Patients Must Be Properly Supervised To Avoid Injury

Unattended Nursing Home Patient Falls Down Stairway In Wheelchair

Some Medical Conditions Virtually Guarantee Elderly Of Falls In Nursing Homes

Falls pose a far greater risk of injury and death for seniors than most people would ever guess.  Understanding the physiological and environmental factors that bring about falls is important both form a fall-prevention perspective as well as to help evaluate a nursing homes potential liability in fall-injury cases.

I came across a very informative article regarding elderly falls by Kathy Kemle, PA-C that appeared in the Clinical Advisor, "Falls in older adults: averting a disaster" which is especially informative and should be essential reading for both patients and caregivers given the prevalence of falls in the older segments of our society.

In fact, there is a significant increase in both the frequency and severity of falls as we age. The fall rate for people 65 and older escalates at a rapid rate as every year ticks by.  Particularly notable is the fact that there are higher fall rates for seniors living in long-term care facilities--- nursing homes and assisted living facility-- compared with senior living in more independent living arrangements.

Ms. Kemle identifies three main factors that increase a persons likelihood of falling:

• Unstable balance on standing
• Use of more than four prescription medications
• hip weakness

The above factors are a fairly accurate predictor of falls on an annualized basis.  Statistics tell us that individuals with just one of the above criteria have a 12% chance of falling each year, but people with all three criteria have a virtual certainly of falling each year.

While a reduction in patients medications is best addressed by physicians, improving the environmental safety at facilities is nursing homes need to address.  Particularly for patients in nursing home settings who may already be in somewhat of a compromised physical state, it is crucial for facilities to both acknowledge the fall-risks and implement preventative measures. 

One of the most obvious ways for nursing homes to reduce patient's chance of falling is to keep facilities clean, organized and fall-friendly.  Basic changes in the nursing home environment can reduce both the likelihood and severity of fall.  Common precautions include:

• Making sure stairways are well-lighted
• Clearly marking steps to alert patients of stairs
• Keeping belongings within easy reach of people-- avoiding struggling to access
• Keeping likely spill areas such as: bathrooms, kitchens and cafeteria clean and dry
• Lower bed heights
• Increasing toilet heights
• Providing safe footwear for patients

Certainly, it is unrealistic to assume all falls in nursing homes, hospital and assisted living facilities can be avoided, but with the implementation of relatively common sense precautions, facilities can greatly increase elders independence and quality of life.

Related Nursing Homes Abuse Blog Entries:

Safe Transfers

Woman Dies From Brain Bleed Following Unsupervised Fall

Colorado Jury Sides With Family Of Nursing Home Resident In Fall Lawsuit

Nursing Home Sued After Resident Fractures Both Hips In Separate Falls

Perhaps no topic in nursing home litigation is more hotly contested that resident fall cases. At the heart of the issue is really the feasibility of the facility in preventing patient falls. Certainly, this topic will continue to be hotly debated amongst nursing home operators and patient advocates as the rights of the patients are balanced against the feasibility of fall prevention techniques.

The nursing home fall debate once again made news headlines in Ohio when the family of a deceased nursing home patient filed a lawsuit against the facility in the aftermath of their mother's death shortly following a fall. 

While the feasibility of preventing the woman's fall is no doubt relevant in addressing the facilities liability, what make this situation particularly disturbing is the fact that the facility never communicated the woman's extensive fall history to the family.  

The lawsuit alleges that Larchwood Village Retirement Community (Ohio) never told Gladys Feran's family of her 17 documented falls during her 16 month stay at the facility.  It wasn't until Ms. Feran was transferred to a hospital in April, 2009 that the family learned of her extensive history of falls from both her chart as well as documentation related to state inspections.

Though it may be a dreaded call to place to the family of an injured nursing home patient to notify them of a fall at the facility--- the call is necessary.  Federal law requires nursing homes to notify family any time there is a change in their loved ones condition.

I firmly believe that facilities failure to notify families about development of a medical condition or an acute event, such as a fall, is done more out of a desire to conceal the truth than out of guilt that the incident occurred in the first place.  My experience is that most of these attempts to cover-up backfire against the facility, the the omission results in significant distrust both amongst the family and jurors as the truth eventually comes to light.

Related:

Nursing Home Falls

New Technology Promises To Reduce Falls In The Elderly Population

Nursing Home Injury Laws: Ohio

Investigator Exclusive: Family sues when mom dies after undisclosed fall at nursing home WKYC.com

An investigation into the fall-related death of patient at Mountain Manor of Paintsville (Kentucky) has resulted in a type A citation against the facility.  The citation comes after an investigation into a patient’s death at the facility when he fell from his bed.

The investigation demonstrated that just days after being admitted to the facility, and after several documented attempts to get out of bed, the facility failed to properly supervise the patient and implement safety precautions such as a bed alarm as ordered by the patient’s physician.

Two days after the script for the bed alarm was written by the patient’s physician, the nursing home patient was found on the floor—next to his bed.  The man was taken to a nearby hospital where he was treated for broken ribs and facial fractures to the area around his eyes.

Eight days after the incident, the man died due to lung complications brought about by his rib fractures sustained in the fall.

Incidentally, Type A citations are handed down by the Kentucky Cabinet for Health and Family Services’ Office of Inspector General after an investigation into a nursing home incident has determined that the residents’ life or safety was endangered due to violations of state regulations.

Bed Alarms For Patients At Risk For Falling

As you likely have guessed, bed alarms are devices used by nursing homes and hospitals to alert the staff when the patient attempts to get out of the bed on their own.  Should the patient attempt to do so, an alarm is triggered at the staffing desk, which would theoretically allow the staff to re-direct the patient or provide assistance to them.

Bed alarms and similar products used on wheelchairs or regular chairs require the timely response of facility staff to be effective.  If staff ignores the alarm or are too busy to properly respond to the patients, the safety device is ineffective. 

Depending upon the facility, bed alarms may be deemed a restraining device and necessitate an order from a physician and / or consent from the family (particularly in cases where the patient is disabled).  If you believe that use of a bed alarm is in the best interest of your loved one, you should speak to the nursing home administrator or DON and ask what the process is for obtaining such a device at that particular facility.

Related:

Nursing Home Sued After Resident Fractures Both Hips In Separate Falls

California Nursing Home Issued Most Severe Citation After Patient Fall And Death

Can a nursing home tie my dad to a wheelchair if he has had episodes of wandering around the facility?

Paintsville nursing home cited in resident’s death Lexington Herald –Leader November 13, 2010 by Valarie Honeycutt Spears

Alden Town Manor is a skilled nursing facility in Cicero, IL that was recently cited by the Illinois Department of Health following a March 30, 2010 survey at the facility. The focus of the survey was related to a March 6, 2010 incident in which a patient fell at the facility and subsequently died due to head trauma and cervical fractures.

An investigation into the incident revealed that Alden Town Manor failed to properly care for the patient in the following respects:

1. Assess a severely injured resident on the floor after a fall

2. Follow its own policy for residents with head injuries

3. Assess and develop interventions and re-evaluate the effectiveness of the interventions after a patient sustains a series of documented falls at the facility.

On March 6, 2010 staff responded to a loud noise in the room of an 83-year-old patient at the Alden Town Manor. When they arrived at the woman’s room they discovered the woman laying face-down on the floor, bleeding from an obvious cut on her head. When the staff arrived the woman was visibly injured but had a pulse.

Even though from the location of the wound and the profuse bleeding, a head injury was obvious, the staff at Alden Town Manor elected to move the injured patient from the floor to her bed without providing any stabilization for her neck.

A review of the patients hospital chart revealed that the woman sustained a fracture of the base of the Odentoid Process at C2. It is believed that the staff’s movement of the patient either caused or exacerbated the cervical fracture that contributed to her death.

In addition to violation of 'nursing care 101', Alden Town Manor staff violated their own policies and procedures for handling patients involved in a fall that specify staff are to complete a neurological assessment of each patient post-fall.

This incident is particularly disturbing in light of the fact that this patient had fallen at Alden two times prior and was further categorized as ‘high risk’ for falls according to her care plan.

As a result of the above occurrence, Alden Town Manor received a $30,000 fine from the Illinois Department of Health (IDPH).

If you have a loved one at Alden Town Manor and are concerned about the care they are receiving, we would honor the opportunity to speak with you. All consultations are confidential and our services are free if there is not a recovery for you.

Related:

Alden Town Manor Rehab & HCC, IDPH Survey, March 30, 2010 (PDF)

Falls In Nursing Homes Are A Serious Threat To The Safety Of Many Patients

Blacks Receive Inferior Care At Most Nursing Homes

Alden Village North Charged With Neglect After Child Dies Due To Inadequate Nursing Care

Even After Repeated Tragedies, Alden Wentworth Nursing Home Refuses To Hire Additional Staff To Assist Patients

Nursing Home Abuse: The Deaths Of 13 Children Linked To Poor Care At Chicago Nursing Home Child Injury Law Blog, October 15, 2010

Perhaps the most basic safeguard nursing homes and hospitals can implement with wheelchair patients is the utilization of wheel-locks.  Too often, physically disabled patients are simply propped up in their wheelchairs with the assumption that they face little chance of getting injured.  

However, as I have discussed before, wheelchair patients must be properly supervised in order to minimize the chance of accidental injury due to the rolling of a chair or falling from it.  The lack of supervision appears to have played a role in the case of a Connecticut nursing home patient who literally rolled from the facility to his death.

The incident involved an 88-year-old man with dementia at Bishops Corner Skilled & Nursing Rehabilitation.  According to news reports of the incident, the man rolled from the front of the facility, down more than 40-foot hill, through a fence, before hitting his head on concrete.  The man was pronounced dead shortly after the incident at a local hospital as a result of the head injury he sustained in the incident.

Making this tragic situation even worse is the fact that the man had tried to leave the facility earlier in the morning.  Staff were notified of the incident when the door alarm went off.  After the incident, the staff imposed a 15-minute check system to confirm the man remained in the facility.  I guess this check system failed?

Bishops Corner is a 130-bed skilled nursing facility that is owned by Genesis Healthcare.  Medicare rates the facility two out of five stars, putting the facility in the 'below average' category.

Related:

Nursing home where man died in wheelchair accident given “below average” rating, The Middletown Press September 1, 2010

Wheelchair-related Falls: Current Evidence and Directions for Improved Quality Care
Gavin-Dreschnack, Deborah PhD; Nelson, Audrey PhD, RN, FAAN; Fitzgerald, Shirley PhD; Harrow, Jeffrey MD, PhD; Sanchez-Anguiano, Aurora MD, PhD; Ahmed, Shahbaz MD, MPH; Powell-Cope, Gail PhD, RN

Allowing a nursing home patient to sit comfortably in their wheelchair in a hall or perhaps in an outdoor area of the facility seems like a pretty innocent act-- right?  I mean aren't patients in wheelchairs entitled to a little fresh air or just hang out in an common area with other patients?

Despite the seemingly harmless act of sitting in a wheelchair, nursing home employees need to take steps to ensure the safety of these handicapped residents-- even if they appear to be sitting idly.  Too often nursing home employees take for granted that wheelchair patients' limited mobility puts them at increased risk for falls and collisions with their surroundings at the facility.

A recent situation involving a disabled nursing home patient made the news, after the woman sustained serious injuries in a fall from her wheelchair.  The woman's injuries include: fracturing her collarbone, sustaining a closed head injury and suffering multiple bruises and abrasions.  The incident occurred at the Jewish Home of Eastern Pennsylvania. 

The incident gave rise to a lawsuit against the facility that alleges aides left the patients wheelchair unattended on a sidewalk that had a decline which caused the wheelchair to roll and crash into a nearby street.  Read more about this nursing home lawsuit involving an injury to a wheelchair-bound patient here.

The need to supervise patients in wheelchairs

Putting a patient in a wheelchair does not relieve nursing home staff of their duty to provide ongoing supervision.  Depending on the patients physical and mental capacities, they should provide a level of supervision appropriate to the individual.  In most cases, providing a safe environment for wheelchair patients includes:

• Making sure locks on the wheels are engaged when the patient is sitting in one area or is incapable of appreciating harm
• Parking wheelchairs in areas where the ground is level
• Keeping patients in wheelchair away from congested areas when they could be pushed or bumped
• Properly utilizing leg braces to make sure they do not have the patients legs in a manner where they could catch on things
• Keeping patients away from fall hazards and unguarded stairways

Certainly, wheelchair-bound patients are entitled to freedoms, yet it remains the responsibility of nursing home staff to supervise them and assure that the wheelchair use does not put them at a heightened risk of harm to themselves or others.

Related Nursing Homes Abuse Blog Entries:

2 Residents Fall From Wheelchairs With 2 Days At Nursing Home

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

Nursing Home Worker Charged With Raping A Wheelchair-Bound Patient At Rhode Island Facility

Can a nursing home tie my dad to a wheelchair if he has had episodes of wandering around the facility?

There's been a lot of talk about a recent jury verdict against Hillcrest Nursing Home, a Kentucky facility, after a patient fell while attempting to transfer herself to the toilet-- and there should be, the jury hit the facility with a $7 million dollar verdict.

The incident involved a patient who was 67-years-young, who was admitted to the nursing home for rehabilitation following a knee surgery.  Perhaps due to the woman's youthful appearance, the nurses aide told the woman that she was busy and she could use the toilet herself.  It was during the unassisted transfer to the commode, that the nursing home patient fell and severely injured the surgically repaired leg.  The leg was so severely injured that it had to be amputated following the fall.

However, as a nursing home lawyer, I am drawn to the common fact pattern that forms the basis of the lawsuit as opposed to the end result.  I see many nursing home and hospital patients suffer needless injuries in the bathroom primarily due to two reasons: 1) the staff fails to provide assistance to the patient to get them on to the toilet and 2) the staff leave the patient on the toilet without any supervision.

Of course no one wants to needlessly invade another person's privacy, but when it comes to patients who require assistance, patient safety must trump expectations of privacy. 

Even when relatively healthy patients can seemingly navigate their way from their bed to the bathroom and place themselves on the toilet, staff must strictly adhere to the doctors orders when it comes to assistance.

Much more so than in other areas of medical facilities, I tend to see patients suffer injuries in the bathroom due to:

• Changes in their blood pressure when getting out of bed or from a wheelchair
• Lack of stability devices within the bathroom-- guardrails, hand grips
• Staff slow to respond to patients requests to use the toilet
• Inadequate staffing levels at facilities to provide the level of patient assistance set forth in a patients care plan
• Staff that ignore physician orders with respect to assistance when it comes to bathroom use

I guess the moral of all this is that while patient privacy certainly has a place, when it comes to using the restroom, don't be shy about asking for assistance--- you just may need it.

Related:

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

Falls In Nursing Homes Are A Serious Threat To The Safety Of Many Patients

Inadequate Training Of Medi-Car Staff Exposes Seniors To Unnecessary Risk During Non-Emergency Transportation

I have a lot of clients who almost apologically tell me how their loved ones 'brittle bones' are responsible for the extensive nature of their injury .  Sure, their bones may be weakened and brittle, but that is not a defense to a claim against a nursing home or hospital for providing inadequate care.

The law has a long-standing tradition where a defendant (wrongdoing person or facility) takes the plaintiff (injured person) as they find him or her.  In other words, the fact that a person was in a weakened state at the time of their injury really has no bearing on the case, except for the fact that the resulting damages from their poor care may be more extensive for a person in a weakened condition than if the injury occurred to a younger person without such complicating factors.

Without a doubt, complications from brittle bones are one of the most problematic things facing many nursing home patients who suffer a fall at a facility.

What is Osteoporosis?

As you age, your bones get weaker, increasing your risk of osteoporosis (a disease that causes weak, porous bones). This can significantly increase your risk of dangerous bone breaks (fractures). Weak bones are caused by low levels of calcium, phosphorous, and other mineral levels in the bone. This mineral loss causes your bones to become brittle and eventually lose their internal support structures. 

Approximately 44 million people (~ 55% of the U.S. population) in the United States suffer from low bone density and 10 million of those people actually suffer from osteoporosis. About 30% of Caucasian postmenopausal women in the United States have osteoporosis, and 54% have osteopenia (lower than normal bone mineral density). 

Signs and Symptoms of Osteoporosis

Osteoporosis does not usually have any signs or symptoms until it is pretty far advanced. Weakened bones can cause back pain, loss of height over time, a stooped posture, and broken bones. However, you can have osteoporosis for years without symptoms, until you suffer from a serious bone break. Therefore, you should have a doctor perform a bone density test if you are:

• A woman older than age 65
• A man older than age 70
• A person over 50 who has suffered from a broken bone during their lifetime
• A person who takes medications associated with osteoporosis (prednisone, aromatase inhibitors, or anti-seizure drugs)
•  A postmenopausal woman (when estrogen levels drop at menopause, bone loss increases dramatically) with at least one osteoporosis risk factor
• A postmenopausal woman who recently stopped taking hormone therapy
•  A woman who experienced early menopause

Risk Factors

There are some lifestyle related risk factors you can change to help improve bone strength, including:

• Low calcium intake
• Tobacco use
• Eating disorders
• Sedentary lifestyle
• Excessive alcohol consumption
• Corticosteroid medications

However, there are also risk factors that you cannot change, including:

• Being a woman  
• Aging
• Being of white or Asian decent
• Family history of osteoporosis
• Above normal levels of thyroid hormone
• Medical conditions and procedures that affect bone health (stomach surgery, Crohn’s disease, celiac disease, hyperthyroidism, and Cushing’s disease).

Prevention of Osteoporosis

Your bone mineral density (BMD) peaks when you are in your early 30s and starts declining as you age. Your likelihood of developing osteoporosis depends on how much bone mass you attained in your 20s and early 30s (the more bone mass you have, the less likely you are to develop osteoporosis) and how quickly you lose it. 

Prevention entails accumulating as much bone density as possible during your early life by eating healthy, getting enough calcium, being physical active, not smoking, and maintaining a healthy lifestyle and maintaining those practices during your later years. 

Increased risk of fractures related to falls in patients with Osteoporosis

Older, brittle bones are more vulnerable to serious bone breaks and compression because they lack the internal support structures to withstand impacts and pressure. Even a relatively mild injury can cause bone breaks. And, women suffering from osteoporosis are twice as likely to suffer from bone fractures when compared to men with osteoporosis. Older adults are at increased risk for dangerous falls because of balance problems, weakness, illness, bad vision,

Bone fractures are most common in the spine and hips (bones that directly support your weight), and the wrists (from bracing yourself with your hands as you fall). A 10% bone mass loss in the vertebrae can double the risk of vertebral fractures and a 10% loss of bone mass can cause a 2.5 times greater risk of hip fracture. 

Hip fractures are one of the most common injuries for elderly people. They usually occur because of a fall and can cause serious and even life-threatening medical complications. Elderly persons can also suffer from compression fractures in their spine, which occur when the vertebrae (back bones) become so weak that they compress or collapse. This can cause severe pain and a stooped posture. 

Osteoporotic bone fractures can cause decreased quality of life, severe pain, disability, and reduced mobility. Maintaining mobility is a significant concern as you age and healthy bones can help you maintain your health, safety, mobility, and independence. One of the best things you can do for yourself if take care of your bones at an early age by exercising, receiving adequate levels of calcium, eating a healthy diet, and not smoking. It is never too late to do something about your bone health. 

Therefore, nursing home staff should take steps to improve and maintain the bone health of all residents. Nursing home facilities should encourage safe and appropriate exercise and activity, provide proper nutrition, providing calcium supplements if necessary, and reducing the risk of dangerous falls.  

Fall prevention is one of the most important things nursing homes can do to ensure that residents do not suffer dangerous injuries. Osteoporosis and weak bones are common in many older adults, so preventative measures to protect the entire population is often the most effective tool to reduce complications for residents with osteoporosis. 

Your family member deserves to receive necessary and appropriate care to achieve and maintain their best possible physical health and well-being. Although your family member is older and aging, they still deserve to receive the steps and care necessary to retain their independence, health, and dignity. 

Lastly, should your loved one sustain an injury during an admission to a nursing home or assisted living facility, don't assume that their osteoporosis precludes them from pursuing a claim against the facility.  Rather, the resulting injuries may likely be compensable regardless of their physical condition at the time of the incident.

Resources:

International Osteoporosis Foundation

National Institute of Arthritis and Muscoskeletal and Skin Diseases: Osteoporosis

The Johns Hopkins Arthritis Center: Osteoporosis Information – A Geriatrician’s Perspective

Related Nursing Homes Abuse Blog Entries:

Nursing Home Sued After Resident Fractures Both Hips In Separate Falls

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

How Many Falls Is Enough To Impose Responsibility On Nursing Home?

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

As winter weather sets in, the city is often covered in a blanket of snow and ice. While the slippery weather conditions present a danger to all of us, snow and ice are particularly dangerous for older adults who are already more likely to suffer from a fall and also more likely to suffer bone breaks and injuries.

Nursing home residents rely on the nursing home property owners (nursing home operators and manager) to provide a facility free of dangers that might cause dangerous falls or accidents. This responsibility includes the removal of snow and ice, which creates a serious risk of falling.

In Illinois, according to the Premises Liability Act (740 ILCS 130), owners or occupiers of land owe invitees and licensees a duty of “reasonable care under the circumstances regarding the state of the premises or acts done or omitted on them.” An owner or lessee must provide a reasonably safe means of access to its business. If you bring a premises liability claim, you, the plaintiff, have the burden of proving that your injuries were caused by a condition on the property that was not reasonably safe that the owner knew or should have known of by the exercise of reasonable care.

However, this duty of reasonable care is different in the case of snow and ice on property. In Illinois, absent a contractual obligation, if you are walking down the street and happen to slip and fall on a snow or ice covered sidewalk or parking lot, the property owner owes you no duty to remove the natural accumulation of snow, water, or ice. (Illinois Snow and Ice Removal Act – 745 ILCS 75).

The Act states that it is undesirable for any person to be liable for damages due to his snow removal efforts, unless his actions amount to “clear wrongdoing.” Illinois follows the natural accumulation rule, where a property owner is only liable for a snow or ice related accident only if their alleged misconduct was willful and wanton or there was an unnatural accumulation of snow or ice or a natural condition that is aggravated by the owner. (McBride v. Taxman Corp., 327 Ill.App.3d 992 (1st Dist.2002); Ziencina v. County of Cook, 188 Ill. 2d 1 (1999)).

Natural accumulation is the result of natural weather conditions; whether accumulation is natural or not is oftentimes a difficult factual question. Examples of natural accumulation are: a sidewalk that has not been shoveled, puddles of water inside buildings from melting snow, ice formed by snow being packed down by pedestrians. Unnatural accumulation would be any actions by the property owner that cause snow or ice to accumulate in a specific location. One exception to the natural accumulation rule is if there is a contractual obligation to remove snow or ice; for example, if the property owner or manager has a provision in a lease providing that the owner agrees to remove snow or ice. If this is the case, the owner may be held liable.

Nursing home facilities must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of its residents. Part of this responsibility is ensuring that “the resident environment remains as free of accident hazards as is possible” (Requirements for States and Long Term Care Facilities – 42 CFR 483).

Therefore, nursing home operators owe residents a higher level of duty than a regular invitee or licensee, which under premises liability would only require them to exercise ordinary or reasonable care in maintaining the premises in a reasonably safe manner. Nursing home residents are more vulnerable than the regular invitee or licensee, and the degree of care owed is greater in recognition of that vulnerability.

Absent any dangerous winter weather conditions, nursing home residents are already more vulnerable to dangerous slips and falls, which can lead to serious injuries such as broken hips and head injuries. Even minor falls can be dangerous because elderly people are more susceptible to bone fractures than younger people because as bones age, they lose the ability to resist the formation and growth of cracks which can lead to bone breaks. The federal code regulating nursing homes is sensitive to nursing home residents’ vulnerability to falls, even specifying a standard for flooring; “the facility must have floors that have a resilient, nonabrasive, and slip-resistant surface.”

Therefore, nursing home operators must take extra precautions to make the nursing home facility premises safe for elderly residents. This includes installing slip-resistant flooring and removing dangerous snow and ice. Nursing home operators have a contractual duty to make the premises free of accident hazards, including hazards posed by snow and ice.  

Unnatural Accumulation Of Snow & Ice

If the nursing home operator removes snow or ice in a negligent manner or creates an unnatural accumulation of snow or ice, they may be liable for the resident’s injuries.  Similarly, if you are visiting a family member at the nursing home and happen to slip and fall on snow or ice, you may bring an action against the nursing home even though you are not a party to the contract because you are a foreseeable user of the premises.  

If you or a member of your family has suffered a dangerous fall because of dangerous snow or ice accumulation at a nursing home, you have the right to hold the nursing home owner or operator responsible for those injuries. The nursing home is obligated to provide a safe environment for all residents, and that includes an environment free of dangerous snow and ice.

Thanks to Heather Keil, J.D. for her assistance with this Nursing Homes Abuse Blog Entry

Resources:

Illinois General Assembly – Nursing Home Care Act 210 ILCS 45
Illinois General Assembly – Premises Liability Act, 740 ILCS 130
Illinois General Assembly – Snow and Ice Removal Act, 745 ILCS 75

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Elmwood Care is a large 245 bed nursing home located in Elmwood Park, IL, a suburb of Chicago. According to the government’s Medicare website, the facility received only one out of five stars, which is a much below average rating. The facility received only one out of five stars for health inspections, which is a much below average rating. In the past year, the nursing home had 48 health deficiencies, which is an alarmingly high number of deficiencies. This is 40 more deficiencies than the average number of health deficiencies in Illinois and in the United States. This is also a serious increase in the number of yearly deficiencies, up from the 13 health deficiencies in the previous year and the three health deficiencies two years ago.

The nursing home has an obligation to provide a safe and secure facility for its residents and to provide proper care and supervision to achieve and maintain the highest level of well-being for its residents. Nursing homes must meet the Requirements for States and Long Term Care Facilities outlined in 42 CFR Part 483.  

Elmwood Care received numerous violations for both quality of care and the facility environment. According to survey reports the facility received violations for failing to:

• Protect residents from mistreatment, neglect, and/or theft of personal property
• Keep each resident free from physical restraints, unless needed for medical treatment
• Give each resident care and services to get or keep the highest quality of life possible
• Give residents proper treatment to prevent new pressure sores (also called: pressure ulcers, decubitus ulcers or pressure sores) or heal existing pressure sores
• Make sure that the nursing home area is free of dangers that cause accidents

According to survey reports, Elmwood Care failed to prevent the spread of infection by failing to implement its complete infection control program for residents with infections on two of the three floors in the facility. Nursing home staff members made several errors in technique for the isolation protocol for residents who were in isolation. These errors included allowing visiting family members to use dirty gowns to pick up new clean gowns, lack of running water in isolation room for family and staff to wash their hands, allowing family members to throw away dirty gloves in another resident’s room (which was not an isolation room), and staff members failing to wash their hands before and after entering an isolation room. Preventing the spread of infection in nursing homes is very important because many residents have weakened immune systems due to illness or age.

Nursing home residents have the right to personal privacy and confidentiality of personal and clinical records. During the survey, staff members failed to provide visual privacy for several residents. This included failing to close privacy curtains when providing treatment for residents and also failing to close window shades on windows that could be seen from nearby homes and businesses.

Residents have the right to be free from any physical restraints imposed for the purposes of discipline or convenience, and not required to treat the resident’s medical symptoms. The facility did not meet this requirement by failing to complete the following activities for several residents: assess residents for the medical need for physical restraints, obtain physician’s orders for restraints, create care plans and provide for a reduction of a physical restraint, release the restraint every two hours, and assess alternatives to provide the least restrictive measures. These failures led to one resident developing an injury to his big toe that later developed into a pressure sore from the use of a side rail restraint. This also resulted in the resident needing several restraints at the same time including the use of a chemical restraint. During the survey, the facility was unable to provide an accurate number of residents with physical restraints.

The facility must ensure that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source are immediately reported to the administrator of the facility and to other officials in accordance with State law. This requirement was not met when the facility failed to thoroughly investigate injuries of unknown origin for one resident. In one incident, a resident suffering from Schizophrenia and Dementia was found on the basement floor of the smoking room in the middle of the night. The resident complained of left leg pain and was brought upstairs without being assessed by a nurse before being moved.

After assessment, the resident was sent to a hospital. The nurse notes document that the resident told staff that a tall man had pushed him on the floor. However, there was no investigation or statements of how the resident suffered when the hip fracture. The facility faxed an initial incident report to the state, but failed to conduct an investigation or submit a final report of the investigation to the state.

Elmwood failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior. The survey revealed odors, unsanitary storage of medical supplies, and failure to maintain a clean, sanitary, and orderly environment. Findings included: dirty shower chairs, food stored in refrigerator with medication, food on activity floor, odor in bathroom, clogged bathroom sink, sewage odor in nursing supply room, no thermometer in freezer, nursing supplies stored on floor of utility room, unclean freezers, dirty feeding tube pump, dark brown stains in some resident bathrooms, urine smell in some resident rooms, cluttered equipment store rooms, and strong urine odor in hallway.

The facility is required to provide residents with the appropriate treatment and services to maintain or improve the residents’ abilities. The facility failed to meet this requirement because it lacked any restorative program, which affected every resident with restorative needs. The lack of restorative nursing program led to a physical decline in the following residents:

• Resident 1 – lack of positioning devices which led to pressure ulcers.
• Resident 5 – decrease in range of motion and new pressure ulcers
• Resident 20 – lack of assessment and devices led to the development of a wound.
• This lack of proper restorative nursing program also led to a failure to evaluate residents to ensure that the least restrictive physical restraints were used.

The facility must ensure that a resident who enters a facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable. The facility must also ensure that a resident who suffers from pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new pressure sores from developing.

Elmwood Care did not meet this requirement as evidenced by its failure to monitor residents at risk for pressure sores, provide devices to prevent the development of pressure sores, provide care and services to residents with pressure sores to prevent the spread of infection and promote healing, and provide education and training to direct care staff in the policy and procedure for wound care. These failures resulted in immediate jeopardy.

The facility must ensure that the resident environment remains free of accident hazards and ensure that each resident receives adequate supervision and assistance devices to prevent accidents. The facility failed to meet this requirement by failing to ensure that residents received adequate supervision to prevent falls and failing to address the increased number of falls per month or the types of interventions being taken to decrease the number of falls.

These failures resulted in a significant number of falls, with one resident’s fall requiring treatment at an Emergency Room for a head injury. These failures resulted in immediate jeopardy. It is important that nursing home staff reduce the chance of accidental falls because elderly nursing home residents are more susceptible to bone fractures and injuries because of weak bones.

Elmwood Care received two out of five stars for nursing home staffing. The facility has 177 total residents, compared to the national average of 94.7 and the Illinois average of 103.9. Each resident received 1 hour 7 minutes of nursing home staff time per day, which is less than the Illinois average (1 hour 12 minutes) and less than the national average (1 hour 24 minutes).

This one-star rated facility had an exceedingly high number of deficiencies over the past year, which calls into question the facility’s ability to provide residents the proper care and services to achieve the best possible physical and mental health of its residents.

If you have a friend or family member who has sustained in injury during an admission to Elmwood Care or any other skilled nursing facility, we would be honored to speak with you about the circumstances.  All consultations are confidential and free of charge. (888) 424-5757

Sources:

Medicare website

IDPH website

Related:

Third Quarter Illinois Nursing Home Violators

Left Untreated, Stomach Aches Can Be Deadly For Elderly Nursing Home Patients

Pressure Ulcer Treatment: Surgical Debridement

Coumadin (generic name - Warfarin), is an anticoagulant (blood thinning medication) that is commonly used to help treat and prevent blood clots that could cause a heart attack, stroke, or pulmonary embolism.  This prescription medication works by blocking the creation of certain clotting mechanisms, which prevents blood clots from forming.  The goal of warfarin therapy is to decrease the clotting tendency of blood but not to prevent clotting altogether.

Complications related to diet

Certain foods and drinks can impair the effect of warfarin.  If you are taking warfarin, you should be consistent in your dietary intake of vitamin K because large amounts of vitamin K can counteract the benefits of warfarin.  The recommended daily allowance for men is 120 micrograms of vitamin K, and for adult women, it is 90 micrograms.  Drinks containing large amounts of vitamin K (green tea) should be avoided. 

Other beverages (cranberry juice, alcohol) can increase the effect of warfarin, causing bleeding problems.  Patients on warfarin should eat a relatively similar amount of foods with high levels of vitamin K on a regular basis (kale, broccoli, spinach, collard greens, Brussels sprouts, and cabbage).

Complications related to falls

A major complication associated with warfarin treatment is bleeding due to excessive anticoagulation.  Excessive bleeding can occur from any area of the body.  Studies suggest that elderly patients on warfarin, especially those over age 80, have an increased risk of bleeding compared to younger patients on warfarin (the rate of major hemorrhage on warfarin was higher than previously reported because the rates were derived from younger patients on warfarin). 

Another study also revealed that there is an increasing incidence of anticoagulant-associated intracerebral hemorrhage that is associated with increasing warfarin use.  Patients taking warfarin should report any falls or accidents and signs of bruising or bleeding.  Because of the associated risks, high dose or long-term treatment with Warfarin is only recommended for people who are at a high risk of developing blood clots that could cause a heart attack, stroke, or pulmonary embolism.    

Because elderly patients on warfarin may have a higher risk of bleeding, nursing home residents on warfarin should be closely monitored for signs of unusual bleeding including bleeding from the gums, blood in the urine, bloody or dark stool, a nosebleed, or vomiting blood. 

Consequently, nursing home staff must track of patients who take Coumadin and closely monitor them for any evidence of uncontrolled bleeding.  Staff must pay particular attention to patients after a fall to avoid complications related to both internal and external bleeding.  Additionally, staff should alert the patients physician for additional directives.

Thanks to Heather Kiel, J.D. for her assistance with this entry.

Resources:

Clot Care: Bleeding rates are higher in those over 80 years old when started on warfarin 

American Heart Association Journals: Circulation: Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation

Mayo Clinic: Warfarin side effects: Watch for dangerous interactions

Neurology: The increasing incidence of anticoagulant-associated intracerebral hemorrhage

Many elderly people suffer broken bones during admissions to nursing homes due to; falls, being dropped, or perhaps improper care from staff.  Regardless how the fracture occurred, a fractured bone in the elderly must be timely identified and treated.

What is a fracture?

A fracture is a broken bone that requires medical attention. Fifty percent of women over age fifty and twenty-five percent of men over age fifty will suffer from an age-related bone fracture sometime in their lifetime.

Elderly people are particularly susceptible to broken bones because as bones age, they lose the ability to resist the formation and growth of cracks that can lead to bone breaks because they cannot withstand as much pressure as younger bones.  Unfortunately, as we age, our bodies ability to heal fractures is compromised.

Nursing home staff can take steps to help maintain bone health in elderly nursing home residents:

• Regular exercise
• Adequate amounts of calcium
• Adequate amounts of vitamin D (essential for calcium absorption)

Osteoporatic Nursing Home Patients and fractures

Elderly nursing home residents who have osteoporosis (porous weak bones) or other conditions that lead to weakened bones or decreased bone density are at risk for bone fractures. Weak bones have low levels of calcium, phosphorous, and other minerals in the bones, which makes people more susceptible to fractures because the bones are more brittle. 

Women suffering from osteoporosis are twice as likely to suffer from bone fractures than men with osteoporosis.  Fractures from osteoporosis are most common in the spine and hips (bones that directly support your weight), and the wrists from bracing. Therefore, nursing home staff should take extra precautions to prevent falls and provide adequate nutrition to maintain the well-being of residents.

Diabetic Nursing Home Patients and fractures

Many nursing home residents also suffer from diabetes. A recent study suggests that there is an association between a drug introduced in the 1990s to help treat type 2 diabetes (thiazolidinediones) and bone fracture. The increased risk of fracture increased as the duration of the drug treatment increased and was observed in both men and women. Therefore, nursing home residents who have been treated with this drug also might have a further increased risk of bone fractures. 

Medical treatment for fractures in the elderly

Treatment for bone fractures depends on the location of the break. For most fractures occurring in the arms, legs, hands, and feet, the initial treatment is splinting the injured limb and immobilizing the joints above and below an injury to prevent movement at the fracture site. Then, the splint is removed and replaced by a cast. 

Some breaks might also require surgery in order to properly align bone fragments, increase stability, and ensure that bones will heal properly. Some fractures might also require metal hardware (pins, plates, or rods) to hold the bones in place. Older adults heal slower than younger people, which can cause additional complications and mobility issues for nursing home residents. 

How we can help

Depending on the circumstances regarding the fractured bones, the medical facility may be responsible for the damages relating to the fracture.  In many cases, we have successfully recovered damages for our clients', medical bills, medical equipment, pain and disability.  If you believe that a nursing home is responsible for your broken bone, we would be honored to speak with you to discuss your legal rights. (888) 424-5757

Resources:

Mayo Clinic: Fractures

Lawrence Berkeley National Laboratory: Why Older People Suffer More Bone Fractures

Science Daily: Risk of Bone Fractures Associated with Use of Diabetes Drug

Related Nursing Homes Abuse Blog Entries:

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

Fall In Stairwell Results In Paralysis-- And Ultimately Death Of Chicago Nursing Home Resident

Nursing Home Sued After Resident Fractures Both Hips In Separate Falls

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

A report issued by the Minnesota Department of Heath has cited White Community Hospital and Nursing Home (Minnesota) for errors made by a nursing assistant during the transfer of a patient out of her bed.  

The incident occurred when the CNA attempted to transfer a disabled patient from their bed to a wheelchair using a sling. During the transfer, the patient was dropped.  The patient suffered a broken arm and leg which contributed to their death two days later.

Specifically, the department of Minnesota health report and the facilities own investigators determined that the CNA's errors caused the patient's injuries and subsequent death.  In particular, the CNA  and nursing home failed to:

• Use two-person lifting technique
• Properly train staff
• Develop and follow a comprehensive 'care plan' for the patient

Laura Ackman, the nursing home's CEO called the patient's death, "an unfortunate accident, and we regret it very much."  According to Ackman, the facility took immediate corrective action, including staff training and the purchase of new equipment.

Certainly, from the information we know about this incident, it appears that the family of this nursing home patient would have a strong case against the nursing home should they wish to pursue a wrongful death case against them.  

I applaud the facility for taking corrective measures following this incident. Nonetheless, it sounds as though the root of the problem is related to under-staffing.  

Despite federal regulations that require nursing homes to have certain 'minimum staffing levels', many facilities simply do not have adequate numbers of staff to provide quality care for their patients.  In the situation discussed above, I am certain that a closer examination of the situation would reveal that there simply was inadequate staff around to assist him or her with lifting the patient.

At a minimum, federal law requires nursing homes to have: at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day.

Resource:

N. Minn. nursing home contributed to death of resident, report says, Statrtribune.com, October 9, 2009

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

Nurses Admit To Problems At Nursing Homes

Minimum Nurse Staffing Ratios

The most dangerous part of the day for many nursing home patients may be getting out of bed in the morning.  When staff fail to supervise or provide proper assistance to nursing home patients during transfers, patients are at risk for falls or being dropped by staff.

Disabled nursing home patients and those with physical limitations must be carefully monitored to avoid injuries while being transferred from one device to another.  Some of the commonly encountered situations where patients are injured include:

• Bathing: facilities failing to provide assistance or provide specialized bathing equipment including chairs, stands and grips
• Transfer into and out of bed
• Failing to take extra-precautions with patients who may have uncontrolled muscle movement: many times these patients require special restraints during transfers
• Failing to take patient medications into the equation: some commonly prescribed medications can make patients dizzy or cause blood pressure spike or drops when patients are moved
• Failing to engage locks on wheelchairs
• Allowing patients to wear socks or improper footwear during transfers
• Failing to monitor patients with walkers

Although facilities like to claim that these incidents are isolated events, a dropped patient is usually indicative of poor staff training and chronic under-staffing.  Most of these transfer-related incidents occur due to:

• Poorly trained staff: Some facilities do not properly train staff in how to use equipment
• Under-staffing: Facilities sometimes to not have enough man power to safely perform transfers as they were intended
• Wrong equipment: facilities must have the proper equipment for the job
• Faulty equipment: facilities must keep equipment in proper repair.  This includes getting replacement parts from the manufacturer
• Failing to provide timely assistance to patients who request it

Cases involving injury or death during transfer are particularly important to investigate as quickly as feasible after the incident in order to preserve the condition of equipment and to obtain statements from witnesses others who may have knowledge of the event.  

If your loved one suffered an injury or died as a result of a fall or being 'dropped' by staff, we would honor the opportunity to speak with you.  Our nursing home litigation team is always available for consultation. (888) 424-5757

Related Nursing Homes Abuse Blog Entries:

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

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

Faulty Handicapped Lift Blamed For Nursing Home Death

Improper Transfer Leads To Fall & Ultimately Death Of Rehab Patient

On June 13, 2009, a nursing home patient fell out of bed and died at Fejervary Health Care Center in Davenport, Iowa.  This fall occurred within 24 hours of the resident being admitted to the nursing home.

Two falls within a 24-hour period resulted in the death of a California nursing home patient.  The incident involved a patient was was recently admitted to the facility for rehabilitation following hip surgery.  The falls took place on May 9th and 10th at Aviara Healthcare Center in Encinitas, CA. 

After the first fall (that did not cause any injury), the staff put a bed alarm on the patients bed to alert the staff if he got out of the bed. Despite the bed alarm, staff at the nursing home failed take notice when the man got out of his bed and entered the nearby hallway.   In an effort to stabilize himself, the man grabbed on to a lift that was parked in the hallway and it fell on top of him resulting in multiple trauma.  Three days later, the man died from his injuries.

An investigation into the matter revealed that the facility should have never allowed the lift machine to remain in the hallway it posed a risk to residents due to its propensity to fall.  Investigators also determined that the facility failed to have proper guardrails that may have further contributed to the man's death.

The facility was fines $100,000 for this incident.  Read more about the fines related to this California nursing home here.

The importance of investigations by state agencies

One of the things that jumped in my head after learning abut this fall incident was how valuable inspections by state agencies are.  Inspectors have access to facilities where they can do a physical inspection of the equipment involved in an alleged incident-- but perhaps most importantly is that they have access to nursing home employees and administrators who have knowledge of an incident-- these people have no choice but to speak with these investigators.

In nursing home litigation cases, these inspections frequently provide the necessary information to successfully prosecute a case.  In most situations, by the time a nursing home negligence lawsuit is filed, the employees involved in an event have long since left the facility and it is difficult-- if not downright impossible to find them.  In the case of a disabled to deceased plaintiff, the testimony is essential to prove the case.

All this is to reinforce the importance of notifying the state department of health immediately upon learning of an event where a loved one was injured or killed.  A timely investigation by state authorities can mean the difference between a successful prosecution of a matter and an 'unfortunate tragedy'.

Related Nursing Homes Abuse Blog Entries

How Many Falls Is Enough To Impose Responsibility On Nursing Home?

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

Never Event #1: Hospital Falls & Trauma

A nursing home negligence lawsuit has been filed against Stearns Nursing and Rehabilitation Center after a 95-year-old resident fell on multiple occasions and suffered hip fractures. The lawsuit alleges that the facility failed to implement fall precautions despite the fact the facility knew the resident suffered from Alzheimer's, was generally confused and considered to be a 'high fall risk'.

The lawsuit claims, Stearns suffered multiple falls resulting in injuries during her admission from May 25th through July 7, 2007. In particular, the lawsuit alleges the following specific incidents:

• On May 27, the resident wandered the hallways, unattended, and fell fracturing her left hip.
• On June 6, while left unattended in a wheelchair and with a shut-off personal alarm, she fell out of the wheelchair.
• On June 15, the resident pulled herself out of her wheelchair and roamed the hallways un-assisted and fell, fracturing her right hip

The lawsuit is pending in Madison County Circuit Court.  Read more about this lawsuit against Stearns Nursing and Rehabilitation Center here.

Nursing Home Falls

More than 1,800 people die each year in nursing home falls.  All health care professionals in the nursing home setting must work together to help encourage nursing home safety.  Nursing homes are required to 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 and sets forth what accommodations should be in place for each resident.

Additionally, staff should always be on the lookout for residents who may require assistance getting about.  If residents have a history of falls, the facility should consider using alarms on chairs or beds to notify the staff when the person attempts to walk on their own.

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
• Hazards in the nursing home- wet floors, poor lighting, improper be heights, improperly maintained wheelchairs, equipment left out of place
• 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
• Inadequate staffing levels that fail to provide sufficient assistance to residents

If your loved one sustained a fall during a nursing home admission, our nursing home litigation team will provide a free case analysis to determine if a lawsuit against the facility is warranted.  Why not put our experience advocating on behalf of the elderly to work for you today?

Related Nursing Homes Abuse Blog Entries

How Many Falls Is Enough To Impose Responsibility On Nursing Home?

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

Falls Amongst The Elderly Can't Be Ignored

Lexington Care Center of Lake Zurich, Illinois has been named in nursing home negligence lawsuit filed in Cook County.  The lawsuit alleges Chicago nursing home failed to monitor an 83-year-old resident who was a known high fall risk.  The woman allegedly fell five times from February through August, 2007.

The fifth and final fall at Lexington resulted in a fractured hip that required surgery.  Unfortunately, the woman remained at Lexington for five days before the staff transferred her to a hospital for x-rays and medical treatment.  Unhappy with the care Lexington provided, the family chose an alternative facility for the woman's medical care following her discharge from the hospital. Read more about this nursing home lawsuit against Lexington Care Center of Lake Zurich here.

Nursing Home Falls

More than 1,800 people die each year in nursing home falls.  All health care professionals in the nursing home setting must work together to help encourage nursing home safety.  Nursing homes are required to 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 and sets forth what accommodations should be in place for each resident. 

Additionally, staff should always be on the lookout for residents who may require assistance getting about.  If residents have a history of falls, the facility should consider using alarms on chairs or beds to notify the staff when the person attempts to walk on their own.

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
• Hazards in the nursing home- wet floors, poor lighting, improper be heights, improperly maintained wheelchairs, equipment left out of place
• 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

Lexington Health Care

Lexington Health Care is a large company housing more than 3,000 people in the Chicago-area.  Lexington operates 21 nursing homes under the the names: Lexington Health Care Centers, Lexington Retirement Centers and Merit Home Health Care.  There are ten health care centers in:

• Bloomingdale
• Chicago Ridge
• Elmhurst
• LaGrange
• Lake Zurich
• Lombard
• Orland Park
• Schaumburg
• Streamwood
• Wheeling

The Minnesota Department of Health released an investigative report concluding a resident of Presbyterian Homes of Arden Hills Nursing Home sustained a broken neck due to a fall or other trauma at the facility.  The investigation follows the death of 91-year-old Gladys Gall, a resident at the facility.  Despite the fact no federal or state nursing home violations were identified, investigators still determined there was ample circumstantial evidence to conclude the nursing home was at fault in the injury and subsequent death of Gall. 

On April 18, 2008 Gall was admitted to an emergency room after complaining of head and neck pain.  A CT scan confirmed Gall's pain was related to a cervical fracture. On April 28th, Gall died from complications related to the cervical fracture.

Gall was likely as high fall risk due to memory loss and advanced osteoporosis.  Gall required assistance from nursing home staff for most daily living activities.

Investigators interviewed both Gall's family as well as staff at Arden Hills in attempting to determine the cause of Gall's broken neck.  Additionally, a neurosurgeon was consulted for the state's investigation and verified Gall suffered a hangman's fracture.  Further, the neurosurgeon opined the severity of the hangman's fracture could not have occurred without trauma.  Although no specific traumatic event could be identified as the culprit of the injury, three conclusions were reached in the report:

• Gall's death was related to her cervical fracture
• The neck fracture was related to a violent incident or fall
• Someone at the nursing home was aware of what happened to Gall because she would have been unable to pick herself up following her type of injury

Nursing home officials dispute the state's findings, pointing out the findings were not related to any specific event involving nursing home abuse or maltreatment nor can the report rule out an accident. Read more about this cervical fracture of a Minnesota nursing home resident here.

Nursing Home Falls

Falls are one of the most common sources of injuries amongst nursing home residents.  Despite, claims by nursing home officials that some falls are 'unpreventable', steps can be taken to minimize the risk of falls and related injuries;

• Identify residents who may be at risk of falling
• Provide adequate staffing to assist residents with transfers, toileting and general mobility
• Remove clutter from the floors
• Encourage residents to use asistive devices
• Minimize the use of medications that can alter blood pressure

Related Nursing Home Abuse Blog Posts On Falls

$50,000 Penalty Sought Against Nursing Home Where Resident Fell To Her Death

Falls Amongst The Elderly Can't Be Ignored

Hip Fractures And Some Unsettling Statistics

Study Links Medication Use With Falls

Web Resource On Hangman's Fracture

Traumatic Spondylolisthesis of the Axis (Hangman's Fracture), Medscape Today

John Leland of The New York Times, wrote a great piece addressing falls amongst the elderly.  Once thought to be an inevitable part of growing old, falls are frequently the result of underlying medical problems.  Equally important, is the fact that post-fall care must be given priority to avoid medical and psycological problems.  After reading this aticle, you will come to realize that there really is no such thing as a 'minor fall' amongst the elderly population.

Once considered an inevitable part of aging, falls are now recognized as complex, often preventable events with multiple causes and consequences, calling for a wide range of interventions, both psychological and physiological, that many patients never receive.

Even falls that cause only minor injury “need to be taken as seriously as diabetes,” said Dr. R. Sean Morrison, a professor of geriatrics and adult development at Mount Sinai School of Medicine in New York, because “they can be a real warning sign that something serious is wrong.”

Dr. Mary E. Tinetti, a falls expert at Yale University medical school, compared falls to strokes in their harmfulness, adding that people do not always report them or seek help, for fear their families will try to put them in nursing homes. For some people, Dr. Tinetti said, admitting that they fall is tantamount to admitting that they are no longer competent to take care of themselves.

Each year, 1.8 million Americans over age 65 are injured in falls, according to the Centers for Disease Control and Prevention. Some rebound as if the injury never happened. But for some, the fall sets off a downward spiral of physical and emotional problems — including pneumonia, depression, social isolation, infection and muscle loss — that become too much for their bodies to withstand.

In 2005, the last year for which statistics are available, 433,000 people over 65 were admitted to hospitals after falling, and 15,800 died as a direct result of the fall. Less visible are the many who survive the fall but not the indirect consequences.

When first interviewed in mid-July, Ms. Aliminosa and Ms. Arnold felt vulnerable and constrained, their world diminished. Both had led accomplished professional lives — Ms. Arnold as a school psychologist, Ms. Aliminosa as a medical researcher — and had been active in the community’s independent living apartments. But neither could be confident about what the future held.

Ms. Aliminosa said she was depressed, and able to walk only in very small stretches. A small woman with a soft voice and grainy New York accent, she barely filled her chair. She seemed defeated. “Emotionally I have not been well,” she said. “It’s made me very aware of my age, and that’s hard to accept.”

Ms. Arnold, by contrast, was full of emotional energy, so angry about her broken hip that she kicked out for emphasis as she talked, turning conversation into a full-contact sport. Before her fall, she had been preparing for a vacation with her daughter at a family beach house on Long Island — the same house where she had spread her husband’s ashes. Now that plan was gone.

“It kills me, it just kills me,” she said. “This was going to be the frosting on the cake, and somebody ate it.”

Of the two women, Ms. Arnold was up against the longer odds. One in five hip-fracture patients over age 65 die within a year after surgery, according to the C.D.C.; one in four have to spend a year or more in a nursing home. When younger people fall, they tend to break their wrists catching themselves, but in older people, who have slower reactions and less upper-body strength, the weight more often falls on their hips or heads. Any underlying conditions, like heart disease or respiratory problems, increase the chances of a downward health spiral.

Ms. Arnold had a history of pulmonary disease, and had been a heavy smoker, starting after high school. “She had a boyfriend in college,” her daughter, Margery Creek, said, “and it was the lesser of evils — sex, drinking or smoking.”

But her lung problems did not keep her down. In 2006, she took a 10-day trip to Sweden. Even after she fell and fractured a hip that autumn, she lived independently and was able to drive, returning to the beach house. That day in mid-July, even as she talked about depression, she took jubilant delight in photographs of her grandchildren and great-grandchildren. “Now if that isn’t the picture of a baby,” she said. “Isn’t she a sweetie?”

If Ms. Arnold were a machine, it would be simple to draw a straight line between her lung disease, her hip surgery and her chances of recovery. Older bodies typically have several weakened systems that are dependent on one another, and rely on drugs that may or may not work well together. “If you take 70-year-olds, on average they’re taking five medications,” Dr. Tinetti said. “When you get to 10 medications” — as a patient might after a fall — “the likelihood of adverse effects is close to 100 percent.”

But psychological factors can be as devastating as the physical trauma, Dr. Tinetti said. “It’s the fear of falling, the lost confidence. Good walkers stop walking, stop going to church. They become socially isolated and depressed.”

After Ms. Arnold’s first broken hip, she had reduced feeling in one foot, which added to the likelihood that she would fall again.

On July 6 this year, it happened: Ms. Arnold turned her body without moving her foot, pulling the closet door down with her when she fell and fracturing her hip bone.

“I’m outraged,” she said a week after the fall, raising her voice and then becoming fatigued. Her breathing was interrupted by coughing spasms. She said she was determined not to end up using an electric cart. “Disappointment,” she said, accenting each syllable. “I had a very good life.”

“But your life isn’t over,” said Deanna Gray-Miceli, an adjunct assistant professor of nursing at the University of Pennsylvania and an expert in geriatric falls who was looking in on Ms. Arnold in the nursing unit.

“Well, it bloody well is,” Ms. Arnold said. “I have no strength. Let’s talk about depression.”

The period of immobility after a fall is particularly dangerous, said Dr. Gray-Miceli, whose research includes studying a group of patients after falls. “Being immobile, you’re not taking deep breaths, you’re more prone to orthostatic pneumonia, or older people can develop urinary incontinence. And that can have a whole cascade of emotional consequences as well as the physical consequences, such as skin breakdown, pressure sores, bladder infection, lung infection.

“We also see temporary confusion from infection,” she added, “And that can lead to someone’s demise.”

Dr. Gray-Miceli’s work focuses on identifying the causes of falls, which might include treatable factors like changes in gait, low blood pressure, declining vision or heart arrhythmias, as well as conditions in the home. In a study by Dr. Tinetti, simple preventive suggestions from doctors, like physical therapy and changes in medication, reduced falls by 11 percent. (The C.D.C. offers tips to reduce falls at home, like removing loose rugs and making sure stairway handrails go all the way to the bottom, at cdc.gov/ncipc/duip/preventadultfalls.htm.)

For Ms. Arnold, it was too late. Shortly after surgery she grew depressed and fatalistic, her daughter said. “One morning when my brother was here, she woke up and said, ‘I’m weary, I’m just absolutely weary,’ ” Mrs. Creek said. “And she had no muscle that came back. Her arms had really gotten down to skin and bones. You hear that term — it certainly seemed that way, no muscle.”

In August, Ms. Arnold developed pneumonia and spent three nights in the hospital. Though she responded well to the medications, Mrs. Creek said: “It was just one more nail. She said she was ready to be with Dad.”

The last time Mrs. Creek called her, in early September, Ms. Arnold could recognize her voice but not respond, Mrs. Creek said. “I think she just said, ‘I’ve had it, I’m checking out.’ ”

Down the hall, Ms. Aliminosa’s response after her leg fracture was just as unpredictable.

On April 4, she was enjoying a visit from two favorite nieces — Ms. Aliminosa never married — when she found herself on the floor of her apartment, she said. She had no memory of how she fell.

Ms. Aliminosa has osteoporosis and a history of falling, so she told her relatives not to touch her until the nurses came. She needed a metal rod in her leg and began a slow process of physical rehabilitation. She said the falls were the first thing that made her feel old. “I’d love to be able to have dinner and take a short walk, and I can’t do that,” she said.

Because she was in a full-spectrum medical facility, her care was well coordinated, said Dr. Albert Siu, a professor and chairman of geriatrics and adult development at Mount Sinai.

“For example, osteoporosis is often at root of this,” Dr. Siu said. “But in a three-day hospital stay, addressing osteoporosis is not at the top of everyone’s mind. There it’s dealing with the pain, the complications and the repair of the fractured hip.” Medications for blood pressure or pain might increase dizziness or chance of falls. In mid-July, while Ms. Arnold was angry but relatively mobile, Ms. Aliminosa seemed resigned to a loss of mobility and independence. The prospect weighed heavily on her. When asked if she had considered counseling for depression, she said she did not think she could bear talking about it. “I think as we get older it’s hard to control our emotions,” she said.

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Even the best facilities occasionally provide bad treatment to their residents.  A wrongful death lawsuit has been recently filed against Schwab Rehabilitation Hospital, a nationally recognized rehab center in Chicago on behalf of the family of a deceased resident.  The family carefully selected Schwab as a rehabilitation center for their loved one's physical therapy and rehab training following the amputation of a leg. 

Unfortunately, even this well respected facility, failed to provide basic care for an elderly man's needs.  When the man was admitted to Schwab, the physicians ordered that the man be transferred in and out of his wheelchair with the use of a mechanical lift and two staff members.  The day after his admission a CNA ignored the physicians' orders and attempted to transfer the man into his wheelchair herself.  In the process the man fell and fractured his hip and femur. 

Like many physically fragile elderly, the injury lead to a spiral of deteriorating medical problems.  Following surgery at nearby Mt. Sinai Hospital, on his hip and femur fractures, the man became immobilized and developed a pressure ulcer on his sacrum.  Additionally, the man was diagnosed with sepsis, pneumonia, and respiratory failure.  Within three months of the fall, the man died.

The man's family filed a lawsuit against Schwab for negligent rehabilitation treatment.  The lawsuit was filed in Cook county Circuit Court.  Read more about this poor treatment at this well known Chicago rehabilitation hospital here.

This case demonstrates that a facilities reputation does not guarantee quality medical treatment.  Incidents at well-regarded medical facilities may occur with less frequency, but are just as devastating as incidents occurring at facilities with lesser reputations.  This case also highlights the importance of staff following physician orders.  If the CNA had simply followed the instructions set forth by the treating physicians this sad incident could have been avoided.

In this case, an investigation conducted by the Illinois Department of Public Health confirmed the care this elderly man received was improper.

A Colorado jury has awarded $375,000 the the family of a deceased nursing home resident.  The family of Doris Wolf brought a lawsuit against Spring Healthcare Center and Sava Senior Care, the parent company for injuries she sustained in a fall while a resident at the facility.

According to the Colorado Department of Public Health, Ms. Wolf was admitted to Spring Healthcare Center for rehabilitation following surgery on her back.  The day Ms. Wolf was to go home, she fell in the bathroom.  Apparently, Ms. Wolf used her call button to ask the nursing home staff for assistance in using the toilet.  After not receiving any response, Ms. Wolf used the bathroom unassisted and fell.  When Wolfe thought an "extended amount of time passed" and no one answered her request, she opted to try to walk toward her walker on her own and broke her ankle. 

The health department investigation also indicated that Spring Creek X-rayed Wolfe's ankle and found no fracture, but a family physician looked at the X-ray results and determined it was fractured in two places.  Similar incidents has occurred in the past.  According to the Colorado Health Department, another resident at Spring Creek Health Center was denied help going to the bathroom in February.

"The resident put on her call light and when staff responded, asked for assistance with toileting," the report reads. "The staff member told her s/he didn't have time to assist her and she would have to wet the bed. Another staff member assisted the resident."

The staff at Spring Creek are doing their job.  The nursing home staff must timely respond to calls for help and provide assistance to those who require it.  Under-staffing probably also plays a large role in these incidents.  If a resident needs to use the toilet should they be forced to suffer the indignity of soiling themselves because the there is inadequate staff or they are not attending to their needs?

Sava Senior Care owns approximately 185 nursing homes across the country, including Spring Creek and Fort Collins Health Care Center.  Sava operates the following facilities in Illinois:

Montebello HealthCare Center
1599 Keokuk Street
Hamilton, IL 62341

Nature Trail Health Care Center
1001 South 34Th Street
Mount Vernon, IL 62864

Odin HealthCare Center
300 Green Street
Odin, IL 62870

Westchester Health and Rehabilitation Center
2901 S Wolf Road
Westchester, IL 60154

Read more about this case of nursing home neglect here.

Related:

Nursing Home Injury Laws: Colorado

Following my recent post on the frequency of hip fractures in nursing homes, I received several responses from blog readers who asked me about the effectiveness of hip pads in preventing injury and hip fractures to nursing home residents.  For those that don't know, hip pads are usually similar to underwear with built in plastic and foam pads.  The overwhelming evidence suggests that hip pads do little to prevent hip fractures amongst the elderly.  In fact, a recent study of 1,000 nursing home residents was terminated because the hip pads were so ineffective in preventing fracture.

According to the study's author, Dr. Douglas Kiel, of Harvard Medical School, 'In the United States, nearly 340,000 hip fractures occur per year, more than 90 percet of which are assiciated with falls, and the number of hip fractures may double or triple by the middle of this century.' Further, 'The highest incidence rates of hip fractures have been reported in nursing home residents, where 50 percent of residents fall each year.' 

So the question remains, why do nursing homes and facities use hip pads in the first place?  I really con not think of any reason other than the fact that some nursing homes would rather use a device to take the place of staff involvement and supervision of their residents.  The only effective way to prevent nursing home falls is to identify people who may be prone to falls and to provide adequate assistance to residents throughout their daily living activites.

Read more about hip pads in nursing homes here.

One resident died after rupturing a blood vessel in his brain and fracturing his neck following his wheelchair tipped--anti-tipping devices were not in place.  A second resident fell forward in her wheelchair and struck her head on the floor resulting in a concussion and laceration requiring stitches-- a prescribed waist restraint was not in place.  The similar incidents occurred within 48 hours of each other at the same nursing home.

What makes these unnecessary events so disturbing is that they occurred within days of each other--these are not isolated incidents.  The events have prompted inspections by state nursing home inspectors.  Pennsylvania Health Department, director of nursing-care facilities Bill Bodner, sums the situation up well, 'the crux of our concern is the fact that in each case, there was miscommunication between the physician and nursing staff, and no clear plan of how the staff should treat these patients.'

Blame for these incidents falls squarely on the shoulders of nursing home staff.  Nurses and other nursing home workers are trained not only to follow physician orders, but also must provide resident care as new needs arise.  The above incidents are not the result complicated medical orders, rather they result from the most basic failures on the part of nursing home staff--failure to open their eyes.  Read more about the failure of nursing home staff to prevent falls here.

Nursing Home Injury Laws: Pennsylvania

A 'transfer' in a nursing home setting generally refers to moving a patient from a bed to a wheelchair.   Transfers are usually done two ways: using nursing assistants or mechanically (Hoyer lift).  The type of transfer depends mainly on the patients physical condition.  If a patient is capable of providing some assistance, a staff lift (one or two person transfer) is generally done.  However, if a patient is paralyzed or suffers from physical disability, the use of a mechanized lift may be required to safely transfer the patient.

The choice of how to transfer a patient from a bed to a wheelchair is up to the facility.  A determination of the type of transfer should be part of the evaluation when a person is admitted to the facility and for quarterly reviews of nursing home patient needs.  It is crucial for the staff at the facility to use the properly predetermined transfer technique or the nursing home resident is at risk to injury. 

Below are videos demonstrating the proper transfer technique for both the 'manual' method and using a Hoyer lift.