Nursing Homes Abuse Blog - By Jonathan Rosenfeld

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

Depending on the individual, even the most mundane parts of a long-term care facility can pose a risk of harm.  While we normally associate an injury at a long-term care facility with an error committed by staff or a faulty device, many facilities-- and particularly those that care for the developmentally disabled--- need to take precautions to make make sure potentially dangerous materials are kept securely out of reach of the residents.

Patients with developmental disabilities and other conditions like Alzheimer's or dementia are most at risk for episodes of self-inflicted harm-- be it intentional or not. 

Consequently, facilities that care for these people must take additional precautions that go beyond merely keeping some of these materials out of sight.  Because many of these people remain vigorous and able-bodied, facilities should ensure that potential dangerous materials are kept in a sure area and train staff on this potential threat to resident safety.

Tragically, an episode involving a developmentally disabled man at a Washington Assisted Living Facilty made headlines when he died after drinking laundry detergent.  The Seattle Times reported that the 30-year-old man was transferred to a community living program months before the deadly incident where he was to be supervised by an organization that concentrates in caring for those with disabilities.  It was also reported that this man lived alone.

Presently officials with The Department of Socials Health Services and local police are investigating the circumstances surrounding this incident.

While we await the results from this investigation, I'm sure that authorities will focus both on this man's background with respect to any similar incidents in the past as well as why a potentially deadly poison was so accessible. Hopefully this agency will take a second look at the way it care for people with similar disabilities an implement much stronger safeguards to prevent similar incidents from occurring in the future.

Related:

Brookdale Assisted Living Facility Fails To Learn From Mistakes: Dementia Patient Dies After Ingesting Detergent

Are Group Homes A Viable Alternative To Nursing Homes?

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

Acute renal failure following detergent ingestion (pdf) Singapore Med J 2009; 50(7) : e256

When selecting a nursing home for a loved one, families frequently go to great lengths to find the best facility.  Hours are frequently spent scouring the Internet looking for insights on particular facilities.  In many cases, visits are made to particular facilities all with the intention of finding the facility that best suits the needs of their loved one. 

Unfortunately, statistics tell us that vigilant efforts and good intentions, may not be enough to protect their loved ones from potential harm.

After reading a recent article regarding Ohio nursing homes, I was again reminded that good intentions on the part of family members can only go so far and it is ultimately up to nursing home staff to provide a quality--- and safe environment for patients.

After evaluating data compiled from nursing homes across Ohio over the past four years, the Hamilton JournalNews the following conclusions were reached: 

• 1 in 10 nursing homes has been cited for substandard care
• Improper nursing home care has been attributed to the deaths of 22 patients
• 42 nursing home patients were injured due to care violations
• Violations and citations were broadly scattered among counties throughout the state

According to the director of the Ohio Long-Term Care Research Project at Miami University, Bob Applebaum, while problems may universally prevail across different types of nursing homes, there is still a difference in the way ‘good’ and ‘bad’ facilities respond to such problems. 

There are instances where very good homes could have immediate jeopardy, and they’ll fix it immediately, according to Applebaum. 

Unfortunaltely, he goes on to say that the unpredictability of these incidents still threatens a broad cross-section of patients, “[i]t’s just the bad luck of the draw.”

While I certainly commend facilities for taking swift corrective action when an error is made or a patient injury is reported, the above statistics are a reminder of just was how widespread problems in nursing homes have become. 

If there's anything to take from these somewhat discouraging statistics, I think that its important for families to remain vigilant in their loved ones care.  After all, families are in the best position to identify potential problems early on and can help prevent issues from escalating to a more serious nature.  

Related:

Deaths, injuries linked to nursing home care in state, The Oxford Press by Ben Sutherly and Hannah Poturalski, September 12, 2011

More Detailed Nursing Home Information Now Available Online

Learning About Nursing Homes, Part 1: Nursing Home Surveys

How Can I Learn More About Facilities?

Yet another episode of nursing home violence was reported at a facility in Southwest Florida when a resident attacked his roommate over a disagreement as to the positioning of the window curtains.  Even though there was a nurse nearby, the victim of the abuse suffered severe facial bruising and fractures that required medical attention at a hospital.

An unknown risk

Probably the last thing patients and families consider when selecting a facility is the possibility of violence--- perpetrated by another patient at the facility!  Leaving families further in the dark is the fact that poor decision making on the part of the facility significantly increases the risk of violence to their loved one.

As a nursing home lawyer who has seen the ramifications of poor decision making on the part of nursing homes, I’ve seen too many occurrences of patient-on-patient abuse go deliberately ignored by the facility out of embarrassment or fear of a poor public image.

Any type of violence involving nursing home patients should be considered a crime and deserves to be fully investigated by law enforcement officials as opposed to people working for the nursing home.  What makes situations involving violence committed by nursing home patients unique-- and frequently difficult to prosecute-- is that it takes place behind closed door in the privacy of a nursing home.

Of course, it is unreasonable to suggest that nursing homes should be strictly responsible for the acts of all their patients. However, things change when facilities begin to have information regarding patient’s aggressive or violent tendencies.  Once a facility learns of a patient’s behavior, they inherently have a duty to take necessary steps to protect other patients and staff.

A legal duty to protect

This isn’t just the patient advocate in me talking, Federal Regulations both prohibit abuse (F-tag 223) and require nursing homes to permit law enforcement to investigate situations involving injuries (F-tag 226).  With respect to f-tag 223, the regulation requires that a resident of a nursing facility has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.

It is simply not acceptable for nursing homes to shrug their shoulders, when it comes to a situation where a patients is beaten.  The language from f-tag 226, requires nursing homes to report patients injuries (abuse) to regulatory agencies so an investigation can be done to determine how the patient was injured.

Basic precautions

As common sense would indicate, keeping patients with aggressive tendencies and psychological disorders away from other frail patients would be an important first step towards minimizing the risk of injury.  However, in situations when patients have ongoing problems, it is incumbent that facilities provide ongoing monitoring of the patients and seek to have the patient removed from the facility to ensure the well being of all.

While certainly a consistently disturbing picture, injuries resulting from the violence of other patients may indeed open the door to liability against the facility.  While pursuing a claim against a facility may be a distant afterthought following a violent episode following an injury, reporting the incident to police authorities, both provides the best opportunity to conduct a complete examination for purposes of both civil liability as well as ensuring other patients remain safe from similar behaviors.

Related:

Elder Abuse: Violence Among Elderly Nursing Home Patients

Nursing Home Abuse: Hidden Camera Catches Nurse Yanking The Wheelchair Of A Disabled Patient

Sexual Assaults In Nursing Homes, Not Exactly A Pleasant Topic-- But Is An Issue That Needs Attention

Patient Beaten To Death At Nursing Home With Long History Of Safety Violations. Should This Facility Really Be Considered A Skilled Nursing Facility Or Simply A Haven for Thugs?

Fall No. Assault Yes. Death Of Chicago Nursing Home Resident Under Investigation

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

At some nursing homes, there seems to be a noticeable delay in providing outside care--- from a specialist or hospital when a patient becomes injured or sick.  Some of these delays may no doubt be attributed to the fact that the staff is optimistic that the patient's condition may improve, making such treatment unnecessary. 

Yet, in other circumstances that I encounter, a delay in seeking medical care for a patient is completely unjustified--- an in some cases downright cruel.  I mean if a patient complains of pain in his or her back following a fall, how long is it necessary to wait before requesting an x-ray service or taking the patient to a hospital?

Due to that fact that some skilled nursing facilities are notorious for poorly recording information in patients' charts, I imagine that many cases involving delayed medical care get rapidly brushed aside as the onset of the condition may be difficult to render from the patient's records.

Thankfully, some cases involving delayed medical care do get investigated.  Just recently, the Minnesota Department of Health investigated the care provided to an ill patient at Sunwood Good Samaritan Society of Redwood Falls.  It turns out that the facilities delay in obtaining medical care for the patient is at least partially to blame for her death last November.

In this case, staff at the nursing home documented the woman's strained breathing problems following supper, but used a fax machine to communicate the problem to the woman's physician.  Even as the woman's condition deteriorated to the point where her pulse became erratic and her fingers turned blue, the staff at the nursing home continued to continued to seek help from her doctor via the fax machine.

More than 24-hours after the woman's physician was contacted, she died from cardio-respiratory failure in the presence of paramedics who were in the process of transporting her to the hospital.

The woman's doctor was interviewed after the incident conceded that the facility should have sought medical attention for her quicker.

While I am uncertain if the staff involved in this incident were disciplined, these employees should take note that federal law requires nursing homes to notify patient's physician when a patient becomes ill or their condition changes. Failing to do so doesn't just jeopardize the patient's well-being, but is against the law!

Related:

State: Nursing home slow to act before resident died from cardiac arrest, Startribune by Paul Walsh, April 14, 2011.

Nursing Home Injury Laws: Minnesota

Are nursing home patients protected under federal law?

Arizona Nursing Home Fined For Multiple Safety Violations

There are many situations involve nursing home injury that involve affirmative acts on the part of staff-- where an improper medical technique, lift or inappropriate dose of medication may have disastrous consequences for the patient.  Yet, there are other situations where equally horrible outcomes arise because of inattentive staff.

Sure, there really may be countless reasons why staff may be inattentive, but the primary reasons usually come down to inadequate staffing on the part of the facility itself.  When nursing home owners and operators heap more and more responsibility on staff-- something must give-- as there is only so much time to do what's necessary and so much energy with which to do it.

Certainly, we could likely tie many common types of nursing home injuries into this common scenario. But I was again reminded of how incredibly important it is for nursing home staff to monitor the patients they are caring for, when I came across the news report of an Australian woman who died apparently from strangulation when she was left unsupervised on the toilet--- likely for six hours!

A formal investigation is now underway concerning the strangulation death of a 90-year-old woman at an Australian nursing home who was routinely left on the toilet by staff at the facility.  According to news reports, the woman who suffered from Parkinson's and required full assistance from staff to get around somehow got entrapped in a shower cord without the knowledge of the staff.

Particularly in situations where patients need to use the bathroom, I have seen numerous situations where staff mistakenly assume personal privacy should take priority over following a patients care plan requirements that may require full assistance with daily living needs.  While the initial visits to the toilet may indeed be awkward for both patient and staff-- staff supervision can frequently mean the difference between patient safety and an unnecessary injury or death.

Related:

Nurses Failure To Assist Patient To Toilet Costs Nursing Home Dearly

Improper Maintenance Of Lift Device Costs Nursing Home Patient Their Life

Today, we are seeing many nursing homes and assisted living facilities expanding their services to accommodate the desires of today's consumers. 

Hair salons, gyms, ice cream parlors and regular outings to theatre, restaurants and malls-- have become the norm at many facilities. 

With the increase in services provided to residents, comes increased responsibilities on the part of facilities to ensure the safety of their residents.

Particularly when it comes to the transportation of nursing home patients in buses or vans operated by the facility, I am seeing a trend of more patients getting injured due to inadequate training of staff members improper equipment being used to transport some of the most fragile patients.

As the passenger in a vehicle, you have a right to expect that not just the other drivers abide by the rules of the road, but the driver of your vehicle does so as well.

Regardless of the purpose of use nursing homes need to take measures to ensure their patients' safety.  When transporting nursing home patients who may have limited mobility, this usually means assisting and checking to make sure they are adequately secured and seat belts are on.

Just like their non-nursing home counterparts, drivers of nursing home vans and buses have a duty to get their passengers to their destination in a safe manner. 

In a matter I am currently litigating, where a man suffered facial fractures and closed head injury when the nursing home van abruptly stopped for no apparent need, we learned that many of the same underlying causes that contribute to more traditional nursing home injuries -- under-staffing and improperly trained staff. 

As it turns out in our case, the operator of the nursing home vehicle started driving the vehicle just days before the date of the accident.  Further, he never received any instruction on securing handicapped patients.

Nursing home or others responsibility for an injury involving a motor vehicle accident

Though certainly not a traditional nursing home injury, motor vehicle accidents involving nursing home patients remain a troubling source of severe injuries.  Carefully dissecting how an accident occurred and determining the parties role in the accident is the first step in moving forward towards recovering from an injury sustained in an automobile accident.

In some cases involving patient injury or death involving a nursing home vehicle, there may be separate policies of insurance to cover the loss.  As lawyers experienced in medical transportation accidents can help navigate the applicable laws and insurance coverage issues.  Like all motor vehicle injury cases, it is best to speak with an attorney before talking to an insurance company representative.

Related Nursing Homes Abuse Blog Entries:

Medicare Standards Require Nursing Home Patients To Be Transported Safely

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

Dropping Patients, Failing To Secure Wheelchairs & Dangerous Driving Put Elderly Patients At Risk Of Further Harm During Ambulance Transport

Particularly when it comes to physically disabled patients, nursing homes must take steps to protect them from harm due to potentially dangerous conditions at the facility. 

When facilities fail to take basic steps to safeguard patients from these environmental hazards, we frequently see patients getting severely injured or killed.

A recent example of nursing homes failure to take basic precautions to safeguard a patients comes from a Missouri nursing home, where a wheelchair-bound patient was left unattended-- and without engagement of wheel lock-- in a stairway at the facility. 

Stltoday is reporting that the above circumstance forms the basis of a lawsuit against Avalon Garden Nursing Home (Missouri) filed on behalf of the Estate of Magdalen Mantych who died following a February 20, 2008 fall down a stairway at the nursing home. Ms. Mantych suffered a broken neck and blunt head trauma in the fall and died three days later from complications related to her injuries.

In my opinion there is simply no excuse for facilities allowing wheelchair patients unrestricted access to stairways.  As a nursing home lawyer, I have been involved in numerous cases where patients have suffered horrific injuries following a fall down and interior or exterior stairway.  Certainly, staff at these facilities need to be reminded how susceptible many of these patients are and remove patients from these hazardous situations before they harm themselves.

Related Nursing Homes Abuse Blog Entries:

Falls Amongst The Elderly Can't Be Ignored

What Are The Rights Of A Nursing Home Visitor Who Sustains An Injury During A Visit?

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

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

Nursing Home Injury Laws: Missouri

One of the things that I am continually reminded about in nursing home injury cases is just how much just plain rotten judgment is made by nursing home staff.  

Sure there are smart and thoughtful folks working in some of these facilities, but I frequently feel like patient safety is an afterthought as opposed to a priority.

Out of Washington, another prime example of poor judgment resulting in a patient injury was reported in Seattlepi.com when a nursing home patient fell from his bed allowing his leg to come into contact with the baseboard heater on the floor nearby.  

The fall went undetected by nursing home staff and the man suffered third degree burns to his leg that were so severe that his leg had to be amputated below the knee.

While we can certainly say that this was an isolated event that was most unfortunate, the article reports that this was not the first time that the patient had fallen out of bed and the alarm used to notify staff when he moved from the bed was not operational.

Further, according to the article, the man has incurred $116,000 in past medical expenses and will likely incur an additional $1.4 million in future medical expenses over the course of his life.

Sadly, nursing home patients across the country continue to suffer horrific injuries due to lapses in the judgment on the part of nursing home staff.  If for no reason other than to reduce the incidence of claims against the facility, staff need to be educated that every protocol regarding patient care is there for a specific reason-- to keep them safe.

Related Nursing Homes Abuse Blog Entries:

Burns In The Nursing Home Population Pose A Serious Threat Of Injury & Further Medical Complications

Stupidity Plain & Simple To Blame For Series Of Portable Heater Burns To Nursing Home Patients

Even The Most Mundane Parts Of A Nursing Home Can Turn Deadly Without Proper Staff Supervision

Cigarette Lighter Mishap Results In Severe Burns To Nursing Home Patient

When a person’s kidneys no longer work properly, dialysis can filter waste products from their blood.  Your kidneys keep your blood clean and balanced.  They filter 200 quarts of blood every day, filtering out waste and excess water, which becomes urine. 

Diabetes and high blood pressure are the two most common causes of kidney disease.  As your kidney health declines, your renal function worsens. 

If your kidneys have less than 25% of their kidney function, serious health problems can occur.  And, if your kidneys have less than 15% of their kidney function, dialysis or kidney transplant is required. 

About 11.5% of adults (ages 20+) in the United States show evidence of chronic kidney disease (CKD).  Signs of chronic kidney disease include:

• Increase or decrease in frequency of urination
• Fatigue
• Loss of appetite
• Swollen hands or feet
• Itchiness or numbness
• Drowsiness
• Trouble concentrating
• Muscle cramps
• Darkened skin

When the kidneys have failed or are close to failing (End-stage Renal Disease – ESRD), the body fills with waste and excess water (uremia).  If left untreated, this can lead to seizures, coma, and even death.  Treatment options are dialysis or kidney transplant.  In 2007, in the United States, mortality rates for ESRD were 157.3 deaths for every 1,000 patient years. 

There are two types of dialysis: hemodialysis and peritoneal dialysis.  Hemodialysis involves a dialyzer filter that connected to a hemodialysis machine.  Your blood flows out one set of tubes to the dialyzer that filters the blood, then the clean blood flows back into your body through a second set of tubes.  The treatment takes about 3-4 hours and must be performed 3 times/week.  Peritoneal dialysis involves a dialysis fluid that is inserted into the abdomen that collects waste products then is drained with a catheter. 

Risk of dialysis-related injuries

One complication of peritoneal dialysis is infection because a tube goes from the peritoneal cavity to the outside of the body where bacteria could enter.  Therefore, the patient must take cleanliness seriously. 

Dialysis patients also have an increased risk of falls because of hemodynamic changes which can cause low blood pressure and dizziness.  Also, many dialysis patients are older adults who suffer from bone or muscle weakness and have limited mobility. 

The average age of dialysis patients is 65 years old.  Risk factors for dangerous falls include: low systolic blood pressure before dialysis, history of falls, low vitamin D levels, comorbidities, and old age.  Therefore, dialysis centers must take extra precautions to reduce the risk of falls including performing a fall assessment, use exercises to improve strength, and avoid low blood pressure.

Human error is another common complication of dialysis.  Dialysis treatment involves multiple medications, dialysis access, and dialysis equipment several times a week.  This poses a dangerous set of circumstances, where errors can have deadly results.  Possible problems include:

• Medication errors
• Dialysis solution (dialysate) could be contaminated
• The wrong dialysate could be used
• The dialyzer could leak
• There could be problems with the patient’s access
• Improper blood draws from area close to patient's access site

One major problem in the 80's was incorrect sterilization of dialyzer membranes, which allowed a patient to be exposed to another patient’s blood and all their associated diseases including Hepatitis and HIV.  To reduce such errors, the Association for the Advancement of Medical Instrumentation (AMMI) set dialyzer reuse standards.  Many patients refused to participate in the reuse programs, and providers favored single-use membranes. 

Dialysis is an important and lifesaving tool for patients with renal failure.  However, dialysis can also pose serious dangers.  Therefore, it is important that dialysis centers take precautions to reduce errors and promote patient health and safety.

Resources:

MedicineNet; Dialysis

Agency for Healthcare Research and Quality: Dangerous Dialysis

Heartland Kidney Network Quality Improvement Department: Fact Sheet – Patient Safety in the Dialysis Facility

Clinical Journal of the American Society of Nephrology: Falls and Fall-Related Injuries in Older Dialysis Patients

International Urology and Nephrology: Prevalence of Falls Among Seniors Maintained on Hemodialysis

National Kidney and Urologic Diseases Information Clearinghouse: Kidneys

The fall-related death of a 58-year-old nursing home patient at Browning Manor Convalescent Hospital triggered an investigation by the California Department of Health that determined that the facilities errors are partially to blame for the death of the patient.

An investigation by the agency revealed that the facility violated its own supervisory guidelines in caring for the man who unbuckled a safety restraint and fell from his wheelchair and fractured his neck.  The man died several days later from complications related to his injury.

In the days leading up to his death, the facility documented the man’s irregular behavior, yet the facility failed to implement any interventional steps that may have prevented him from harming himself in a fall. 

According to the facilities own policies, any patient who has physical aggression and behavioral outbursts is to receive one-on-one monitoring.  An investigation by California officials determined that the facility never followed its guidelines and implemented such care.

As a result of the care violations and the man’s subsequent death, Browning Manor Convalescent Hospital received a $100,000 fine and AA citation.

My take:

I can appreciate how some people reading about this incident may call into question the strict fine imposed against this nursing home given the fact that this patients actions are apparently responsible for his own injury.

However, having litigated nursing home negligence cases involving similar circumstances, I definitely feel like nursing homes must be held responsible for failing to take interventional measures to protect patients.

While we will really never know what difference the affirmative acts on the part of the nursing home would have made on these circumstances, I am confident that the aggressive sanctions imposed on Browning Manor will cause the staff to change the way they handle similar circumstances in the future--- and potentially save a patient's life.

Related:

Nursing Home Gets $100K Fine After Resident Dies Camila Bastidas - 23ABC North County Reporter, October 27, 2010

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

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

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

Sometimes I see nursing home negligence cases where a facilities errors stem from the fact that staff fail to pay attention to an initial physician order or care plans developed by the facility for a patients care.  Perhaps the order itself was ambiguous, or perhaps the writing was illegible?  But what happens if a physicians order is just plain wrong?

Certainly, in cases where orders are ambiguous, illegible or downright suspect, it is up to the nursing home staff to clarify the orders with a supervisor at the facility or to take it upon themselves to confirm the order with the patient's physician.  Put another way-- staff can not leave their common sense at the door when implementing patient care.

Frankly, I was pleased to see a recent jury verdict in a case where the jury acknowledged that that nursing home staff can not pass the buck in all situations-- even when the physician is partially at fault. 

A California jury recently awarded a brain damaged woman $3.1 million in a case where the staff at St. Edna Subacute & Rehabilitation Center administered an overdose of morphine to a rehab patient who was recovering from a foot surgery.  The 57-year-old woman's podiatrist has mistakenly prescribed 50 mg of morphine instead of the 30 mg of Demerol that he intended.

Even though the morphine dosage was unusually high and staff were similarly warned of the excessive dosage by a pharmacist, the staff at St. Edna took it upon themselves to administer the mistakenly prescribed drug.

Even after the woman became visibly ill from the morphine, the facility still made errors in delaying the implementation of medical care and taking the woman to a hospital.  The combination of the excessive morphine dosage was well as the delay in care resulted in the woman sustaining a brain injury.

The $3.1 million award was composed of $2.0 million for pain and suffering and $1.1 million in medical costs.  The jury furhter apportioned the nursing home 90% responsible and the prescribing physician 10% at fault. 

In addition to the compensatory damages awarded above, the jury will also determine if punitive damages should be awarded based on the nursing home's conduct.

St. Edna Subacute & Rehabilitation Center is part of Covenant Care, a large nursing home operator with 25 facilities throughout California.

Related:

Woman injured at O.C. nursing home gets $3.1 million O.C. Watchdog, August 19, 2010

Insulin Overdose Kills Nursing Home Resident

Fentanyl Overdose Leads To 1.6M Nursing Home Settlement

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

Morphine Intoxication Of Nursing Home Patient Results In Significant Jury Verdict

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?

One of the most memorable cases I worked on involved a young man who was in a nursing home following a severe injuries he sustained in a construction accident.  Due to the nature of the man's injuries, a catheter was used to drain urine from his bladder.  Despite doctors orders to change the catheter every 30 days, months went by without any catheter change.  In fact, six months went by without a catheter change.

Finally, after six months without a catheter change, a nursing home employee recognized the obvious problems: cloudy / brownish urine and testicles extremely swollen due to infection.  The situation initially resulted in a hospitalization where the man's testicles were surgically removed.  Unfortunately, the staff's intervention was too little, too late.  Within a week of arriving at the hospital, the man died from a condition known as urosepsis.

Urinary Tract Infections

Urinary Tract Infections (UTIs) seem like a minor problem, especially in nursing homes, considering the range of common diseases, infections, and illnesses. However, UTIs can prove very dangerous, especially when nursing home facilities fail to prevent UTIs in the first place or fail to provide proper and prompt treatment.

Urosepsis

Urosepsis is basically a severe urinary-tract infection. A UTI occurs when bacteria travels up the urethra (the opening in the body through which urine passes) into the bladder. UITs account for over 30% of infections reported by acute care hospitals and are the most common type of healthcare-associated infection. 

The bacteria can stay contained in the bladder (cystitis), travel to the kidneys (pyelonephritis), or even spread into the bloodstream (urosepsis). With urosepsis, you can suffer a dangerous drop in blood pressure, which can deprive your organs of oxygen. It can even prove fatal if you do not receive prompt antibiotic therapy, with an associated problem of increased use of antibiotics and multidrug-resistant bacteria.

Symptoms of UTIs include:

• Strong, persistent urge to urinate
• Burning sensation when urinating
• Passing frequent, small amounts of urine
• Blood in urine
• Cloudy, strong-smelling urine
• Bacteria in urine

More severe UTIs can also cause the following symptoms:

• Flank (upper back and side) pain
• Lower abdomen pain
• Fever
• Shaking and chills
• Nausea
• Vomiting
• Frequent, painful urination

While most urinary infections are mild, they can progress to more serious infections. Risk factors for urosepsis include:

• Older age
• Being female
• Having an indwelling urinary catheter (Foley catheter)
• Suffering from kidney stones
• Having impaired immunity

Urosepsis and catheter usage

UTIs are a common problem for the elderly because they are more likely to suffer from common risk factors. There is a marked increase in the prevalence of UTIs in both women and men after age 65. Females are more likely to suffer from UTIs as they age because of physiology and hormone changes. 

First, women have a shorter urethra, making it easier for bacteria to travel into the bladder. Second, as women age because the tissues of the vagina, urethra, and base of the bladder become thinner and more fragile. In addition, decreased estrogen levels causes pH changes in the vagina, allowing E.coli colonization, which causes about 80% of all UTIs. Men, on the other hand, suffer more UTIs when older because of prostatic disease. 

Risk factors include:

• Atrophic urethritis
• Atrophic vaginal mucosa (atrophic vaginitis)
• Benign prostatic hyperplasia
• Prostate cancer
• Catheter use
• Chronic bacterial prostatitis
• Genitourinary abnormalities
• Genitourinary calculi
• Renal and perinephric abscess formation
• Urinary diversion procedures
• Urethral strictures

Improperly maintained catheters are one frequent cause of UTIs. Usually, the longer a catheter is in place, the more likely an infection will develop. Up to 35% of patients requiring a urinary catheter for seven days or more will develop a CAUTI. About 50,000 long-term care residents have catheters at any given time according to the CDC’s 2009 report on catheter-associated urinary tract infections (CAUTIs). 

It is recommended that catheters are used only in appropriate situations and are left in place only as long as necessary. (See “Never Event #4: Catheter Associated Urinary Tract Infections and Nursing Homes Abuse Blog: Catheter Usage)

There are steps that nursing homes can take in order to reduce the risk of CAUTIs (proper use, proper technique, and proper situations). Proper use of urinary catheters is important, including:

• Not using urinary catheters to manage incontinence
• Using urinary catheters only in patients as necessary
• Remove the catheter as soon as possible
• Not using urinary catheters as a means of obtaining urine for culture or other diagnostic tests when the resident can voluntarily void

Instead, urinary catheters should only be used when necessary. Situations where indwelling urethral catheters are appropriate include: 

• When resident has a bladder obstruction
• Critically ill patient cannot voluntarily void urine for tests or to measure urine output
• Patients undergoing urologic surgery
• To help genital or anal wounds heal
• If resident requires prolonged immobilization
• To improve comfort for end of life care

Proper technique for urinary catheter insertion can also help reduce the risk of CAUTIs including:

• Washing hands before and after inserting or touching the catheter or catheter area
• Ensuring that only properly trained professionals insert/maintain the catheter
• Only touch the catheter when necessary
• Use sterile equipment
• Ensuring that healthcare personnel who take care of catheters receive periodic in-service-training

If used properly (proper situation and proper technique), indwelling urinary catheters can be a helpful tool when caring for nursing home residents. However, when proper technique, use, and care of catheters are not achieved, serious bacterial infections can occur.  

It is frightening how quickly a simple UTI can turn into a dangerous bacteria infection (urosepsis) that could prove fatal. Bloodstream infections in the elderly are associated with a higher mortality rate compared to bloodstream infections in younger age groups. Therefore, prevention of dangerous UTIs and proper treatment is important. 

If you or a family member has an indwelling catheter, it is important to ask questions about why it is necessary, for how long it is necessary, and proper and hygienic care. 

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

Sources:

Nursing Homes Abuse Blog: Never Event #4: Catheter Associated Urinary Tract Infections

Nursing Homes Abuse Blog: Catheter Usage

CDC: Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009

The Merck Manual of Geriatrics: Urinary Tract Infections

Geriontological Nursing: Urinary Tract Infection - Guidelines to assessment, treatment, and prevention in the older adult

The American Journal of Medicine: Bloodstream infections in the elderly

International Journal of Experimental, Clinical, Behavioural, Regenerative and Technological Gerontology: Unique Aspects of Urinary Tract Infection in the Geriatric Population

Journal of the National Medical Association: Problems in diagnosing infections in the elderly

The Journal of Urology: Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection

Emerging Infectious Disease Journal: Engineering out the risk for infection with urinary catheters

Journal of the American Medical Directors Association: Complications of chronic indwelling urinary catheters

If you were playing a word association game, I bet you'd be hard pressed to combine nursing home patients and car accidents!  While the terms may mix like oil and water in many contexts, in my world as a nursing home lawyer I frequently see the two intermixed-- and the the results certainly don't favor the patients.

In my nursing home ligation practice, I see many cases where nursing home patients are horribly injured in car accidents either as pedestrians or as passengers.  While most think about nursing home patients passing time in an idyllic setting, the truth is that there is a significant portion of the nursing home population that leaves the facility for their personal recreation, visit with doctors or tend to personal business. 

Because auto accidents make up a significant number of accidents for nursing home patients, I plan on going into the three major categories of automobile injury cases affecting nursing home patients and the respective liability issues for both driver and nursing facility.

As I see it, nursing home patients are involved in injuries due to: other drivers (pedestrians), passengers in vehicles or in the case of dementia or Alzheimer's patient-- wandering from the facility.

Elderly pedestrians involved in auto accidents

Many nursing homes are located in metropolitan areas where vehicle traffic is heavy.  Though the centralized location may be convenient for family and visitors, busy city environments are particularly dangerous to elderly nursing home patients who walk or roll along the street in wheelchairs.

The constant traffic and rapidly changing traffic controls can be substantial obstacles for everyone, but particularly those with special needs such as elderly people with assisted walking devices or diminished hearing or eyesight. 

Several years ago, my office represented an elderly man, who happened to be a nursing home patient, who was struck by a truck making a right-turn as he made his way to a convenience store literally located across the street from the nursing home.  The man suffered severe orthopedic injuries to his legs-- bilateral femur fractures and de-gloving injuries when he was thrown from his electric wheelchair and run over by the rear wheels of the truck. 

Though the man's family initially contacted us as a perspective negligence claim against the nursing home where he resided, we quickly learned that the truck-driver was really the one who was responsible for accident and the man's injuries.  In the course of litigation, the truck driver acknowledged that he was unable to see the elderly man due to the height of his truck and the relatively low height of the electric wheelchair-- despite the fact that that the man was in the cross walk and obeying the traffic signal.

Pedestrians have the right of way

Most jurisdictions have traffic laws that give pedestrians-- even those with physical disabilities-- the right of way when sharing the road with automobiles.  In this context, the driver of the vehicle is usually the one primarily responsible for resulting injuries especially if the pedestrian was obeying the traffic signals.

In some circumstances following a collision with a pedestrian, an assertion may be made by the offensive driver that the person was too old or had diminished senses.  In my experience, such arguments typically backfire-- badly. 

Not surprisingly, in most elderly-pedestrian vs. auto collisions, I see the real fault falling lying on the drivers who fail to keep a proper look out or who refuse to wait the literal seconds it takes for a person to get out of harms way.

Liability of nursing home or driver?

In situations where a pedestrian really has no business walking around unassisted, there may be a cause of action against the facility where he or she resided for the facilities failure to provide assistance.

However, if a nursing home patient is capable of appreciating the risks associated with walking around, they certainly should be entitled to do so.  

Particularly with elderly pedestrians, the resulting injuries sustained in automobile accidents can be devastating.  Unlike similar accidents occurring in a younger population, older people tend to heal-- far slower and require much more extensive care.

As lawyers who have championed the rights of the elderly for more than 30 years, we have developed a unique perspective on the overall effects of injuries on aged bodies.  In many respects our appreciation for the severity of the injuries sustained by the older population has resulted in verdicts and settlements admired by our peers in the legal community.

If you or a elder was involved in an auto accident, I invite you to speak with our elder law attorneys to discuss your legal options.  All consultations are free of charge and completely confidential.  (888) 424-5757

Resource articles:

Accidents involving older people: a review of the literature
JM Lilley, T Arie, CED Chilvers - Age and Ageing, 1995 - Br Geriatrics Soc

Toleration of head injury by the elderly
LA Amacher, DE Bybee - Neurosurgery, 1987 - journals.lww.com

Injuries in restrained motor vehicle accident victims
GW Hendey, SR Votey - Annals of emergency medicine, 1994 - Elsevier

Injuries to the elderly in the traffic environment
H Sjögren, U Björnstig - Accident Analysis & Prevention, 1991 - Elsevier

The collective negligence of multiple nursing home employees does not impute criminal conduct on the part of the corporate owner according to a recent ruling made the Supreme Judicial Court-- the highest court in Massachusetts.

The decision stems from the death of a 74-year-old patient at a MA nursing home owned by Life Care Centers of America.  Despite the patient's extensive history with respect to wandering from the facility, the facility failed to take basic precautionary measures that would likely prevented the wheelchair-bound patient from falling down a set of stairs to her death.

An investigation into the patient's death concluded revealed that there were no physician orders for a device called a WanderGuard in the patient's chart.  Had the WanderGuard been administered to the patient, she would not have been unable to literally wheel herself out the front door of the facility in her wheelchair.

"The Commonwealth is attempting to promote conduct that is no more than negligent on the part of one or more employees into wanton or reckless conduct on the part of the corporation," Justice Judith Cowin wrote in the majority opinion.

As a lawyer, I certainly respect the wisdom of this court.  However, as an advocate for victims of nursing home abuse and neglect, I find that too often corporate nursing home owners foster a culture where patient-care is an after thought and paying civil claims is simply a way of doing business.  

I certainly admire Attorney General Martha Coakley's desire to pursue this type of simply wrong conduct criminally.  Perhaps laws need to be stiffened to force nursing home operators to regain control over their staff.

Life Care Centers of America operates more than 200 skilled nursing homes, assisted living facilities, retirement living communities, home care services, and Alzheimer's centers.

Read more about this important decision regarding nursing home care here.

Related:

Investigation Concludes: Most Nursing Home Administrators Are Never Disciplined For Poor Care

Lawsuit Claims That Nursing Home Failed To Intervene In Case Involving The Sexual Abuse Of A Patient

"Life Care Center" Permitted To Accept New Patients After State Finds Poor Living Conditions

Foot problems are probably one of the last things many of you associate with nursing homes. Like many things though, foot care is incredibly important when a patient is in pain or has become disabled due to a foot ailment.

A podiatrist is a licensed physician who diagnoses and treats foot and ankle conditions, injuries, and diseases.

In Illinois and most states, podiatrists must be licensed in order to practice podiatric medicine. The Illinois Division of Professional Regulation licenses Podiatric Physicians. The Illinois Podiatric Medical Practice Act of 1987 (225 ILCS 100) and accompanying Podiatric Administrative Code (Title 68, Chapter VII, Subchapter b, Part 1360) establish and implement the licensing requirements and guidelines for podiatrists. But, not all podiatrists are board certified, but many are, and certification indicates a certain skill and ability level. The American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) certifies podiatric orthopedics and primary podiatric medicine, and the American Board of Podiatric Surgery (ABPS) certifies foot and ankle surgeons. 

As you age, common foot and ankle problems include:

• Corns
• Calluses
• Ingrown toenails
• Bunions
• Heel spurs
• Arch problems
• Ankle and foot injuries
• Deformities
• Infections
• Foot problems associated with diabetes and other diseases including vascular disease

In order to diagnose a foot problem, podiatrists can use x-rays, laboratory tests, physical exams, and patient histories to assess symptoms and risk factors. Podiatrists use a variety of tools to treat foot and ankle problems including:

• Medications
• Physical therapies
• Custom-made shoes
• Corrective shoe inserts (orthoses)
• Surgery
• Casts to set fractures

Podiatry is a useful tool for many nursing home residents because of how common podiatry services are required. Podiatrists can be very important in keeping elderly people and disabled people mobile. An independent practice podiatrist in a nursing home can act without supervision of a nursing home staff member. The podiatrist can perform patient evaluations, design treatment plans, and update service plans as required. 

Nursing home staff members should still be aware of residents’ podiatry treatments in order to ensure that residents receive all prescribed services. Also, nursing home staff members need to be aware of all signs and symptoms that might indicate any complications, additional medical problems, or worsening of condition. 

Proper care and maintenance of all foot and ankle problems will dramatically improve the quality of life for nursing home residents who already face reduced mobility because of advanced age and other health problems. If you or a family member have foot or ankle problems, it is important to ask the nursing home whether they have an independent podiatrist at the nursing home or other professional to attend to your needs. 

Resources:

American Podiatric Medical Association: About Podiatry

Illinois General Assembly: Podiatric Medical Practice Act of 1987

Illinois Administrative Code: Part 1360

Illinois Division of Professional Regulation: Podiatry Licenses

Bureau of Labor Statistics: Podiatrists

Massachusetts Consumer Affairs and Business Regulation: 249 CMR 4.00

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

Falls are a common problem facing elderly people in and out of nursing homes.  By some accounts, every elderly person in America will fall at least one time over the course of the next year.  Many of these falls will cause injury and some will even cause death.

In the case of falls occurring in the nursing home setting, many clients and their families focus their attention on tying a specific number of falls to a facilities responsibility.  Truth be told, there really is no magic number when it comes to identifying a specific number of falls after which a nursing home or hospital becomes responsible.

Rather, in determining a nursing home's fall related liability, it is important to determine not just the actual number of falls that occurred prior to the injury causing fall, but to look at the situation as a whole.  Taking a look at the residents 'fall-risk assessment' completed by the facility on admission should help determine what safeguards should have been in place to prevent falls.  In the case of multiple falls, it is important to look to see if a new assessment was completed after each fall.  Put another way, there is no magic number of falls for imputing responsibility on the part of a facility.

While in the fall mode, I came across this article regarding a lawsuit filed against a nursing home for failing to take precautions before a resident fell and died from her injuries.  The lawsuit alleges that Windsor Chico Creek Care and Rehabilitation Centers failed to implement fall precautions for a woman who was admitted to the facility following a back injury that made her susceptible to falls.

The woman's husband filed a nursing home lawsuit claiming that the facilities negligent conduct resulted in the woman falling from her bed and fracturing her hip. The woman subsequently underwent surgery for the hip fracture and contracted aspiration pneumonia during her recovery that ultimately caused her death.

The lawsuit alleges that despite the facilities own orders for safety precautions, Windsor Chico Creek Care and Rehabilitation Center failed take the following precautionary measures to prevent the woman's fall from occurring:

• Failed to use guardrails on the bed
• Failed to use an alarm system to alert staff if the woman fell from her bed
• Failed to used a lowered bed style to minimize the risk of falling from an elevated height
• Failed to hire an adequate number of staff to provide assistance

In this case, should the allegations proved to be true, this facility faces liability even though no prior falls took occurred.  The lawsuit also names Helios Healthcare LLC, the owner of Windsor Chico Creek as a co-defendant in the case.

Related Nursing Homes Abuse Blog Posts

Nursing Home Sued Following Death Of Resident In Fall

Woman Dies From Brain Bleed Following Unsupervised Fall

Study Links Medication Use With Falls