Jonathan Rosenfeld's Nursing Homes Abuse Blog : Jonathan Rosenfeld's Nursing Homes Abuse Blog | Lawyer & Attorney : Strellis & Field Law Firm | Bed Sores, Senior Neglect, Elder Abuse, Sexual Abuse: Chicago, Illinois

When you consider forms of cruel treatment, maybe you consider beds of nails or solitary confinement? However, another form of cruel treatment-- the use of restraints, is commonly used with innocent nursing home patients. At some facilities, patient restraints are a commonly used tool used by facilities in lieu of providing actual hands-on patient care by facility staff.

In the past, nursing homes used physical restraints such as: bed rails, lap belts, vests, wrist ties and special chairs to assist them in literally controlling their patients.  In addition to de-humanizing patients, the use of restraints was attributed to rapid physical deterioration and increased rates of patient injury.

In response the the poor publicity and family outrage, many skilled nursing facilities have made great efforts to reduce use of restraints.  The reduction in restraint usage was recently discussed in an article by Megan Brooks on Medscape.

Ms. Brook's article analyzed data from a News and Numbers report from the Agency for Quality Improvement and Patient Safety (AHRQ), which was part of a 2009 National Healthcare Disparities Report.  In short the reduction in use of restraints seems promising-- from 1999 to 2007, the number of nursing home patients who were restrained dropped more than 50%.  

By most estimates, just 5% of nursing home patients are restrained by facilities. Restraint usage varies significantly based on the following factors such as ethnicity, age and sex.  

Certainly this is promising news for nursing home patients in general.  However, the data contained in the AHRQ report does not contain enough specifics regarding nursing home patient demographics to assess if restraints are being improperly utilized. 

To restrain or not?

This really is a very difficult question to answer and the answer varies significantly amongst experts.  I feel restraints may be justified when the patient is at risk for harming themselves or others. 

In my experience, I have witnessed facilities slow to utilize restraints--- even after repeated episodes of falls.  In one of my cases, the facility refused to restrain a patient despite fourteen reported falls (many with associated injuries) at the facility. Unfortunately, the patient's fifteenth fall resulted in a head injury which ultimately cost the patient her life.  In the course of litigation, I asked the director of nursing why the patient was not restrained, she advised that the facility was a 'no restraint facility'.

In this case, I think there certainly is a very strong argument that I can (and will make) that with a no restraint policy, the facility was not properly equipped to care for this patient due to her extensive history of falls.

In another restraint case I worked on, a patient was seriously injured when she was left unattended in her geri-chair with an improperly placed lap belt.  Apparently, the belt was too loose and when the woman slipped down in her chair, she became entangled and choked.  Again, in the course of litigation, the facility disclosed that lap belts were used on all patients --- regardless of their physical abilities.

Certainly, regardless of a facilities restraint usage policy, it is up to the facility adequately supervise patients to ensure the usage / non-usage of restraints doesn't interfere with the patients well being. Further, this is an important issue for families to discuss and know where the facility caring for their loved ones stands on this issue.

Related Nursing Homes Abuse Blog Entries:

Many Nursing Homes & Assisted Living Facilities Continue To Threaten The Safety Of Their Patients With The Use Of Bed Rails In Their Facilities

Warnings Do Little To Prevent Bed Rail Entrapment 

Bedrail Entrapment

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

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Even at nursing home facilities with relatively high Medicare ratings and low average number of health deficiencies, serious problems can still occur. Despite a three-star (average Medicare rating), Addolorata Villa (a nursing home located in Wheeling, Illinois with 91 certified beds) failed to provide proper care and services to an elderly female resident after a fall, which then required an ER visit for serious injuries. 

Addolorata received two stars for its health inspections for five health deficiencies over the past year. This is three less health deficiencies than the average number of health deficiencies for Illinois nursing homes and also three less than the average number of health deficiencies for United States nursing homes. Despite the average rating, this facility still suffers from serious health deficiencies, which resulted in serious injuries. 

In March 2009, Addolorata Villa failed to properly monitor a resident after a fall and also failed to properly notify the attending physician of a change in condition. The resident ended up in the ER with a brain bleed and fracture because of these failures. Elderly residents are particularly susceptible to falls because of weakness, illness, and balance problems. 

On March 24, 2009, an 83 year old female resident suffering from Dementia fell from her chair directly across from the nurse’s station. The resident suffered facial lacerations, swelling, and bruising. The nurse assessed the resident, returned her to the chair, and administered first aid. 

Facility staff continued to monitor the resident who denied pain despite restlessness, agitation, grimacing (which is a symptom of pain) and continued swelling and bruising of her left eye, which progressed to the extent that the staff was unable to open her eye to check the eye and pupil response. However, on the morning of March 26, the resident was noted to be more lethargic and was sent to the emergency room (ER) for evaluation. The resident was then admitted to the hospital with a brain bleed and cervical fracture. 

The facility failed to provide timely, frequent and comprehensive neurological assessments, and also failed to notify the physician in a timely manner of the change in neurological status and change in the condition of the left eye. These failures resulted in a 33 hour delay in medical treatment for the elderly resident. The facility’s failures and neglect resulted in this resident suffering from prolonged pain and further injury, ending in an ER visit. 

Each and every nursing home resident has the right to receive the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being. This requirement was not met when the facility failed to provide proper treatment to this resident after her fall. During the following May 7, 2009 complaint investigation, the surveyor found that the facility’s significant failures placed this resident’s health and safety in immediate jeopardy.

When choosing a nursing home facility for a family member, there are many factors that should influence your decision, including the number of residents, number of staff, location, past health deficiencies, Medicare rating. You must be aware that even relatively good facilities with an average Medicare rating can have serious health deficiencies, which can result in serious injuries. 

Sources:

IDPH: Addolorata Villa

Medicare: Addolorata Villa

Chicago Business: Illinois Ranks High on Bad Nursing Home Report  

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The son of a deceased nursing home patient blames 'under-staffing' as the primary reason why his mother fell and subsequently developed pressure ulcers.  Gary Brown filed a lawsuit against a county operated nursing home in Nebraska on behalf of his deceased mother's estate.

In addition to under-staffing, the lawsuit alleges the facility allowed his mother to develop pressure ulcers (also referred to as pressure sores, decubitus ulcers or bed sores) during her recovery from a fall at the facility. Despite the fact that the pressure ulcers progressed and became infected, the facility also allegedly failed to notify the woman's personal physician.  Lastly, it is claimed that the pressure sores contributed to the patient's death.

Read more about this lawsuit due to development of pressure ulcers here.

Nursing Homes Obligation To Prevent Pressure Ulcers

Nursing homes must develop a customized program to prevent and monitor each resident's risk for developing pressure ulcers.  Unfortunately, at facilities that are inadequately staffed, many of the preventative measures set forth in a care plan are not complied with.

Pressure ulcers may develop when a patient is left in one position for a long period of time. Consequently, many nursing home patients need to be 'turned' on a regular basis.  Many facilities have charts to help staff keep track of the re-positioning schedule for each resident.

To minimize development of pressure ulcers, nursing home residents should be:

• Cleaned regularly with mild soap and lukewarm water
• Moisturized daily
• Kept dry and clean-- especially kept free from urine and feces
• Rotated on schedule to prevent the build up of pressure from one area of the body
• Encouraged to get proper nutrition and hydration
• Kept the bed elevation as low as possible- this reduces pressure on the sacrum and buttocks

Related Nursing Homes Abuse Blog Entries

Government Report Confirms Pressure Ulcers Harm All Nursing Home Residents; Regardless Of Race, Sex or Age

Nursing Home Visits. An Opportunity To Conduct Your Own Inspection.

In For Rehab. Out With Bedsores.

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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

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The North Carolina Nursing Home, where an Alzheimer's patient recently fell to her death after she literally wheeled herself through multiple sets of unlocked doors will likely face a fine of $50,000 -- the maximum penalty.  As we recently discussed, on December 18th,  87-year-old Annie Bell Scarboro went unnoticed by staff at the Five Oaks Manor in Concord, and wandered through several doors and kitchen area and onto an unlit and unguarded loading dock where she fell four feet to her death.  The North Carolina Department of Health and Human Services suggests the nursing home be fined $10,000 per day for the five days between Scarboro's fall and when repairs to the facilities door alarms and fencing around the dock area where she fell were completed.  A final determination on the amount of the fine the facility will face will be determined by Centers for Medicare and Medicaid Services.

Here is the full report regarding this North Carolina Nursing Home.

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Falls in trauma top the list of preventable medical conditions in hospitals, accounting for 193,566 incidents in 2007.  Falls in hospitals (and similarly in nursing homes) are deemed to be preventable by Medicare because with proper fall/risk assessments and staff assistance most falls in hospital could be avoided.  A number of factors should be addressed by a hospital to determine if a person is at risk for falls:

• Medication that may effect balance or coordination
• Does the person normally use an assistive device like a walker or cane?  If so, one should be provided by the facility at all times.
• Age.  Older residents have a far greater risk of falling than their younger counterparts
• Is the person able to use the bathroom themselves?  If not, regular assistance should be provided by the staff.

In a recent study by researchers at Washington University in St. Louis, patients were injured in 42% of falls occurring in the hospital.  Hospital patients were seriously injured in 8% of the falls with head trauma or fractures.  The study also determined that the people most likely to sustain a serious fall-related injury were those on their way to or in the bathroom.  

In addition to determining patients who are at high risk for falling, hospitals should take precautions to minimize the likelihood of falls due to sloppiness or inadequate staffing.  In order to assure resident falls are minimized hospitals should make sure the following in done:

• Remove clutter from floor.  
• Remove improperly fitting slippers and other clothing.
• Keep bed rails up when patients are sleeping.
• Provide adequate staff and equipment when transferring into and out of bed.
• Install handrails in areas where patients need stability.
• Keep call lights within reach of residents in bed at all times.  Residents can request assistance easily.
• Lock wheels on wheelchairs and beds when transferring patients.

If a fall occurred during a hospitalization, do not assume that the fall resulted from an unforeseeable condition.  There is a good likelihood that the hospital should of identified the patients likelihood of falling and taken precautions. 

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Bad nursing homes generally have a pattern of poor care.  There will always be isolated incidents at even the most well staffed facilities.  However, when repeated incidents occur within a brief period of time there are usually deeper problem with the facility. 

Case in point, two recent lawsuits were filed against the Devon Gables Health Care Center.  The first lawsuit involves, Elfriedel Sitzman, a female resident who was not give adequate care following a stroke.  The lawsuit claims that Sitzman fell and broke her arm in a fall during her stay at the facility from November through December, 2007.

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