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

Given the frequency (approximately 80+% of all nursing nursing home patients will experience a fall this coming year) with which nursing home falls occur, facilities must be on the lookout when it comes to implementing fall prevention techniques in order to improve patient safety.  Too often, the prevention comes too late-- if at all.

Here are our most popular fall-related entries over the past year:

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

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....

Never Event #1: Hospital Falls & Trauma

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:...

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

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....

What Is Hypostatic Blood Pressure & Why Is There An Associated 'Fall Risk'?

Hypotension (low blood pressure) is a problem for many nursing home residents, causing dizziness and fainting. Blood pressure readings measure the pressure in arteries - systolic pressure (the top number in a reading) measures the pressure the heart generates when pumping blood out to the rest of the body and diastolic pressure (the bottom number in a reading) measures the amount of pressure between heartbeats. A systolic blood pressure of 90 millimeters of mercury or less or a diastolic blood pressure of 60 millimeters of mercury or less is considered low....

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

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:...

Even Common Falls Put Elderly At Risk For Developing Subdural Hematomas

Frequently undiagnosed and under-appreciated, falls amongst the elderly can frequently result in brain bleeds or technically termed 'subdural hamatoas'. Because elderly are predisposed to developing subdural hamatomas, staff in nursing homes and hospitals need to be tuned into the symptoms and when to seek additional medical care....

Bone Fractures In The Elderly Require Special Attention To Improve Recovery & Prevent Complications

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....

Blood Thinning Medications, Such As Coumadin, Pose Substantial Danger To Nursing Home Patients Involved In Falls

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....

If your loved one suffered an injury related to a fall at a hospital or nursing home, the facility may be responsible for their injuries.  You can always call our office to discuss the potential matter, free of charge.  Toll-free across the country (888) 424-5757

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The News & Observer, had an article about the difficulty proving physical abuse in disabled nursing home residents who are unable to communicate any information about the act. The article focuses on an 88-year-old disabled woman who sustained bruises to her face(consistent with abuse) while a resident at Sunnybrook Healthcare and Rehabilitation in Raleigh, N.C. The woman suffered from advanced dementia and was unable to walk or roll over-- therefore bruising due to a fall could immediately be ruled out.  Read the full article about the abuse of disabled nursing home residents here.

Elder abuse in North Carolina

Complaints of elder abuse in North Carolina increased 20% between 2007 and 2008.  According to Sharon Wilder, a state ombudsman for long-term care, reports of abuse, neglect and exploitation will continue to increase both as a function of the rise in the numbers of the elderly population and as a result of caregivers demand to get answers following an incident.

"We now have baby boomers emerging as the sandwich generation and as caregivers for their elders," Wilder added.  "Their nature is to ask more questions and to want more answers.  There are more willing to contact whoever they need to get answers." 

According to North Carolina nursing home surveys, just 15% of the reports of elder abuse occurred in a long-term care setting, with the remainder of alleged abuse occurring in private homes and reported by relatives, neighbors or health care professionals.

Abuse of the elderly in long-term care settings

Despite a seemingly endless supply of news headlines, directing attention to this despicable act, most cases of elder abuse go unreported.  Remember, you know your loved one better than anyone else.  If you suspect mistreatment or abuse, immediately report the situation to local police and/or ombudsmen.  A timely investigation can go a long way towards identifying the individuals responsible for the abuse and hold them accountable.

The following conditions warrant investigation:

• Unexplained bruises, cuts, burns, sprains, or fractures
• Frozen joints
• Unexplained venereal disease or genital infections, vaginal or anal bleeding
• Bloody clothing
• Sudden changes in behavior
• Staff refusing to allow visitors to see resident or delays in allowing visitors to see resident
• Resident being kept in an over-medicated state
• Sudden loss of an appetite

Over the course of the the past 30 years, lawyers at Strellis & Field, have helped families coping with the fallout from elder abuse.  In many cases, we have successfully recovered damages from the facilities where the abuse occurred.  If you have a question related to abuse in a long-term care setting, we would honor the opportunity to speak with you.  (888) 424-5757

Web Resources:

The National Center On Elder Abuse

World Elder Abuse Awareness Day

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Winchester House, a Lake County, Illinois nursing home, has chosen to settle a pending nursing home negligence lawsuit involving a resident who fell multiple times in the facility and ultimately died.  Under the terms reached during mediation, the family of Helen Menneke will receive $1 million for the loss of their 83-year-old relative.

Helen Menneke was admitted to Winchester House in 2004 for treatment and care of dementia. Ms. Menneke fell several times over the course of her admission, suffering a traumatic brain injury and fractured bones.  

Although nurses implemented an alarm system for Ms. Menneke's bed and wheelchair, they were unsuccessful in preventing additional falls.  The nursing home has reportedly made changes in the manner nursing home employees check on nursing home residents following this lawsuit.

How many falls must occur before a nursing home can be held responsible for a resident's fall-related injuries?  The answer is dependent upon the needs of the resident.  If the individual required full assistance for transfers and care needs, the nursing home owes a duty to provide staffing assistance at all times.  If however, the resident is more independent the duty of a facility becomes somewhat clouded.

Regardless of the resident's fall-risk potential, the nursing home must take notice after a resident falls.  After the nursing home has notice of a resident fall, the facility must re-evaluate their preventative measures to prevent additional falls from occurring.  The use a restraints, alarms and most importantly staff supervision are key to assuring nursing home residents remain safe.  If your loved one has sustained a injury from a fall, do not assume the fall was not preventable.  An experienced nursing home attorney will be able to evaluate the matter and determine if the nursing home may be responsible for the injury.

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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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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.

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