IDPH has cited and fined Country Health nursing home in Gifford after a resident there suffered a fractured kneecap in a fall.
Falls are a serious issue in the long-term care industry. When nursing home residents fall, they tend to suffer catastrophic injuries such as fractured hips and brain bleeds at a rate far greater than may be experienced in the community at large. Even when they don’t sustain those kind of catastrophic injuries, falls tend to beget more falls and even less serious injuries often have significant negative long-term consequences for the health, well-being, and quality of life for a resident who has experienced a fall.
With this is mind, falls are a significant point of focus in the care planning process, which begins with a fall risk assessment. Every nursing home will have a multifactorial fall risk assessment tool, but the two most crucial factors are having some form of balance or musculoskeletal dysfunction (which leaves you at risk of losing your balance) combined with some degree of constant or intermittent confusion, dementia, or poor safety judgment (which leaves you at risk for making poor decisions regarding your own abilities and/or obtaining help with walking or transfers). When a resident is a fall risk, then a fall prevention care plan must be developed which addresses the resident’s particular fall risk factors. The care plan must then be carried out day-to-day, shift-to-shift. Federal regulations require that nursing home residents be provided with supervision and assistive devices necessary to prevent accidents.
This background brings us to the citation issued here. This was a resident who had been properly assessed as being a fall risk for a number of factors, but including dementia. She had a well-known history of being impulsive regarding waiting for help and required a quick response per her care plan. On the night of the fall, a nurse discovered her sitting on the edge of her low bed, expressing a desire to go upstairs (notwithstanding the fact that the facility had only one floor). Rather than help her up to walk, or placing her back to bed or in her wheelchair, the nurse told the resident to wait and she would get an aide.
The aide was at that moment warming up his dinner, but left to go help the resident. As he walked into the room, she stood up on her own, lost her balance and fell to her knees and hitting her head on the side table. She was brought to the emergency room where she received four stitches to close the wound to her head and was diagnosed with a fractured kneecap. The kneecap was treated by being placed in am immobilizer. This is something that will likely have serious adverse effects on her overall level of mobility in the future.
The basic problem with the course chosen by the nurse is that she relied upon a resident with dementia to follow instructions, especially in light of the fact that the resident expressed a desire to get up and expressed a desire to go upstairs when there was no upstairs – evidence of significant confusion. In light of this the proper options would have included sounding a call light to get help, helping the resident herself, or putting the resident back to bed or in a wheelchair while the aide was returning. Instead, she left a resident who was ready to get up and walk unsupervised in a position where she was ready to do so. This is exactly the kind of fall that demonstrates why residents who are unable to make solid judgments regarding their own safety should not be left in a position where their safety depends on them following instructions.
One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result. Order our FREE report, Built to Fail, to learn more about why. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.
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