IDPH has cited and fined Symphony at Midway Nursing Home in Chicago after a resident there suffered multiple injuries in a fall.
Care planning is the basic process by which the care needs of nursing home residents are met. It is a multi-step process which starts with an assessment which identifies the risks to the health and well-being of the resident. From the there, steps or interventions are put into place and assigned to various staff members to carry out on a day-to-day, shift-to-shift basis. The interventions then must be communicated to the staff who then must implement the care plan. Finally, it must be evaluated and revised if it proves inadequate in practice or if there are further declines in the resident’s condition.
It all starts with the assessment – if you have a bad assessment that understates the risks to the resident, you end up with a care plan that doesn’t meet the needs of the resident. That is what happened in this case.
Nurisng home falls present a serious risk to the health and well-being of residents. Even if a resident doesn’t sustain a major injury like a hip fracture in a nursing home fall, that is a matter of luck, not skill. Past that one nursing home fall tends to be a predictor of additional falls to come. Therefore, fall risk is a standard part of every nursing home assessment. There are few standardized, tested scales used to predict fall risk in the long-term care setting the way that the Braden Scale is used to assess the risk of developing bed sores.
In our view, there are two major factors which contribute to fall risk. The first of these is some type of muskuloskeletal issue which affects strength and/or balance to the point that the resident is unable to sit, stand, or walk safely. The other major risk facor is behavioral, meaning either poor safety judgment, impulsivity, constant or intermittenty confusion, and/or dementia which makes it more likely that the resident will so things that are not safe for them to do or fail to wait for or obtain help from the staff. To be sure, there are other factors such as incontinence or medication usage which can contribute to fall risk, but muskuloskeletal issues and behavioral issues are the major ones.
Care planning must be redone periodically. Federal regulations require that it be done every quarter, but should also be done where there are declines in the resident’s condition.
The resident at issue suffered from impairments in strength and range of motion and also suffered from dementia and had documented impulsive behaviors. In short, this is a resident who was a classic fall risk. The last time that this resident was assessed for fall risk was in June, 2017 and was at that time assessed as being at low risk for falls. No interventions were put in place. Between then and when the resident had the fall at issue in the citation on February 2, 2019 (yes, more than a year and a half later), there were no other documented fall risk assessments. Needless to say, there should have been several done in the interim.
On the day of the resident’s injury, an aide was called to the resident’s room and found the resident on the floor bleeding from the head apparently having fallen from bed. The aide reported that the resident would frequently move from side to side, but there were no interventions in place to keep the resident from falling from bed. The resident was brought to the hospital where testing showed that he had brain bleeds on both sides of the brain as well as a possible fractured hip.
This is exactly the kind of thing that happens when care planning is not done as needed. This resident was clearly at risk for falls, yet nothing was done in a regular systematic, way to prevent the kind of accidental injuries that result from falls. This was a complete failure on the part of the nursing home.
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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