IDPH has cited and fined Red Bud Regional Care nursing home after a resident there suffered a broken hip and leg in a fall occurring when she was left alone in the bathroom.
Nursing home falls have serious implications for the long-term well-being of residents. Many nursing home residents suffer from osteoporosis or brittle bone disease, which leaves them at risk for suffering hip fractures in falls. Others are taking blood thinner medications which leave them at risk for suffering brain bleeds after a fall.
For this reason, fall prevention is a specific area of focus in the care planning process. The process begins with an assessment to determine whether a resident is a fall risk. Nursing homes use various standardized tools to help make this determination, but there are two common areas in all of these tools which are specific factors. One is whether there is any balance or musculoskeletal dysfunction which can lead to a fall. The other is whether there is some form of cognitive issue such as dementia, confusion, or poor safety awareness. If any of those cognitive factors are present, the resident cannot be counted on to follow instructions or make good decisions for their own safety which increases the risk of a fall. Wtionhen a resident is a fall risk, then a fall prevention care plan must be put into place.
The resident at issue had been admitted for rehabilitation and had a history of falls and a diagnosis of dementia. The Minimum Data Set (MDS) specific that she was an assist of two staff with transfers and walking and that she suffered from severe cognitive impairments. She required stand-by assistance while washing her face and hands or brushing her teeth or hair.
On the day of this nursing home fall, the resident was at the sink brushing her teeth and washing her face in the morning. The aide assigned to help her told her to wait at the sink while the aide brought her roommate down to the dining room. Shortly after the aide left the room, she heard a sound coming from the resident’s room and found that the resident was on the floor, having stepped away from the sink to get clothes to start getting dressed.
The resident was brought to the hospital where x-rays showed that the resident had suffered a fractured hip and femur (thigh bone), all of which required surgical repair. The resident returned to the nursing home but was unwilling to participate in physical therapy even with family encouragement, whereas before this fall, she had been participating in therapy and making good progress. Now, she is wheelchair-bound. Loss of the ability to walk, even minimally sets the stage for a number of other health issues to develop such as bed sores, worsening osteoporosis, pneumonia, blood clots, and other ills.
This was a predictable and very preventable fall. Nursing home staff should know better than to rely on residents with severe cognitive impairments to make good decisions about their own safety, and where supervision is needed, it should be provided, as required by federal regulations. All that had to be done in this case was to finish attending to the resident and making sure that she was in a safe position before bringing the roommate down to the dining room.
The fact that the aide elected to cut this corner is part of the dynamics of what happens in an understaffed nursing home. Sadly, not having enough help is a feature of the nursing home business model. 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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