IDPH has cited and fined Sauk Valley Senior Living in Rock Falls after a resident there fell and suffered third-degree burns after landing against a heater.
The resident at issue lived in a room which did not get heated adequately by the boiler for the building, so the facility bought a series of electric baseboard heating units to make up for it. The temperature setting on the heating units could be adjusted, but were supposed to be set for comfort, although anyone could adjust the heating levels and there was no policy in place regarding the use of the heating units.
The resident at issue lived in one of the rooms where the heating unit was in place, and his bed was placed about a foot away from the heating unit. He woke up in the middle of the night to go to the bathroom, slipped and fell, and landed with his back against the heating unit. He was discovered a short time later by staff who saw that the skin was blistered. He was sent to the emergency room where he was diagnosed as suffering from third-degree burns. When the state surveyor came in to inspect the facility, the surface of the heating unit was measured at 145 degrees.
There are two basic federal regulations which cover accidents in nursing homes including nursing home falls. One is 42 CFR Part 483.25(d)(1) which requires that the facility be as free of accident hazards as possible and 42 CFR part 483.25(d)(2) which provides in essence that resident receives supervision and assistive devices necessary to prevent accidents.
The issue of whether the nursing home was at fault for the fall to begin with was not a focus of this citation, although as a nursing home lawyer, that would certainly be a part of my investigation. The more pertinent issue was the use of the electric heating unit and the temperature it was set to as well as the placement of the bed so close to the heating unit. 145 degrees is hot for anyone; however, our skin thins as we age (which is part of why bed sores are such a major issue in nursing homes) which made the use of that heater in that manner something that was particularly hazardous.
Obviously, the real solution to the problem of cold rooms would have been to make the repairs required to the boiler so that all of the rooms would be adequately heated without the use of the baseboard heaters. However, that would have been the more expensive solution, and as might be expected in the long-term care industry the cheaper solution was adopted.
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