IDPH has cited and fined Manorcare of Palos Heights East nursing home after a resident there suffered a fractured hip in a fall.
Care planning is intended to be more than an exercise in paperwork. It is supposed to be a framework for the actual delivery of care, and in order for the care planning process to be effective, it must have meaning and must be communicated to the team which is delivering care to the resident.
The care planning process begins with an assessment which is intended to root out what the threats to the health and well-being of the resident are. Falls are a major threat to the life and quality of life of nursing home residents, so this is an area which is specifically addressed during the care planning process. If a resident is identified as a fall risk, a series of steps must be laid out which should be carried out on a day-to-day, shift-to-shift basis, and then must be revised if the care plan proves to be inadequate in practice or if there are further declines in the condition of the resident.
There are a number of factors which can place a resident as being at risk for falls. The two major factors are having some degree of musculoskeletal dysfunction and intermittent or constant confusion. The musculoskeletal issues obviously increase the risk of falls, but the intermittent or constant confusion means that the resident cannot be relied upon to make good decisions for their own safety or call for help as needed. Falls tend to beget additional falls, so a history of falls can also contribute to a resident’s fall risk.
The resident at issue was a fall risk. She actually had a fall while using the bathroom two days before the fall at issue, but should have been considered a fall risk regardless as her Minimum Data Set (MDS) showed moderate cognitive impairments and need for two-person extensive physical assistance. The nursing staff further told the state surveyor that the resident felt like she could do more on her own than she really could – a sign of poor safety judgment.
In this facility, the residents who are considered fall risks are given a band to wear, but this resident did not have hers on at the time of her fall. As a matter of routine residents who are fall risks are kept congregated in the common room or at the nurse’s station for easier supervision. After the fall she had two days earlier, her care plan was updated to include the resident not being left alone in the bathroom.
On the night of this nursing home fall, an aide left a room across the fall and found the resident laying on her side, complaining of left hip pain. The resident had been trying to change into bed clothes on her own, lost her balance and fell. The resident was wheelchair-bound and was not able to propel herself, but no one was able to determine how the resident returned to her room.
The resident was brought to the hospital where x-rays showed that she had a fractured hip. Fractured hips have a significant mortality rate for senior citizens and often result in significant declines in the quality of life for residents who suffer one even when they do survive.
There were a number of breakdowns in the delivery of care to this resident. The resident was very clearly a fall risk given what was shown on her MDS and the recent fall. However, the band which was designed to alert staff to that fact was not on the resident – a missing communication tool. Past that the resident was brought to her room and left unattended to change into bed clothes, resulting in a lack of supervision for a resident who needed it badly. These simple steps, not taken, led to a significant injury for this resident.
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