Niles Nursing & Rehabilitation Center was cited and fined by IDPH after a resident wandered from the facility. He fell while he was gone sustaining multiple facial fractures.
The resident was 90 years old and suffered from dementia. He had multiple orthopaedic issues but walked well. The incident happened on the first day that the resident was admitted to the nursing home. After the admission assessments were completed, the resident was seen wandering on the first floor, going out onto the patio. There was a security door which was connected to an alarm which sounded at the reception desk.
While the receptionist was seated at her desk speaking with a CNA who was checkinghis schedule, alarm went off at the reception desk. The receptionist turned off the alarm. After not being able to see the resident for a few minutes, she asked the CNA to go outside and look for him. When the CNA returned saying that he could not find the resident, the receptionist called a Code Purple (resident missing) instead of a Code Green(resident out of the building). Because of the choice she made, staff did not start looking outside the building for 30-40 minutes after.
The staff never found the resident. Instead the received a call from the hospital, saying that he was in the emergency roon there. He had fallen while out of the facility and suffered multiple facial fractures.
The technical term for a resident wandering from a nursing home unattended like this is elopement. It is a major risk to the well-being of the resident, as they can have falls, as happened here, or have any number of other mishaps such as suffering injury/illness due to adverse weather conditions, can be hit by a car, made the victim of a criminal assault, among other things.
One of the basic assessments that is completed when a resident is admitted to a nursing home is an elopement assessment. This measures the resident’s risk of leaving the facility. In this case, the resident spoke primarily Korean which could have been a barrier to doing a good assessment. One simple measure that can be taken and probably should have been taken in this situation is to apply a wangerguard. This is a device which is applied to the resident and when the resident leaves an area (a wing, the building, etc.), an alarm sounds. Since the resident suffered from dementia and was able to walk well, this would have been a reasonable step especially since the resident was new to the facility and likely to be disoriented.
Past that, there were systems in place to address the risk of this resident wandering and being out of the facility on his own. The facility had an alarm which had the ability to heard throughout the facility, but was set to sound only at the receptionist’s desk. Once the alarm sounded there, it was up to the receptionist to call the appropriate code to get a search underway for the resident before he wandered too far from the facility. This was not done either, as the code that was called only started a search within the building and not in the community where the greater danger was.
Multiple failures, all leading to serious injury for the resident. 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 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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