IDPH has cited and fined Chateau Nursing & Rehabilitation Center nursing home in Willowbrook after a resident there suffered spinal fractures due to falling from her wheelchair after being pushed forward by the staff when there were no leg rests on her wheelchair.
Wheelchairs are a common sight in nursing homes, and as long as they are used properly, they are generally safe, helpful equipment for the care of nursing home residents who need that level of assistance. The key of course is that they are used properly, and proper use of a wheelchair requires that the leg rests to the wheelchair be applied when the wheelchair is being pushed by staff.
The reason that leg rests are required to be used when the resident is being pushed forward in the wheelchair is that without the leg rests in use, there is a chance that the resident’s feet will drop to the floor while the wheelchair is being pushed forward. When this happens, one of two things are likely to occur: (1) that the resident’s legs will get pulled underneath the chair, resulting in a twisting mechanism which can produce fractures or tears to ligaments and cartilage or (2) that the resident can be thrown forward out of the chair, resulting in the kinds of injuries you might see if a resident falls forward while walking – except that this fall will happen at a higher speed.
The resident at issue was wheelchair bound. She suffered from Parkinson’s which left one arm contracted against her body. However, she was able to self-propel in her wheelchair using her feet, meaning that she was able to move throughout the nursing home in her wheelchair by walking her feet forward. For many wheelchair-bound residents, this is an important part of maintaining some degree of independence.
This resident experienced not one, but two nursing home falls due to staff pushing her in her wheelchair with no leg rests applied. The first occurred two months before the fall at issue. In that fall, she was being pushed forward by staff with no leg rests on the wheelchair. She dropped her feet to the floor and was thrown forward out of the wheelchair. Fortunately, there were no injuries from this fall.
After the fall, there was a care planning meeting held with the family. The family agreed to obtain leg rests for the wheelchair and a bag for them to be kept on the back of the wheelchair. The resident’s care plan was updated to include using leg rests while pushing the resident in her wheelchair and the staff was given in-service training on the use of leg rests while pushing the resident in her wheelchair. The change in the care plan was noted on the care card which advises staff of the contents of the care plan.
On the day of the fall, the resident was being pushed forward into the dining room by an activity aide. There were no foot rests applied to the wheelchair even though they were in the bag that was hanging on the back of the chair. Even though she attended the in-service training, the aide explained to the state surveyor that she did not know that the leg rests needed to be applied according to the care plan and that she could not see the bag because the resident was seated on top of a mechanical lift sling and the bag with the leg rests was was hidden by the sling.
While the resident was being pushed into the dining room, the resident’s feet dropped to the floor and the resident was thrown forward out of the wheelchair, and hit her head on the floor. This is of course a near-replay of the fall two months earlier. It is also one of the truly predictable mechanisms of injury when a nursing home resident is pushed in a wheelchair that has not foot rests.
Sadly, in this fall the resident did not escape injury. She was brought to the hospital where it was determined that she suffered a fracture of the C1 vertebra, the bone at the top of the spinal column. She had a previous compression fracture of the T4 vertebra, located in the upper portion of the mid-back. It was decided that she was not a good surgical candidate, so she was placed in a hard cervical collar. Because she actively tried to remove it while in the hospital, restraints were used. Once she was discharged to the nursing home, she received supervision from a 1:1 sitter whose job was to keep her from removing the hard collar and causing further injury to herself.
The obvious and basic cause of this fall is the failure to place the foot rests on the wheelchair while pushing her forward. It resulted in a very predictable injury to the resident. Even though the staff and this aide specifically were in-serviced to use the foot rests, this should be a basic part of the training that staff receives in caring for every resident in the facility. This resident was not the only one put at risk from being pushed in a wheelchair with no footrests.
Past that, the aide explained to the state surveyor that the care card which indicated that foot rests were required was in the resident’s room, and as an activity aide, she did not go into resident rooms. However, part of the care planning process is communicating the contents of the care plan to the staff charged with carrying it out. The care plan is supposed to guide the actual provided, and if the staff delivering the care does not know what is required, the plan is nothing more than paperwork.
These breakdowns, especially the failure to train staff, are sadly common in the long-term care industry. 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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