IDPH has cited the McLean County Nursing Home in Normal, Illinois after one of its residents with a high “fall risk” suffered a hip fracture from falling in the home.
Staff Was Aware of High Fall Risk
On the evening of the fall, a nursing home aide had brought the resident to her bathroom at 5 p.m. The resident was then seen at 6:45 p.m., seated on her wheelchair by the foot of her bed. Then about an hour later, staff heard her calling for help. They found her on the floor with obvious signs of injury. They brought her to the hospital, where she had to undergo surgery for her broken hip.
Prior to this incident, there were obvious signs that the resident needed protection from falls.
Her quarterly assessments showed that her risk of falling went from “moderate” to “high.” She was also specifically assessed to be unsteady when standing from a seated position. These should have prompted revisions to her care plan, with proactive steps for the staff to reduce her fall risk. For instance, her unsteady motion when trying to stand up meant that she needed extensive assistance when using the toilet.
This is especially important because the resident had a known behavior of frequently getting up to go to the bathroom on her own. Staff members themselves were well aware of this. They described to the state surveyor that she would get up from her wheelchair and try to go to the bathroom unassisted.
Worse, they would find her walking down the hallway with her Depends around her ankles after she had used the bathroom on her own, unable to lift the sanitary garments back into place. An impediment around the ankles is dangerous for someone who has a high fall risk.
On top of all these, the resident was known to have dementia.
Nursing homes must take into account that residents with dementia might not be able to follow instructions well, recognize their physical limitations, or make good decisions for their safety. This should be factored into a resident’s care plan.
However, for this particular resident, the main intervention that was planned was to have the resident use the call light. This is an instruction that a person with dementia might not be able to follow. It was not likely to be an effective intervention for this resident who had dementia and a high fall risk.
Proactive Care Was Required but Not Undertaken
Considering her profile, the resident needed more proactive care around her. This could have included a toileting schedule that is developed from her observed bowel and bladder patterns.
This nursing home could have noted the usual times when she needed to use the toilet, then provided her with an aide to assist her during those times. Other measures could have included regular rounding and placing the resident in common areas instead of by herself.
Her painful fracture might not have occurred if she was given more appropriate attention and care at the nursing home.
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