IDPH has cited and fined Taylorville Skilled nursing home after a resident there suffered a fracture hip in a fall afteer experiencing three earlier falls.
One of the truisms in the long-term care industry is that falls tend to beget additional falls. Falls are a serious issue in the nursing home industry in part because they happen with such frequency in a geriatric patient population and have such serious potential for serious injury, resulting in major declines in function and quality of life.
Because nursing home falls are such a serious issue, they are a specific area of focus in the care planning process. The care planning process is a multi-step, multi-disciplinary process by which a series of steps (or interventions) are assigned to various categories of staff in the nursing home.
The last two steps are really the most critical: evaluation and revision of the care plan. This requires the staff, on an ongoing to basis to evaluate the care plan to determine whether the care plan is meeting the needs of the resident. If the care plan proves to be inadequate in practice or there are changes in the resident’s condition or needs, then the care plan must be revised to meet the needs of the resident. When it comes to the topic of nursing home falls, the fact that a fall has occurred is almost always a sign that the fall prevention care plan needs to be revised because it was either inadequate to begin with or because the resident’s fall history is a predictor of additional falls.
This resident suffered three falls before a fourth resulted in a fractured hip.
Before the first fall, she was very clearly a fall risk. She required stand-by assist for ambulation, had poor safety awareness, refused help, and was non-compliant with the call light. Following the fall, 30-minute checks were added as a fall prevention measure. When the second fall happened, she was found on the floor in her room with hematoma on the back of her head. She was sent to the emergency room where she was diagnosed as also having suffered a fractured rib. The care plan was updated to include the 30 minute checks due to noncompliance with the call light. At the time of the third fall, the resident was found on the floor of her room, incontinent of stool. The care plan was updated to include frequent checks and offering toileting every 2 hours.
When the fourth fall occurred, the resident was once again found on the floor of her room, bleeding from a head laceration and with an obvious leg deformity. She was sent to the hospital where a fractured hip was diagnosed. The hip fracture required surgical repair. However, even with successful surgical repair, fractured hips often have serious consequences to the resident’s quality of life.
The nursing home did attempt to revise the care plan, but did so in ways that did not meet the care needs of this resident. Residents who demonstrate consistent non-compliance with the use of a call light need to be kept in common areas where they can be kept under continuous direct observation by the staff. Many nursing homes have gone away from the use of a bed or chair alarm as a matter of policy, but residents such as this are reasonable candidates for use of one even as their use is discouraged in federal regulations.
Offering assistance with toileting is also a reasonable step, but use of a toileting schedule is actually a more effective tactic to address the risk of a resident falling while on their way to the bathroom. However, developing a toileting schedule requires an investment of resources to develop – an investment of staff time that understaffed nursing homes cannot make. Sadly, understaffing is an inherent part of the nursing home business model. 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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