IDPH has cited and fined the Good Samaritan Home in Quincy after a resident there experienced ten (!) falls in less than 2 weeks, the last resuting in a brain bleed which led to the resident being placed on hospice care.
One of the truisms regarding nursing home falls is that the occurrence of one fall tends to forecast the occurrence of additional falls. There are a number of reasons that this is true: the resident loses confidence in their ability to stand or walk; the resident has some injury which makes weight bearing more challenging; or it is a demonstration that the resident is unable to control their actions or make good judgments for their own safety. This is why the occurrence of a fall is a serious event that requires notification of the physician and revision of the resident care plan.
The resident at issue was admitted to the nursing home on February 5. She was assessed as being at high risk for falls due to advanced dementia, incontinence, unsteady balance, and needing the assistance of staff for transfers. During the period between February 7 and February 17, the resident experienced 9 falls. Following the ninth fall, she the care plan was revised to include 1-to-1 supervision.
The last fall happened on February 20. It occurred at 6:00 a.m. and was described as an unwitnessed fall occurring after the resident got up from a recliner at the nurse’s station. The reisdent had a golf-ball sized lump and a laceration on her head and was unable to form sentences that made sense. Her pupils were uneven, so she was sent to the hospital. A CT scan was done there which showed the presence of a brain bleed. She was lethargic and unarousable and was placed on hospice.
Federal regulations require that residents receive supervision and assistive devices necessary to prevent accidents, and a fall is one of the types of accidents covered by the regulations. This resident was properly assessed as a high fall risk and experienced multiple falls, all of which made the occurrence of an additional fall predictable. To address that risk, the care plan called for 1-to-1 supervision.
A care plan is more than just a piece of paper that is in a nursing home resident’s chart – it is a guide to the care that must be delivered to keep a resident safe. If the fall was unwitnessed, that tells us that the 1-to-1 care that was supposed to be provided was in fact not being provided. Leaving a resident at risk for falls near the nurse’s station is a common fall prevention measure, but that is not the same as 1-to-1 supervision. Violation of a care plan is a basis for a nursing home abuse and neglect lawsuit, and in this case if the injuries from the fall were a contributing cause to the death of this resident, that would be a basis for a nursing home wrongful death lawsuit.
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.
Other blog posts of interest:
Non-functional alarm leads to fall and fractured hip at Sunset Home in Quincy
Heritage – Mt. Sterling resident breaks leg in fall
Pittsfield Manor resident suffers fatal fall
Care plan violation at Central Nursing Home
Fall from toilet at Leroy Manor
Brain bleed from fall at Pontiac Healthcare
Click here to file a complaint about a nursing home with the Illinois Department of Public Health.
