There is a framework from providing the vast majority of routine care in a nursing home setting. This referred to as the care planning process. When it is done properly, the risk of residents suffering unnecessary injuries and wrongful deaths is greatly reduced. However, we often find that there are serious deficiencies in the care-planning process which sets the stage for disaster. In fact, for the vast majority of nursing home cases, the care planning process serves as a framework for investigating and prosecuting a wide variety of nursing home abuse and neglect cases such as those involving bed sores, nursing home falls, or choking accidents.
There are six basic steps to the care planning process, and breakdowns in any one of these areas can result in serious injuries or death for nursing home residents. Identifying which of these areas had breakdowns is the focus of our investigation.
Step #1: Assessment – this is a structured way of analyzing what the risks to the health and well-being of the resident are. This is done initially when the resident is admitted to the nursing home and the again each quarter or when there is a significant change in condition. The assessment is supposed to be standardized and reproducible meaning that any nurse who performed the assessment would get the same results. To that end, standardized tools such as the Braden Scale (which measures the risk of developing bed sores) are used.
Step #2: Care Planning – A care plan is a written document which recognizes the risks to the health and well-being of the resident, sets goals for the health of the resident, and assigns interventions or steps to be taken by the various health care disciplines (such as nursing or dietary) who are to carry out each step.
Step #3: Communication – Once the care plan has been developed, it must be communicated to the member of the nursing home staff charged with carrying it out. This should be a simple enough process, but in practice, we find that nurses and other staff members have a hard time explaining how that occurs which leaves the issue in doubt as to whether the contents of the care plan are ever communicated to the people charged with doing the work.
Step #4: Implementation – The care plan must be carried out day-to-day, shift-to-shift. It is not a “one and done” kind of thing. When we have cases where the issue is the failure to carry out the care plan, the focus is a simple one: one the days you carried it out, nothing bad happened and on the days that you didn’t, there were bad outcomes.
Step #5: Evaluation – As the care plan is being carried out, it must be evaluated on an ongoing basis to determine whether or not it is effective. A care plan may prove to be ineffective due to decline or other changes in the resident’s condition or it mat so happen that the care plan as developed may prove in practice to be ineffective. When these things happen, that takes us to
Step #6: Revision – When the care plan is not effective in practice or the resident has declines or other changes in condition, then the care plan must be changed to meet the needs of the resident. In practice we often find that the nursing staff is too busy to seriously consider the effectiveness of a care plan or the changing needs of the resident, and as a result, care plans which are not working or not meeting the needs of the resident are left in place.
The care planning process covers the vast majority of the care which is provided to residents of nursing homes. It also is where the failures of the nursing home are most easily seen.
These are some of the cases my firm has handled where the care planning process was involved in the injuries suffered by my clients:
Failure to care plan for resident known as fall risk
Care plan violation leads to fall and broken hip
Failure to care plan for choking risk result in death
Inadequate fall prevention care plan leads to hip fracture
Failure to follow fall prevention care plan leads to fall and hip fracture
Failure to revise care plan leads to fall and broken hip
No care planning done for known choking risk
Here are some recent blog posts where breakdowns in the care planning process are shown:
