We secured a wrongful death settlement on behalf of the estate of a nursing home resident who was admitted to the shelter care unit of a nursing home and had a fall 3 days after admission which caused her to suffer a fractured hip, a post-operative stroke, and death.
The client had been living in an apartment at the home of her son with the help of a 24-hour caregiver. The caregiver was needed because she suffered from mild dementia, was unable to walk safely on her own, and was legally blind. As the family’s funds ran low for paying the caregiver they decided to admit the client to a nursing home so that she could continue to get the care she needed. The facility the family selected was approximately 50 miles from the son’s home and was chosen in part because of its religious affiliation and because it was near her daughter’s home so the daughter,a retiree, could visit frequently.
The client was admitted into the shelter care unit of the defendant nursing home. A shelter care unit is a lower level of care than skilled or intermediate care and requires a high level of independence on the part of the resident because many of the traditional services provided in intermediate or skilled care units are not available in a shelter care unit. Shelter care units are not subject to federal regulations that govern the care provided in skilled and intermediate care units.
There are many differences in the care provided in shelter care units versus skilled or intermediate care units. One is in the staffing level – they are much lower and in this facility, there was no nurse and only 2 CNA’s to cover 48 residents on 2 floors of the shelter care unit during the overnight hours. There are also no fall risk assessments and no fall prevention care plans done and bed alarms are not used. Living in the shelter care unit of this facility required a much higher level of independence than had been exhibited by the client in years.
The family contacted the nursing home expressing interest in having the client admitted to the skilled care unit. At some point, the admission was converted to the shelter care unit. However, the family was unaware of how that occurred and of the implications of the differences in care between the skilled care and shelter care unit. The admission documentation contained a handwritten note “Shelter care???” No one was willing to admit to writing that note or of being able to identify the handwriting. The client was admitted to the shelter care unit without anyone having actually done an in-person assessment of the client until she actually arrived in the nursing home.
The family caregiver accompanied the family for the admission to the nursing home and spoke with the admitting nurse and provided the information that was requested of her. However, she was not asked questions which would have revealed that the client was up frequently in the middle of the night due to the use of a diuretic (water pill) that she took for cardiac issues and that she was frequently disoriented when she woke up in the middle of the night.
During the three days she was in the nursing home before she fell, the family saw her being left alone in a way that had not happened when she was living at home and expressed concern to the nursing staff that this was not safe. The staff assured them that she was acclimating to the nursing home, but no one explained to the family that there would be no fall prevention care plan put into place because she was admitted to the shelter care unit.
On the third night she was in the nursing home, she awoke to use the bathroom. On the the return trip to bed, she fell and suffered a fractured shoulder and a fractured hip. The fact that she was returning from the bathroom was significant because had she been in the skilled care unit, a fall risk assessment would have been done which showed her to be a fall risk and a fall prevention care plan would have been put into place which would have included the use of a bed alarm. Had that been done, the alarm would have been sounding the entire time from when she got out of bed, walked to the bathroom, went to the bathroom, got up, and then started walking back from the bathroom – more than enough time for the staff to respond to help her.
She was taken to the hospital where she underwent surgery to repair the fractured hip. She was a high-risk surgical candidate because she suffered from atrial fibrillation which increased the risk that she would develop blood clots. Blood clots frequently occur after major surgeries such as hip replacement operations.
The surgery itself was successful; however, she suffered a major thromboembolic stroke following the surgery. A thromboembolic stroke is one caused by blood clots and she could not be given anticoagulant drugs which would have helped prevent that because of the risk of post-operative bleeding. After the stroke, she was not able to swallow, and the family made the decision to place her on hospice where she died five days after the stroke.
The theories of liability we pursued were that the nursing home improperly admitted the client to the shelter care unit of the nursing home when admission to the skilled care unit was required and that the nursing home failed to properly inform the family of the implications in terms of the kind and quality of care the client would receive in the skilled care unit versus the shelter care unit.
Following the filing of this suit, the nursing home put into place a standardized process for screening residents for suitability for admission into the shelter care unit. Hopefully, this will result in fewer improper admissions to the shelter care unit and that more families will get the kind of care their loved ones actually need.
The case was settled for $250,000. (Winnebago County).
