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Fall 2006 - Nursing Home Litigation Newsletter:
Nursing Home Falls
Approximately half of all nursing home residents fall each year, which is 2 to 3 times that of community-dwelling seniors. Residents with Alzheimer's or other dementia fall at twice the rate of older persons without dementia.
Some attorneys evaluate these matters as traditional slip-and-fall cases, rather than as falls resulting from substandard care.
Case Evaluation
The first step in evaluating a nursing home fall case is to review the resident's chart, which should detail the care that was provided. It is advisable to obtain the chart for the resident's entire stay, not just for the days or weeks preceding the fall. Incident reports can sometimes be obtained without filing a lawsuit.
The Rhode Island Department of Health conducts annual inspections of nursing homes and keeps past surveys. A review of these surveys may show a pattern of violations and failure to address them.
Filing Suit
Negligence can be based on a nursing home's failure to properly assess a resident and implement a care plan to prevent foreseeable falls; failure to order proper safety precautions or devices; and failure to staff the facility adequately.
A breach of contract theory can be pled and is based on the nursing home's breach of it’s’ agreement to provide safe and reasonable care in accordance with state and federal nursing home regulations.
Filing Suit
Negligence can be based on a nursing home's failure to properly assess a resident and implement a care plan to prevent foreseeable falls; failure to order proper safety precautions or devices; and failure to staff the facility adequately.
Discovery
Discovery can be extensive because nursing homes are required by state and federal regulation to generate and maintain a variety of records. One of the most important documents is the care plan. The care plan is based on assessments made when residents enter the nursing home, and must be updated periodically or when there are changes in a resident's condition. When assessments identify residents who are at risk for falling, the care plan must include interventions to prevent falls.
Falls going to the Toilet
Residents’ falls are usually foreseeable. Many falls occur when residents try to make it to the bathroom alone. A proper care plan might provide for a plan to toilet in advance of need.
Falls getting out of Bed
Falls occur frequently when residents try to get out of bed without assistance. Lowering a resident's bed can prevent a damaging fall that might occur from the height of a traditional nursing home bed. A pad placed beside the bed at night can help to prevent serious injury if a resident falls when getting out of bed alone. Bed alarms that sound when a resident attempts to get up can also be an effective intervention.
Multiple Falls
Multiple falls may be a sign of neglect. The standard of care requires nursing homes to determine the circumstances of each resident fall, re-evaluated whether the fall precautions being used are effective and update the care plan with proper fall precautions following every fall.
Experts
Nursing home experts should be retained to analyze the resident's chart and compare it with the care plan to see if proper precautions were ordered. Experts can establish whether fall assessments were done properly to identify residents who were at risk for falls, determine if the care plan was reviewed and revised to reflect changes in residents' condition, and/or advise whether interventions were working successfully or should have been changed.
Conclusion
Nursing home fall cases can be complex, expensive, and challenging. By focusing on the foreseeability of falls, the inadequacy of care plans, and the failure to implement proper fall precautions, attorneys will be able to successfully prosecute these cases.
RECENT RHODE ISLAND SETTLEMENT
Confidential Settlement, East Providence, RI
Wrongful Death of 73-Year-Old Husband
Cause of Death: Subdural Hematoma due to Blunt Force Trauma from Fall.
Seventy-Three (73) year old husband was admitted to nursing home with known propensity for falling. Fell several times in the nursing home.
Nursing Home inadequately assessed resident upon admission for fall risk; failed to assess the effectiveness of fall precautions after each fall and failed to implement proper fall precautions.
Resident struck his head as a result of un-witnessed fall and died from head injuries.
NEWS
Jeffrey Padwa is the President of the Rhode Island Trial Lawyers Association and a member of ATLA's Nursing Home Litigation Group.
Padwa testified on numerous occasions in 2006 before the RI Department of Health regarding proposed Nursing Home regulations.
Legislation was passed in 2006 requiring facilities housing the elderly in Rhode Island to be notified of new residents with criminal backgrounds so that adequate precautions can be implemented to protect other residents.
COMMON NURSING HOME INJURIES
Falls and Fractures - Falls result in fractures, head injuries and may cause death.
Decubitus Ulcers - Pressure sores are preventable and should not occur.
Severe Dehydration and Malnutrition - Many elderly require assistance with eating or drinking.
Medication Errors - Medication errors result in adverse effects.
Restraint Injuries - Elderly can strangulate on restrains.
Elopement – Unsupervised residents can wander away and suffer injuries or death.
Physical Abuse and Assault – Background checks are required to be conducted on employees.