South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

News Channel 36 in Concord, North Carolina had a tragic story of a resident  who fell to her death at a nursing home.  State inspectors have launched an investigation at the Concord nursing home.

The 87-year-old woman was found with a massive head injury on the ground beside an outside loading dock.   The article mentions that a fence near the loading dock is brand new, clearly installed after the patient at Concords Five Oaks Manor Nursing Home was found on the ground.  She'd fallen 4 feet to the ground, hit her head and died after being rushed to the emergency room.

The nursing home administrator did not report the woman's fall or death to the state.  A state spokesman says someone else reported it to them. Concord police told News Channel 36 the same thing.

Just last week Medicare ranked Five Oaks among the worst nursing homes in the country with just one out of five stars. Two state inspections from this year showed deficiencies. One cites accident and supervision problems, with one example where a patient "was on the floor" and staff had to be "disciplined."   Another said a patient was "outside the building."

 Channel 36 had a follow up to this story here.  In the follow up article, the family expressed concern that someone else could die there. The family says she had gotten out of the facility before.

Her daughter, Rosemary Ritchie, said she is worried about other patients at Five Oaks Manor. Doctors told her that her 87-year-old mother was brain dead because of a fall that the nursing home could have prevented.

She says her mom somehow got through a kitchen door that didn't have an alarm or lock on it. That door led out to the back of the facility and a loading dock. "I put her there trusting they would keep her safe and then this happened. It's not right," Ritchie said.

News Channel 36 tried repeatedly to get in touch with management at the nursing home and were told they would not comment.

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The May 4 death of a local nursing home patient has been ruled a homicide.  However, no criminal charges will be filed in the case.   Elsie Powell is suspected of pushing Edna Shaw to the floor at Encore Senior Village on University Parkway. Shaw hit her head on the floor.  Both were residents at a nursing home.   The Medical Examiners Office ruled that the blunt impact to Shaw’s head contributed to her death and ruled the death a homicide, the report said.

Powell’s condition has continued to deteriorate, Assistant State Attorney David Rimmer wrote in the report.   “It is doubtful that she was even mentally competent when the incident occurred,” Rimmer wrote. “Therefore, in my opinion, no criminal charge should be filed against her for the unfortunate death of Miss Edna Shaw.”
 

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Article about lawsuit over husband's fall at nursing home by David Yates, writer for The Southeast Texas Record. 

The nursing home staff found him in a pool of his own blood two years ago.  Clifford Ozen has suffered from seizures and decreased mobility sinc ethat fall.  The Senior Rehabilitation and Skilled Nursing Center in Port Arthur allowed Mr. Ozen to fall from his bed.  His wife, Sharon Ozen, filed suit against the healthcare provider July 9 in Jefferson County District Court.

On July 28, 2006, Sharon Ozen visited her husband at the 199-bed rehabilitation facility.   After leaving the center, Sharon received a call and was advised that her husband was being rushed to the hospital.   "According to Mr. Ozen's chart, an aide called a nurse because he was found on the floor with his head lying against the frame of the bedside table," the lawsuit said. "Defendant's staff observed blood on the floor in a puddle, as well as a contusion and laceration to the top of Mr. Ozen's head."

Since the fall, Clifford Ozen has suffered from seizures and has been bedridden. Upon his admission to the nursing home in January 2006, Clifford was diagnosed with dementia, confusion, wandering and an unsteady gait.   All risk factors for falling.  Nursing home was on notice that he could fall but did nothing to try to prevent him from injuring himself even though his wife consented to the use of restraints and safety devicesto protect him.

"The only safety precautions being utilized for Mr. Ozen were side rails on his bed and geriatric chair," the suit says. "These precautions were used only intermittently. Further, during his stay, he was unable to ambulate himself and had an impaired safety awareness."

Sharon alleges she informed the nursing home staff of her concerns, but the healthcare provider negligently failed to assess her husband's risk for falling.  The nursing home also allegedly "failed to adequately protect him from falling in light of his confusion, agitation and impaired safety awareness."

Senior Rehabilitation and Skilled Nursing Center is owned by Victoria, Texas-based Regency Nursing & Rehabilitation Centers, Inc.

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The Washington Post had a recent article about how falls in the elderly lead to death caused by brain injuries.  This is why it is so critical for nursing homes to have sufficient staff to supervise resdients, prevent falls, and have a fall prevention program.  Below are excerpts of the article.

The elderly fear breaking a hip when they fall, but a government study indicates that hitting their head can also have deadly consequences: Brain injuries account for half of all deaths from falls.

The study by the Centers for Disease Control and Prevention is the first comprehensive national look at the role brain injuries play in fatal elderly falls. It examined 16,000 deaths in 2005 that listed unintentional falls as an underlying cause of death.  CDC researchers found that slightly more than half of the deaths were attributed to brain injuries. The other deaths were due to a variety of causes including heart failure, strokes, infections and existing chronic conditions worsened by a broken hip or other injuries sustained in a fall.

"A lot of people don't think a fall is serious unless they broke a bone, they don't think it's serious unless they break a hip. They don't worry about their head," said Pat Flemming, a senior physical therapist and researcher at Vanderbilt University

Each year, one in three Americans age 65 and older fall. About 30 percent of such falls require medical treatment.   Previous CDC research showed that the U.S. death rate from falling has risen dramatically _ about 55 percent _ for the elderly since the 1990s.

As people age, veins and arteries can be more easily torn during a sudden blow or jolt to the head, said Marlena Wald, a CDC epidemiologist who co-authored the study.   That can cause a fatal brain bleed. Other factors can contribute, such as the use of blood-thinners, said Judy Stevens, another CDC researcher and co-author.

The severity of brain injuries isn't always immediately apparent, and some people may not lose consciousness. Wald noted a scenario seen in hospitals in which an elderly fall victim comes in alert and talking, but dies an hour or two later.

The study also found that deaths and hospitalization rates for fall-related brain injuries increased with age. Brain injuries accounted for about 8 percent of hospital stays for non-fatal falls.

There are several steps older Americans can take to try to prevent falls. Exercise can increase leg strength and balance. Glasses or other vision correction measures can help people avoid obstacles. And being careful with the use of drugs that can affect thinking and coordination _ such as tranquilizers and sleeping pills _ can also make a difference.

"Falls are not an inevitable consequence of aging. These head injuries are not inevitable, either," Wald said.

The research is being published in the June issue of a scientific publication, the Journal of Safety Research.

___

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Journal of Clinical Nursing has an article about a recent study linking the use of sleeping pills containing benzodiazepines to increase falls in nursing homes.
Older patients taking benzodiazepines were 2.9 times more likely to fall   Obviously, patients who fall suffer severe injuries.   Some older patients have impaired cognitive function or limited functional ability and physical strength stemming from chronic physical ailments, increasing their risk of a fall, often when walking or being moved.

In addition, older patients are take multiple medications, whose side effects increase the patients' chances of a fall.  Physical restraints may be used to decrease the possibility of falling and being injured.

"Even if no physical injury occurs, fall victims may develop a fear of falling again and thus reduce their activities as a result," the authors wrote. "This can lead to unnecessary dependency, loss of function, decreased socialization, and a poor quality of life."

The researchers found that use of sleeping pills containing benzodiazepines was significantly associated with fractures supporting the findings of most previous studies.

Patients using wheelchairs and bed rails were less likely to fall, but neither of the associations reached statistical significance. Nevertheless, "the use of these might be regarded as protective or preventative strategies," the researchers said.

Bed rails can cause injuries if patients climb over them, and physically restraining an already agitated individual can increase fear and worsen behavior, they said.   "In addition, restraints can lead to serious complications, including circulatory obstruction, skin tears, incontinence, fractures, and dislocations," they wrote. "These restraints should be used with care and consideration." 

The Study recognized that restraints cannot completely eliminate falls in nursing homes and that they may not be appropriate in every situation, but concluded that "our results support the hypothesis that they might be protective when used selectively together with fewer sedatives, especially benzodiazepines."

Primary source: Journal of Clinical Nursing
Source reference:
Fonad E, et al "Falls and fall risk among nursing home residents"J Clin Nurs 2008; 17: 126-134.

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Here is another article about a nursing home's failure to prevent a resident from falling and then failing to intervene or inform the family. 

The family was never told that their 60-year-old mother had broken both legs in a fall and died of complications.  Eventually,  the family discovered the horrific details. Their mother, Linda Ober, had been dropped by staff at the nursing home where she lived and left to moan for help in her bed for five days.

Employees tried to cover up the injury by giving her pain medication and telling her that her memory of being dropped as they moved her out of her wheelchair was simply a bad dream.  The family is haunted by the thought that her mother spent her final hours wondering why her daughter didn't come to see her. According to the suit, the resident  told hospital staff that they didn't need to call her daughter, because nursing-home employees said they would. Cunningham, who lives a mile from the nursing home, said she was not told.

"I wasn't there to hold her hand," said Cunningham, breaking into tears. "All I needed was a phone call."

Thomas D'Amore, the attorney representing Cunningham and her siblings, said Ober's death was the result of having too few staff and not adequately training them to care for the center's residents. According to the U.S. Department of Health and Human Services, a review of the Gateway nursing home about the time of Ober's death found that the number of nurse-hours per resident was below the state average by 33 percent.

She was critically injured Oct. 29, 2006, when two employees dropped her after improperly wrapping a sling around her torso to move her from her wheelchair to her bed, according to the suit.   X-rays show Ober's badly broken legs. In one X-ray, her femur is jutting away from its normal position by 45 degrees. According to a summary of a state investigation that D'Amore provided, staff who treated Ober at Mount Hood Medical Center said Ober's pain was "off the scale" and that "you could feel the bones in her legs moving in your hands, and they were crunching."

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Falls in Nursing Homes

How big is the problem?

In 2003, 1.5 million people 65 and older lived in nursing homes (National Center for Health Statistics 2005). If current rates continue, by 2030 this number will rise to about 3 million (Sahyoun et al. 2002).
Each year, a typical nursing home with 100 beds reports 100 to 200 falls. Many falls go unreported (Rubenstein 1997).
As many as 3 out of 4 people in nursing homes fall each year (Rubenstein et al. 1994). That's twice the rate of falls for older adults living in the community.
Patients often fall more than once. The average is 2.6 falls per person per year (Rubenstein et al. 1990).
About 35% of fall injuries occur among residents who cannot walk (Thapa et al. 1996).
About 5% of adults 65 and older live in nursing homes. But people in nursing homes account for about 20% of deaths from falls in this age group (Rubenstein 1997).

How serious are these falls?

About 1,800 people living in U.S. nursing homes die each year from falls (Rubenstein et al. 1988).
About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures (Rubenstein et al. 1988).
Falls can make it hard for a person to get around, cause disability, and reduce quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation (Rubenstein et al. 1994).

Why do falls occur more often in nursing homes?

Falling can be a sign of other health problems. People in nursing homes are generally more frail than older adults living in the community. They tend to be older, have more chronic illnesses, and have difficulty walking. They also tend to have problems with thinking or memory, to have difficulty with activities of daily living, and to need help getting around or taking care of themselves (Bedsine et al. 1996). All of these factors are linked to falling (Ejaz et al. 1994).

What are the most common causes of nursing home falls?

Muscle weakness and walking or gait problems are the most common causes of falls among nursing home residents. These problems account for about 24% of the falls in nursing homes (Rubenstein et al. 1994).
Hazards in the nursing home cause 16% to 27% of falls among residents (Ejaz et al. 1994; Rubenstein et al. 1994). Such hazards include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs (Rubenstein et al. 1994; Ray et al. 1997).
Medications can increase the risk of falls and fall-related injuries. Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs, are of particular concern (Mustard et al. 1997; Ray et al. 2000).
Other causes of falls include difficulty in moving from one place to another (for example, from the bed to a chair), poor foot care (Ray et al. 1997), poorly fitting shoes, and improper or incorrect use of walking aids (Tinetti 1987).

How can we prevent falls in nursing homes?

Fall prevention takes a combination of medical treatment, rehabilitation, and environmental changes. The most effective interventions address multiple factors. Interventions include:

Assessing patients after a fall to identify and address risk factors and treat the underlying medical conditions (Rubenstein et al. 1990).
Making changes in the nursing home environment to make it easier for residents to move around safely. Such changes include putting in grab bars, adding raised toilet seats, lowering bed heights, and installing handrails in the hallways (Ray et al. 1997).
Reviewing prescribed medicines to assess their potential risks and benefits and to minimize use (Cooper 1994; Cooper 1997).
Providing patients with hip pads that can effectively prevent most hip fractures if a fall occurs (Kannus et al. 2000).
Using devices such as alarms that go off when patients try to get out of bed or move without help (Rubenstein et al. 1994).
Exercise programs can improve balance, strength, walking ability, and physical functioning among nursing home residents. However, it is unclear whether such programs can reduce falls (Nowalk et al. 2001; Vu et al. 2005).

Do physical restraints help prevent falls?

Routine use of restraints does not lower the risk of falls or fall injuries. They should NOT be used as a fall prevention strategy (Capezuti et al. 1996).
Restraints can actually add to the risk of fall-related injuries and deaths (Rubenstein et al. 1994). Limiting a patien's freedom to move around leads to muscle weakness and reduces physical function (Rubenstein et al. 1997).
Since federal regulations took effect in 1990, nursing homes have reduced the use of physical restraints (Rubenstein et al. 1994). Some nursing homes have reported an increase in falls since the regulations took effect, but most have seen a drop in fall-related injuries (Ejaz et al. 1994).

References

Bedsine RW, Rubenstein LZ, Snyder L, editors. Medical care of the nursing home resident. Philadelphia (PA): American College of Physicians; 1996.

Capezuti E, Evans L, Strumpf N. Physical restraint use and falls in nursing home residents. Journal of the American Geriatrics Society 1996;44:627-33.

Cooper JW. Consultant pharmacist fall risk assessment and reduction within the nursing facility. Consulting Pharmacist 1997;12:1294-1304.

Cooper JW. Falls and fractures in nursing home residents receiving psychotropic drugs. International Journal of Geriatric Psychology 1994;9:975-80.

Ejaz FK, Jones JA, Rose MS. Falls among nursing home residents: an examination of incident reports before and after restraint reduction programs. Journal of the American Geriatrics Society 1994;42(9):960-4.

Kannus P, Parkkari J, Niem S, Pasanen M, Palvanen M, Jarvinen M, Vuori I. Prevention of hip fractures in elderly people with use of a hip protector. New England Journal of Medicine 2000;343(21):1506-13.

Mustard CA, Mayer T. Case-control study of exposure to medication and the risk of injurious falls requiring hospitalization among nursing home residents. American Journal of Epidemiology 1997;145:738-45.

Nowalk MP, Prendergast JM, Bayles CM, D'Amico MJ, Colvin GC. A randomized trial of exercise programs among older individuals living in two long-term care facilities: the FallsFREE program. Journal of the American Geriatrics Society 2001;49:859-65.

National Center for Health Statistics. Health, United States, 2005. With Chartbook on Trends in the Health of Americans. Hyattsville (MD): National Center for Health Statistics; 2005.

Ray WA, Taylor JA, Meador KG, Thapa PB, Brown AK, Kajihara HK, et al. A randomized trial of consultation service to reduce falls in nursing homes. Journal of the American Medical Association 1997;278(7):557-62.

Ray WA, Thapa PB, Gideon P. Benzodiazepenes and the risk of falls in nursing home residents. Journal of the American Geriatrics Society 2000;48(6):682-5.

Rubenstein LZ. Preventing falls in the nursing home. Journal of the American Medical Association 1997;278(7):595-6.

Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Annals of Internal Medicine 1994;121:442-51.

Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Annals of Internal Medicine 1990;113(4):308-16.

Rubenstein LZ, Robbins AS, Schulman BL, Rosado J, Osterweil D, Josephson KR. Falls and instability in the elderly. Journal of the American Geriatrics Society 1988;36:266-78.

Sahyoun NR, Pratt LA, Lentzner H, Dey A, Robinson KN. The changing profile of nursing home residents: 1985-1997. Aging Trends; No. 4. Hyattsville (MD): National Center for Health Statistics; 2001.

Thapa PB, Brockman KG, Gideon P, Fought RL, Ray WA. Injurious falls in nonambulatory nursing home residents: a comparative study of circumstances, incidence and risk factors. Journal of the American Geriatrics Society 1996;44:273-8.

Tinetti ME. Factors associated with serious injury during falls by ambulatory nursing home residents. Journal of the American Geriatrics Society 1987;35:644-8.

Vu MQ, Weintraub N, Rubenstein LZ. Falls in the nursing home: are they preventable? Journal of the American Medical Directors Association 2005;6:S82-7.

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Page last modified: August 26, 2006


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