Nursing Home Neglect - Part One: Falls

Two major problems that exist in nursing homes include the high rate of preventable bedsores and falls resulting in injury. In a two-part series, we will discuss both. Here, in part one, we examine the common issue of falls among occupants of nursing homes.

Americans are living much longer than our relatives, largely due to significant improvements and availability of healthcare services and investment in medical research. Studies show that the number of people 65 years and older rose from 8% in 1950 to 12% of the total population in 2000. What’s more, this figure will rise to 20% by 2050 and will likely continue to rise steadily thereafter.

Unfortunately, living longer can also mean declining health. For some, aging means decreased independence and long term care needs. Far too often, families are forced to make the difficult decision of how to provide the best care and treatment for their loved ones. One option is placing your loved one in a long-term care facility or nursing home. Many families choose this route so that professionals are caring for their loved ones at all times.

Many of us were shocked to read an article published this past July (2017) in the Northwest Indiana Times, which reported that “Indiana ranks worst in nation for long-term care” for seniors and people with disabilities.The findings were part of the Long-Term Services & Supports Scorecard, conducted in part by AARP.

"One of the things that's really clear is that change needs to happen quickly," said Kristen LaEace, CEO of the Indiana Association of Area Agencies on Aging, in the Times article. "It would appear one of the reasons why we haven't made improvements is other states are changing and adapting faster than we are. It doesn't necessarily mean we haven't made improvements. It means other states are outpacing us."

LaEace notes that a new law, House Bill 1493, directs the state's Division of Aging to develop a plan to expand the state's community- and home-based services for seniors and people with disabilities. However, she also noted that the U.S. Senate's plan to repeal and replace the Affordable Care Act is projected to cut funds to Medicaid, which pays for most of the long-term care services in the state. "That could set Indiana back years," she said.

Indiana had ranked 47th in the last two scorecards, done in 2014 and 2011. In the latest report, bordering states ranked 22nd (Michigan), 30th (Illinois), 34th (Ohio) and 50th (Kentucky).

Critical issues in nursing home care:

According to the CDC (Centers for Disease Control) the consequences of a fall are often severe for those residing in nursing facilities. 10-20 percent of falls in these institutions result in severe injury, and about 1,800 residents die from fall related injuries every year. Between half and three-quarters of residents will suffer a fall in any given year. Despite these statistics, falls in long-term care facilities are preventable if proper and appropriate precautions are taken.

Examples of improper care that could result in a preventable fall include:

Lack of proper equipment. Nursing home beds often lack bed rails, don’t use bed rails appropriately or beds are adjusted so that they are too high off the ground. The Code of Federal Regulations (CFR) at 42 CFR 483.13(a) states: "The resident has the right to be free from any physical or chemical restraints imposed for the purpose of discipline or convenience and not required to treat the resident's medical symptoms." A doctor can prescribe a bed rail, however, to address a patient who had been deemed a fall risk. Another option is a bed alarm if a resident tries to get up without assistance.

Inadequate staffing. Nursing homes, like doctors and hospitals, are a business. They operate in order to turn a profit. Due to the high costs of medical care, many facilities reduce staff to a very few and they are charged with the responsibility of far too many residents. This can cause a patient in need to suffer for a long time prior to getting help. This can also contribute to a resident attempting to get up when trying to meet his or her own needs.

Poorly trained staff. There are federally mandated minimum training standards for nursing assistants. However, just because a nurse or assistant has met the minimum standards does not mean they are entirely competent. Moreover, there is a high turnover rate for nursing home staff. Many of these new employees may not have been adequately trained or screened before being hired. The new staff may not be familiar with the nursing home’s standard procedures for preventing falls.

Existing health conditions. There are countless diseases and conditions that increase a patient’s fall risk: Parkinson's, Alzheimer's, and other such diseases result in unsteady gaits that can lead to falls. Patients with a history of stroke or seizure are particularly vulnerable to injury from a fall. Other health problems, like orthostatic hypotension, can cause residents to become weak or faint if they try to stand up suddenly. Furthermore, many medications may increase the risk of a fall. Maintaining a close watch on residents affected by these and similar conditions reduces the risk for falls.

Lack of a comprehensive fall prevention plan. Fall prevention in nursing homes includes the proper placement and installation of bed alarms, chair alarm systems, fall mats, improved lighting, emphasis on keeping rooms and hallways free of clutter, re-assessment of medications, use of sitters and increased overall staffing.

Environmental hazards. 16 to 27% of falls among residents in nursing homes are caused by environmental hazards. Such hazards include unstable furniture, beds and toilets at inappropriate height, unavailability of grab bars or railing, wet or slippery floors, rugs or frayed carpets, cords and wires, poor lighting, improperly fitted or maintained wheelchairs, personal items that are out of reach, and improper footwear or clothing.

When an individual is admitted to a nursing home, the nursing home must conduct a fall risk assessment and ensure that they are fully capable of providing the requisite care to prevent a fall from occurring. This fall risk assessment is an ongoing process which must be updated based on the patient’s changing condition.

It is a fact that nursing home falls are preventable. When a fall happens, serious injuries are likely, and the risk of mortality greatly increases. With the baby boom generation quickly becoming the largest age group in our population, more and more people than ever before will be housed in nursing homes for around the clock care.

What can you do?

Report nursing home abuse and neglect immediately. If you suspect there is immediate danger, call 911.

Another source for help is The Indiana Attorney General’s Patient Abuse and Neglect program. It was created to protect vulnerable Hoosiers—patients in nursing homes, homes for the disabled, assisted living residences, homes for the mentally ill and other residential care facilities.

You can and should request an investigation into nursing home injuries or neglect from the Indiana Department of Health.

Finally, call us Theodoros & Rooth. We have over 110 years of combined experience handling personal injury cases, including injuries from nursing home negligence. Our team of dedicated attorneys will investigate your situation and will take immediate and aggressive action if we determine there has been mistreatment. The initial consultation is always free, and there are no attorney fees unless you receive compensation.

Taking care of you and your family with respect, understanding, and compassion is part of what we do at Theodoros & Rooth.

Sources: CDC (Centers for Disease Control), AARP, Northwest Indiana Times.