Falls & Fractures

As people age, health problems can lead to decreased mobility. Many individuals residing in Illinois nursing homes are there for rehabilitation and strengthening. They go to get better, to heal from surgery, and to regain independence. Unfortunately, poor care, low staffing numbers, and ownership who put profits ahead of people can all lead to less than adequate care. Falls are among the most common injuries seen in nursing homes. Some of the most common causes of falls include:

• Lack of assistance with toileting
• Improper bed check schedule
• Lack of precautions, such as bed alarms, lowered beds, or staff attendance
• Accepting patients with needs that are greater than what the facility can provide
• Poor continence care

Many times, residents may also suffer from dementia or other memory conditions that can lead them to forget that they are unable to walk. These patients present a unique challenge, but it is not a reason to suffer falls. A nursing home should have measures in place to ensure that such patients are frequently attended to and assisted with going to the restroom, changing clothes, and performing other activities of daily living. Falls can lead to:

• Hip and leg fractures
• Head injuries
• Brain bleeds
• Uncurable surgical sites and infections due to poor wound care
• Extremely high medical bills
• Advanced deterioration in condition and loss of enjoyment of life
• Death

Final Points About Nursing Home Falls. It is worth noting that the Centers for Medicare and Medicaid Services (CMS) typically considers falls in a healthcare environment to be “never events,” meaning they should never happen. This is even so true that in many cases, Medicare and Medicaid will either pay less or pay nothing at all to the nursing home for the care needed to fix the damages. In other words, CMS considers these to be a “you break it, you fix it” type of scenario. Of course, nursing homes have gotten very good at justifying their own negligence and arguing that the falls are “unpreventable” based on a host of factors. Some common arguments a nursing home will make after a fall are listed below, along with the realities that we’ve seen about these excuses.

• “We aren’t allowed to use bedrails; they’re a restraint.” This is actually only partially true. A few years back, CMS came out with guidelines for the use of things like bedrails. They discovered that when used inappropriately, they can actually discourage a resident from attempting to move about, leading to worse overall health outcomes. However, all such reports and guidelines come with a clear caveat that in order to use them, you simply need a medical reason and consent. So, if a physician orders them as part of a fall risk mitigation plan, and the patient or their authorized representative consent to it, these are not restraints.

• “We aren’t supposed to use bed or chair alarms; they’re a restraint.” Much like bed rails, when used appropriately and under a doctor’s supervision, they can be part of an overall strategy to protect a resident. Yes, if used without a physician’s orders or supervision, some low-level nursing staff may simply set the alarms and forget the patient. But silent alarms especially can make a big difference. These are used in a way that they only sound at the nurse’s station, alerting staff that the patient may be getting up unassisted.

• “We told your mother not to get up and to wait for help.” This may sound like a good excuse. It’s always the resident’s fault, right? Well, when dealing with nursing home residents, there may be cognitive decline. Even a resident who is of sound mind may occasionally get confused, due to a change in surroundings and medications they’re taking. Likewise, we have heard thousands of stories over the years from families and residents explaining that they would wait hours for a response when they used the call light. Therefore, these excuses fail. It would be absolutely cruel to argue that a senior should sit for hours waiting for help, well knowing they may be incontinent or cannot wait that long. Most seniors, in an effort to avoid embarrassment, will simply attempt to get up and use the bathroom themselves. This is why proper staffing is so important.

• “We put the call light within reach and taught your father how to use it.” Again, this is the same excuse as saying the resident wouldn’t wait long enough for help. Remember, a call light being in reach is only as good as the people paying attention to it. If all the staff are busy or outside smoking on break, and no one is paying attention, then that call light may as well be a paper weight.

• “We lowered the bed so that he wouldn’t get hurt if he fell. We don’t know how or why the mat was moved.”  This is perhaps one of our favorite bogus excuses. Lowering a bed and using a fall mat is a nice way to avoid serious injuries if someone falls from their bed. But it also has the added risk of creating a hazard. If the resident is able to move about and ambulate, even with assistance, it is very common for the resident to put their feet on the matt, lose balance, and the mat fly out from under their feet actually causing the fall. Likewise, these matts sort of assume the person will fall out of bed. If this is a real fear, then other measures are more appropriate, such as more frequent bed checks, actually monitoring the call light, and using silent alarms so the nurse’s station will receive an alert when the patient is moving about. Most seniors in this type of situation are not going to move very fast. As they shift body weight and begin getting up, the alarm goes off at the nurse’s station, and the staff can walk down and in most cases get to the person before they’ve gotten up. Granted, there are those rare occasions where a fall is truly unpreventable and was unexpected, but this is not the case most of the time.

• “He just got up so fast, there was nothing anyone could do.”  In all our years of representing injured nursing home residents, we’ve never really met a vulnerable senior who moved so quickly and unexpectedly that a healthy and physically capable nursing staff couldn’t get to them on time. We’re sure it has happened, but in most cases, residents are documented as a fall risk, they are known to need assistance just getting out of bed or using the bathroom, yet somehow they hit the call light, wait for what feels like hours, then try it on their own. A review of over 100 of our past cases reflected that in all but 3 fall cases we’ve handled, the individual was “found” on the ground after a fall, meaning, the falls are unwitnessed and staff often gets to the scene hours after it has occurred, despite the resident laying on the ground screaming for help. So, no, this would not be a situation where it all “happened so fast,” but rather, no one was around.

• “Your husband is noncompliant and simply won’t wait for assistance.” We generally see this in cases of dementia or other types of cognitive decline. Patients may not realize or understand their limitations. They may forget later in the evening, as the sundowning effect takes hold, leaving an otherwise aware resident with an unjustified sense of strength and mobility. A resident who has just had surgery or requires assistance moving around may completely forget this and try to move on his own. To blame an injury on someone like this is to entirely ignore that they are in the nursing home likely for this very reason to start with, and it is the staff’s job to care for and protect them. Otherwise, why take them to a nursing home? If they could easily follow instructions and remember details like how to use a call light at 3:00 a.m., they’d still be at home.

As you can probably tell, there are a lot of nuances and complicated arguments that come up when litigating a nursing home fall. In rural southern Illinois nursing homes, injuries can be very severe, but because these are smaller and remote facilities in the country, they may be surveyed less frequently, and families may not be able to visit as often. If your loved one has suffered injuries from falls in a nursing home, give Crossroad Legal a call today. We are available to take your call 24/7. There’s no fee to get started, and we only collect payment if we recover compensation for you and your family.