Head Traumas

Not all falls are serious, but many can be. In nursing homes, it is not uncommon for residents to suffer severe or even deadly falls. One of the most common ways that nursing home residents die from falls is head trauma. Due to frailty, previous falls or fractures and imbalance, when older adults fall, they may not be able to catch themselves as easily, and nursing home rooms are often full of hazards, despite state laws and regulations requiring them to be “free from hazards” at all times. A serious head injury can have lasting or even fatal results. Consider a few of the complications that a senior may experience after a fall and the ways that nursing homes make it hard to prove fault.

Delayed Transfer After Fall. In particular, when nursing home residents fall, they are often not witnessed.  This means that unless the resident is very sharp mentally and able to recall the specifics of how they fell and what they struck, staff may not be able to easily know what types of tests to perform. In other words, do they do a CT scan of the shoulder, X-ray the hip, MRI the brain, etc.? Sadly, our healthcare system doesn’t usually allow for or pay providers to go “fishing” by scanning a whole body after a fall, so it can be hard for nursing home staff – and emergency room staff for that matter – to know what to do. This is why an immediate transfer to the hospital is necessary. Most ER physicians, if correctly and appropriately advised that the resident suffered an unwitnessed fall, will order brain scans. This is especially true if the nursing staff advised the hospital of any changes in mental status.

What are Neuro Checks, and Why are they Important? After a fall, even one where staff do not believe any head injury has occurred, the standard of care requires checking the resident’s neurological function every few hours for the first day, then at least a handful of times thereafter. While these standard procedures may vary slightly depending on the age of the resident and level of nursing care received, neuro checks can go a long way toward helping ER physicians know what to look for. For instance, if following a fall, a normally sharp and cognitively intact resident is suddenly confused and lethargic or sleepy, this can be a huge red flag that suggests a brain bleed or brain injury.  This information would likely make most emergency room nurses and doctors send the resident for imaging studies and blood tests to determine if there’s a possible traumatic brain injury or brain bleed. But if the nursing home staff don’t mention any of it to the hospital or delay transfer too long, they effectively deprive the resident of the opportunity to receive proper care, often leading to death.

Rapid and Immediate Death After Head Injury. One of the most common things we see with head trauma cases is a resident suffering a fall, hitting their head on a piece of furniture, then dying in their bed within 24-48 hours of the fall. The last thing nursing staff should do is put a head trauma patient back to bed, but they do it all the time. Whether it is poor training, inadequate staffing, or simply laziness, many head trauma patients are never even sent to the hospital or given appropriate follow up care to determine the extent of their injuries. The nursing home later will argue that you can’t prove they caused the person to die, even though the death occurred just a day or two after the fall. This is perhaps the most disingenuous argument we hear. In short, they will argue that they allowed a person to fall, hit their head and almost immediately become confused, lethargic then die, but because they did nothing to test or follow up, there’s no proof.

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