THREE STORIES ABOUT NURSING HOME FALLS IN MINNEAPOLIS PAPER

As an attorney who practices in the area of elder abuse and neglect primarily in nursing homes and other types of elder care facilities, I have handled numerous cases where falls have lead to serious permanent injury or frequently in the death of the resident. Unlike many types of accidents, falls are often preventable with adequate and trained staff providing proper care and monitoring. Even if the actual fall event is an accident many facilities fail to take the necessary required steps to protect the interests of the vulnerable adult, by not adequately responding to the fall event.

During the last few weeks there was a three part story in the Minneapolis Star and Tribune paper outlining the risks of falls to the elderly, several of stories came from clients of our firm that wish to share their tradegy of proventable neglect leading to falls to help educate others.

In interviews with the Star Tribune, more than a dozen former nursing aides who worked at Minnesota nursing homes that have had fall-related deaths cited staffing problems as a concern. By at least one federal measure, 75 percent of Minnesota nursing homes are understaffed, although both state and federal staffing standards are vague.

Minnesota ranks third highest in states for falling deaths in those 65 and older from 1999 to 2006, whether they were in nursing homes or not. After a fall, a spiral of decline often begins in the elderly. Weakened by the ordeal, victims succumb to pneumonia or see their chronic health conditions erupt with a vengeance. The fall, medical experts say, sets off a deadly systemic chain reaction, hastening the end of life. It’s a growing concern as the U.S. population ages, setting the stage for more falls, more pain, more untimely deaths.

The Star and Tribune story also states: hospital bills to treat the elderly for falls totaled more than $1.1 billion in Minnesota between 1998 and 2005, according to the state Health Department.

Advocates for the elderly say if more of the deaths related to falls were subject to a more rigorous regulatory microscope, it would reveal both overburdened staffs and mismanagement. But Minnesota’s system leaves scant public record of how many falls were avoidable and how they could have been prevented.

The Star and Tribune story continued: under federal rules, every nursing home resident must be assessed for fall risk. Over the past two years, small consortiums of Minnesota nursing homes have made fall-prevention a priority. Under a state incentive program, some get extra payments to improve their performance. One group, Empira, received $4.2 million last year for 16 participating nursing homes.

For the rest of the articles in the Star and Tribune, click here

For part 2 of the story on falls by the Star and Tribune, click here

For the final part of the three part story, click here

The Star and Tribune story included a chart of deaths related to types of injury: for a copy of that chart click here

ASSESSMENT AFTER THE FALL IS CRITICAL

After a fall the individual needs to be closely monitored and assessed by qualified nursing or home staff. Often the nursing home does not insure that the resident is assessed by a RN or medical doctor, rather they rely on the LPN and nursing assistant staff to look for changes in the condition of the resident that could signal a problem related to the fall, the most common of which is a subdural hematoma, leading to brain swelling, and often death.

Frequently falls result in the breaking of a bone, many times at the level of a joint such as in the hip or knee. The injury may result in the resident becoming bedridden or confined to a wheelchair for rehabilitative care. The loss in ambulation can then lead to many other risk factors such as bed sores from the pressure of laying on the same area for extended periods of time, and loss of muscle strength, leading to additional falls. Fall injuries can also lead to death months after the incident from complications such as pneuomonia.

Avoiding falls is very important and should be one of the primary focuses in the nursing home. To protect the residents the nursing home should be frequently monitoring the resident to determine the risks for falling and taking interventions to reduce the change of a fall incident. The effectiveness of the interventions should be evaluated to ensure the effectiveness of safety interventions and if they need to be modified. This is particulary important if there is any sudden change in a resident’s ability to function physically and changes with the cognitive or behavior status of the resident. These changes could be due to an underlying medical condition which needs to be addressed, or problems with medication or numerous other issues. Assessments needed to be performed by a qualified RN nurse, not lower level nursing staff, who should instead be making observations, and reporting their finding to those qualified to inact appropriate safety measures.

This website is not intended to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation.

Falls Among Older Adults: An Overview

According to the CDC

How big is the problem?

* More than one third of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001).
* Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma (CDC 2005).
* In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (CDC 2005).
* The rates of fall-related deaths among older adults rose significantly over the past decade (Stevens 2006).

What outcomes are linked to falls?

* Twenty percent to 30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. These injuries can make it hard to get around and limit independent living. They also can increase the risk of early death (Alexander et al. 1992; Sterling et al. 2001).
* Falls are the most common cause of traumatic brain injuries, or TBI (Jager et al. 2000). In 2000, TBI accounted for 46% of fatal falls among older adults (Stevens et al. 2006).
* Most fractures among older adults are caused by falls (Bell et al. 2000).
* The most common fractures are of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990).
* Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997).
* In 2000, direct medical costs totaled $0.2 billion ($179 million) for fatal falls and $19 billion for nonfatal fall injuries (Stevens et al. 2006).

Who is at risk?

* Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women (CDC 2005).
* Women are 67% more likely than men to have a nonfatal fall injury (CDC 2005).
* Rates of fall-related fractures among older adults are more than twice as high for women as for men (Stevens et al. 2005).
* In 2003, about 72% of older adults admitted to the hospital for hip fractures were women (CDC 2005).
* The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens et al. 2005)
* Nearly 85% of deaths from falls in 2004 were among people 75 and older (CDC 2005).
* People 75 and older who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald et al. 1999).
* There is little difference in fatal fall rates between whites and blacks, ages 65 to 74 (CDC 2006).
* After age 75, white men have the highest fatality rates, followed by white women, black men, and black women (CDC 2005).
* White women have significantly higher rates of fall–related hip fractures than black women (Stevens 2005).
* Among older adults, non–Hispanics have higher fatal fall rates than Hispanics (Stevens et al. 2002).

How can older adults prevent falls?

Older adults can take several steps to protect their independence and reduce their risk of falling. They can:

o Exercise regularly; exercise programs like Tai Chi that increase strength and improve balance are especially good.
o Ask their doctor or pharmacist to review their medicines–both prescription and over-the counter–to reduce side effects and interactions.
o Have their eyes checked by an eye doctor at least once a year.
o Improve the lighting in their home.
o Reduce hazards in their home that can lead to falls.

What is CDC doing to prevent falls among older adults?

CDC supports research and dissemination on ways to help prevent falls among older adults. To read about these activities, follow the link to CDC Fall Prevention Activities.

CDC has also developed brochures and posters, in partnership with the CDC Foundation and MetLife Foundation, to educate older adults and those who care for them about preventing falls and the injuries that result.

My thoughts as a nursing home abuse and neglect attorney is that many of the falls  incidents and serious resulting injuries or death as referenced in the attached article were preventable if proper assessment, care and supervision was provided for the resident.   I generally do not blame the very hard working and dedicated nursing and aide staffs at the facilities but rather the management.    The business motive in many facilities is profits over people by  allowing the nursing homes to be understaffed by qualified RNs who are capable of making accurate assessments of the resident with an eye on changes in condition.   There is also a need to provide adequate numbers of care providing support staff such as  LPNs, and registered nursing home aides NARs to assist.    Often times the neglect uncovered in the cases I handle is due to the staffing levels or the degree of training provided to the staff.   Additionally many accidents occur due to a shortage of necessary support equipment such as Hoyer lifts, tag alarms, pressure mattresses, etc.

If you or a loved one has suffered an injury or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact Attorney Kenneth L. LaBore, directly please send an email to klabore@prslegal.com, or call Ken at 612-767-7503.