According to an article from: Advanced Practice Nursing eJournal, dated September 10, 2008; Falls are common among older adults. One third of adults over 64 years old, living outside of institutions, fall each year, and the likelihood of falling continues to rise with older age. Among the elderly, falls cause significant morbidity and mortality, and often contribute to functional decline, depression, social isolation, and nursing home admission. Compared with community-dwelling elders, nursing home residents generally have more comorbidities and advanced disease, including dementia. It is not surprising then that nursing home residents are nearly 3 times more likely to fall than elders living in the community. The article continues:
Fall Prevention
Risk Assessment
The first step to preventing a fall is to determine the risk. Although there are many fall risk assessment tools in the literature, no single tool is valid in all practice settings and most are not well validated. Nevertheless, the logic of identifying elders at risk for falls is undeniable because many risk factors are well documented. An assessment should be completed so that risk factors can be minimized, if not eliminated. Selecting the most appropriate tool for nursing home residents should be based on 2 criteria: The tool should address the most common risk factors, and it should be simple and practical to use.

The Minimum Data Set (MDS) is an interdisciplinary assessment tool required by federal regulations for use in nursing homes. The MDS identifies some of the risk factors for falls, including a history of falls, dizziness, wandering, restraint use, and use of drugs in high-risk classes. As its name implies, the MDS is not a comprehensive assessment tool, and yet it is too lengthy for quick fall risk assessments. So in addition to the MDS, many nursing homes use 1-page tools that are commercially available, posted on the Internet, or that have been created within the facility. At a minimum, any quick tool should include the following:
1. A history of falls;
2. Cognition, including fluctuating mental status;
3. Impulsivity;
4. Vision;
5. Ambulation;
6. Continence;
7. Use of high-risk medications (eg, antihypertensives, diuretics, and hypoglycemics);
8. Use of assistive devices for transfer or ambulation;
9. Attached equipment (eg, catheters, intravenous lines, and oxygen); and
10. Familiarity with the environment.

For residents with a history of falls, it is helpful to determine the circumstances of previous falls, although this information may not be available. Are there common characteristics to the falls? For example, have the falls happened when she was using the bathroom, at the same time of day, when her blood sugars were low, or when she was wearing her high heels or not wearing her glasses?

Federal Regulations Require that the Nursing Home Resident Receives adequate supervision and assistive devices to prevent all accidents including falls.
• Ensure that the resident receives adequate supervision and assistive devices to prevent accidents. (42 CFR §483.25 (h))
(h) Accidents. The facility must ensure that—
(1) The resident environment remains as free of accident hazards as is possible; and
(2) Each resident receives adequate supervision and assistance devices to prevent accidents.

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.
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 pneumonia.

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 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 implement 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.

If you or a loved one has suffered an injury from neglect 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@guardianlegalservices.net, or call Ken at 612-743-9048.

In a story in the Star Tribune on Tuesday it was noted that Minnesota Department of Health Investigators concluded that Providence Place failed to change a resident’s care plan after she had twice previously tried to open a door to a stairway. The woman eventually opened the door and rolled down a stairwell in her wheelchair and died last May. The State’s report stated that according to the care plan the resident “needed assistance of staff to avoid potentially dangerous situations.” The resident had a suffered from anxiety, depression and other behavior problems, and had a history of wandering around the facility, include the stairwell in the past.

Here is the link for the rest of the story: Nursing home blamed for fatal wheelchair fall

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.

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 pneumonia.

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 especially 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.

The Omnibus Budget Reconciliation Act of 1987 (OBRA 1987), also known as the Nursing Home Reform Act, specifies that a nursing home “must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care…”

To participate in the Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for long term care facilities as prescribed in the U.S. Code of Federal Regulations (42 CFR Part 483).

Under the regulations, the nursing home must:
• Have sufficient nursing staff. (42 CFR §483.30)

• Conduct initially a comprehensive and accurate assessment of each resident’s functional capacity. (42 CFR §483.20)

• Develop a comprehensive care plan for each resident. (42 CFR §483.20)

Ensure that the resident receives adequate supervision and assistive devices to prevent accidents. (42 CFR §483.25).

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.

If you or a loved one has suffered an injury from neglect 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@guardianlegalservices.net, or call Ken at 612-743-9048.

There was a story in the Star & Tribune last week concerning a finding of neglect when a nursing home nurse fail to properly intervene on behalf of a resident who was having difficulty breathing at the Texas Terrace Center in St. Louis Park, Minnesota.
For the rest of the story: State: Nurse’s neglect led to nursing home death.

Federal Law mandates that resident in a nursing home:

42 CFR Section 483.25 - Quality of care.

Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.
(l) Unnecessary drugs(1) General. Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used: (i) In excessive dose (including duplicate drug therapy); or (ii) For excessive duration; or (iii) Without adequate monitoring; or (iv) Without adequate indications for its use; or (v) In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or (vi) Any combinations of the reasons above.

Report Suspected Abuse and Neglect

If you suspect abuse or neglect to any vulnerable adult, please contact the Minnesota Department of Health/ Department of Human Services, where you can file a confidential report protecting those unable to do so for themselves. Positive change and accountability starts with reporting all suspected neglect and abuse.

By filing a complaint about suspected neglect or abuse a trained investigator is assigned to review the issue and the facility to protect the safety of the residents by identifying areas of care not in compliance with the minimum state and federal standards.

For assistance with filing a complaint with the state concerning abuse or neglect on the behalf of your family member or yourself, WITHOUT CHARGE, please call or email attorney Kenneth L. LaBore to schedule an appointment.

According to Minnesota Statute § Subd. 21(a) “Vulnerable adult” means any person 18 years of age or older who:
(1) is a resident or inpatient of a facility;
(2) receives services at or from a facility required to be licensed to serve adults under sections 245A.01 to 245A.15, except that a person receiving outpatient services for treatment of chemical dependency or mental illness, or one who is served in the Minnesota sex offender program on a court-hold order for commitment, or is committed as a sexual psychopathic personality or as a sexually dangerous person under chapter 253B, is not considered a vulnerable adult unless the person meets the requirements of clause (4);
(3) receives services from a home care provider required to be licensed under section 144A.46; or from a person or organization that exclusively offers, provides, or arranges for personal care assistant services under the medical assistance program as authorized under sections 256B.04, subdivision 16, 256B.0625, subdivision 19a, 256B.0651, 256B.0653 to 256B.0656, and 256B.0659; or
(4) regardless of residence or whether any type of service is received, possesses a physical or mental infirmity or other physical, mental, or emotional dysfunction:
(i) that impairs the individual’s ability to provide adequately for the individual’s own care without assistance, including the provision of food, shelter, clothing, health care, or supervision; and
(ii) because of the dysfunction or infirmity and the need for care or services, the individual has an impaired ability to protect the individual’s self from maltreatment.
(b) For purposes of this subdivision, “care or services” means care or services for the health, safety, welfare, or maintenance of an individual.

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.
If you or a loved one has suffered an injury from neglect 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, please send an email to klabore@guardianlegalservices.net or call Mr. LaBore directly at 920-920-8911.

Woodbury Health Care Center

In a story dated April 13, 2010, by Paul Walsh from the Minneapolis Star & Tribune newspaper detailed a RN from a Woodbury Nursing Home who was faulted by the State of Minnesota for Improper Conduct. The complaint deals with a wrongly ordered halt to CPR on a dying resident in the nursing home.

For more information concerning Woodbury Health Care Center and this incident go the the attached: Minnesota Department of Health and type in facility name and under Provider Type either put “nursing home” or “all”.

As an attorney who handles nursing home abuse and neglect cases confusion in the Do-Not-Recusitate (DNR) or Do-Not-Intubate (DNI) leading to many situations where care is either withheld or provided when not wanted. Confusion on the DNR/DNI status of a resident can be dealt with through a clear and consistent policy at the nursing home to ensure that the resident or their legal representative’s wishes with respect to emergency care issues is addressed and that there is those wishes are easily found and identified by the staff when there is such a need. Failure have appropriate policies and procedures to determine a resident’s code status is another form of avoidable nursing home abuse and neglect suffered by our most vulnerable citizens.

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.

If you or a loved one has suffered an injury from neglect 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@guardianlegalservices.net or call Ken LaBore at 612-767-7503.

According to a story from the Star & Tribune titled:
Nursing home aide stuffed sock in dementia patient’s mouth

The story states:
“An aide at a northwestern Minnesota nursing home crammed a sock in the mouth of a screaming resident because the woman, elderly and in the late stages of dementia, wouldn’t be quiet, according to a state Health Department report released Tuesday.

The report quotes a co-worker as saying, “What the hell are you doing?” as the incident unfolded on Jan. 4 in the resident’s room at the Sunnyside Care Center in Lake Park.

The co-worker told an investigator that the nursing assistant “chuckled” and responded that the resident “wouldn’t quit hollering,” the report added. The co-worker then removed the sock from the resident’s mouth.”
This is an example of completely avoidable and in-execusable neglect, demonstrating a lack of concern for human dignity.

Nursing Homes must learn to treat the vulnerable resident under their charge with the respect they deserve. As an attorney who handles nursing home abuse and neglect cases, I wish I could say this type of incident, reckless and abusive care, is isolated.

Nursing Home Elder Abuse and Neglect Nursing home abuse and nursing home neglect of the elderly and vulnerable in nursing homes and other facilities occurs in many forms. A nursing home lawyer is here to assist your loved ones with holding the wrongdoers accountable. Some types of abuse are obvious such as elder sexual or elder physical assault or financial exploitation. Others forms of abuse and neglect are less noticeable and are often the result of having fewer nursing staff and aides than are needed and required. Staffing and training issues lead to many forms of avoidable neglect such as: falls, pressure ulcers (bed-sores), medication errors, dehydration and malnourishment, urinary tract infections, unsupervised residents wandering or suffering burn injuries and a multitude of other problems. Ken LaBore represents a professional Minnesota Nursing Home Law Firm, which is dedicated to holding nursing homes accountable for providing quality care to residents pursuant to the contracts they sign with the government, Medicare and Medicaid. The nursing home has an obligation to provide the: “highest quality of care practicable”. If you suspect abuse or neglect to any vulnerable adult, please contact the Minnesota Department of Health where you can file a confidential report protecting those unable to do so for themselves.

WHAT SHOULD I DO IF I SUSPECT NEGLECT OR ABUSE If you have reason to suspect that a loved one sustained an injury in a hospital, nursing home or assisted living facility the State of Minnesota Department of Health will investigate the issue upon reasonable suspicion. The first step to resolve the issue is a complaint form which must be filed with the MDH to start an investigation. The MDH Complaint Form is a three page document filed through the Office of Health Facility Complaints (OHFC) through a specified complaint form, which requests a reporting parties name, address and other contact information, the name of whom the complaint is on behalf of, the name and address of the facility, the date of the incident and a narrative statement on what occurred. The form contains a notice called a Tennessen Warning stating that the information you provide on the form may be used in an investigation report, however, your identity is confidential and is not revealed to the general public, except as required by law. The form goes on to give some situations where it may be necessary to reveal your identity to persons in a hearing. Giving your name is optional, but failing to do so may hinder efforts to resolve the problem. For more information and a copy of an OHFC Complaint Form go to: http://www.health.state.mn.us/divs/fpc/ohfcinfo/hfccomplaintform.pdf

Elder Physical and Sexual Abuse:

• Way to avoid Physical and Sexual abuse of the elderly is outlined in a brochure from Eldercare Rights Alliance called: Elder Abuse is a Crime.
• National Citizens’ Coalition for Nursing Home Reform (NCCNHR) provides a free brochure and article on the called: Faces of Neglect.
• The Power and Control Wheel for Elders and People with Disabilities.
• The Types of Elder Abuse and Warning Signs is a brochure and checklist of warning signs to look for to avoid elder abuse produced by Eldercare Rights Alliance.

Elder Financial Exploitation and Abuse:

• Eldercare Rights Alliance materials on Financial Exploitation of the elderly and vulnerable: Theft In Nursing Homes Awareness and Prevention.
• Minnesota Eldercare Rights Alliance, Personal Property Inventory Form, to use upon admission.

Resources for Resident’s and Family of Nursing Homes - Long Term Care Facilities

• Minnesota Nursing Home Residents’ Bill of Rights brochure from Eldercare Rights Alliance
• The Eldercare Rights Alliance has a brochure called Tips for Choosing a Nursing Home
• Center for Medicare and Medicaid Services, CMS, Nursing Home Compare provides the user with assistance in finding a nursing home based upon particular criteria such as the types of care and rehabilitation provided, location and past history of the facility.
• Minnesota Department of Health, Nursing Home Report Card provides a way to compare nursing homes in Minnesota based upon the quality of care provided in the facility as determined by the facility’s survey and complaint history.
• Family Councils are an important way that family and other community members can promote quality care of the resident of nursing homes, complaints made by the family council must be addressed by the facility under penalty with the state surveyors. The Minnesota Eldercare Alliance produced the following brochure on Family Councils.
• The ElderCare Rights Alliance information on the Elder Justice Program which provides training to members of family and resident councils.
• Resident Councils are a direct way for residents to get involved in issues related to the quality of care given to the residents.

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.

If you or a loved one has suffered an injury from neglect 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@guardianlegalservices.net, or call Ken at 612-767-7503.