Legal Review and Commentary - Nursing home resident with Alzheimer’s disease falls from window, fractures hip: $555,000 verdict
Legal Review and Commentary - Nursing home resident with Alzheimer’s disease falls from window, fractures hip: $555,000 verdict
By Mark K. Delegal, Esq., and Jan Gorrie, Esq.
Pennington, Moore, Wilkinson, Bell and Dunbar, PA
Tallahassee, FL
News: After being transferred to a nursing home purported to have a secured Alzheimer’s unit, a 79-year-old man with the disease, while attempting to wander away from the facility, fell from an unsecured window and broke his hip. A Florida jury returned a $555,000 verdict against the nursing home and its parent company.
Background: Because the man was prone to wander, the operator of his previous nursing home felt it was not equipped to keep him from leaving the facility unaccompanied and suggested to the family that he be moved to a facility that could better address his special needs. The man transferred to a nursing home whose administrator claimed the facility operated a specialized, secured locked-down Alzheimer’s unit.
However, the new nursing home had trouble keeping its Alzheimer’s patients in house — residents could regularly be found at a nearby fast food restaurant. Although the nursing home was in Florida, it did not have central air or heat. Window air-conditioning units cooled the home, and it was common for the standard, double-hung windows, set approximately four feet from the floor, to be open.
The resident tried several times to leave through the open windows in the otherwise secured Alzheimer’s unit. One day, while trying to leave through an open window, he fell and fractured his hip. He later died from pneumonia, which was unrelated to his fall.
The plaintiff maintained that the nursing home facility did not properly operate the specialized Alzheimer’s unit, that the home was understaffed, and that the staff was overworked. The plaintiff’s expectations were not for one- on-one, staff-to-patient supervision, but for the Alzheimer’s unit to be secured.
In addition, the plaintiff said the facility did not use alternatives, such as ankle monitors that track the comings and goings of residents.
In its defense, the nursing home said that its staffing ratios and work hours were within reason and complied with state regulations.
Soon after the trial, the company operating the nursing home filed for bankruptcy. The facility was then sold and is now operated by another nursing home chain.
What this means to you: This case illustrates many of the challenges facing the nursing home industry, particularly those facilities providing dementia care. Prospective payment systems have become the standard for much of the health care industry, and nursing homes are no exception. Payment is based on predetermined rates, which are not necessarily associated with day-to-day, facility-specific operational costs. Rates are generally calculated on historic costs of services dating back three to four years, so reimbursement is generally fixed and finite. However, costs to maintain the standard of care for patients who are difficult to manage, such as those with Alzheimer’s, are rising.
"In order to operate within the constraints of prospective reimbursement systems, operational costs must be contained," says Susan Lind, corporate risk manager for American Baptist Homes of the West in Pleasonton, CA.
"In some instances, this has translated to there being fewer trained health care professionals caring for persons in nursing homes, with the balance being provided by custodial caregivers," she explains. "The situation in this case may have been the result of the custodial caregivers placing the patients’ comfort above their safety. Custodial caregivers would probably be more attuned to addressing the lack of adequate air conditioning than the fact that Alzheimer’s patients are prone to wander and need to be maintained in secured environments.
"In addition to the standard operating costs, over the last five years, the nursing home industry has seen a significant rise in the number and value of settlements and/or judgments against [facilities]. This is not to say that those judgments and verdicts have not been appropriate. It is more a note on another cause of the spiraling cost of nursing home care. In some instances, the per-day operational costs can be increased by at least 10% based on the cost of current malpractice/professional liability insurance premiums," Lind says.
"In this particular case, it seems that single adherence to maintaining a secure environment might have saved the resident’s hip on that particular day. However, given the fact that patients were often retrieved from a nearby fast food restaurant suggests that there were other means of escape. I cannot imagine that all of the patients found down the street actually climbed out of the open windows. If that were the case, it seems that staff training and education or perhaps some additional signage or a door monitor would have been beneficial to keeping tabs on residents’ whereabouts," she says.
Reference
Estate of George E. Kramer v. Unifour of Florida Inc. and Brian Center Health & Rehabilitation of Tampa Inc., Hillsborough County (FL) Circuit Court, Case No. 97-05481.
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