Over the 22 plus years I have been in elder law I have too often received the call from the family “Dad died last night.” He went to a nursing home after a hospitalization and they planned he would return home after a few weeks. But, it didn’t happen. It is true, seriously ill elders can die from something that a younger person would simply bounce back from. But still you wonder “did it have to happen?”
Sometimes, it did not have to happen.
I attended the fall elder law conference of our State Bar and attended a presentation by national expert in facility litigation, Barbara Mackenzie. She gave a list of injuries that should not happen and if they do, they are warning signs that something may be seriously wrong.
Use this list if you have a family member in a nursing home or any elder care facility such as assisted living or memory care. Each of the following is an indicator of a potential life-threatening problem. Use this rule: Any problem must not be repeated and must have a prevention plan.
1. Bruising: Always check your elder. Periodically be there at bathing time. If you see a bruise or any injury including skin rash or redness, investigate! Ask how, when and where it happened? What is the treatment and prevention plan? When an unexplained bruise appears review with staff whether they know what caused the bruise or not. If they do not know there is a chance it happened in bed.
2. Bed Injuries. A bed should be a safe place. If there are rails to keep your elder in he or she may try to climb over them to get to the bathroom. It is very difficult for a frail, weak elder to climb over a rail. They may easily fall and suffer a bruise and or worse. There have been cases where the fail elder died of suffocation when her neck got caught between the bed and rail.
3. Bed sores/skin ulcers. Unless your elder has been diagnosed with a medical condition that makes such injuries likely, they should not be expected. These may happen in bed, especially for incontinent elders, and also in wheelchairs. An ulcer on an ankle may result from being immobile in the chair all day long. These are another reason you should be present at bathing. Know the early stage warning signs and be sure the facility has a treatment plan.
4. Injuries from Restraints. Restraints keep an active elder from getting up. They may be used in a chair or in a bed. Wherever they are used the elder will try to get free of the restraint and be injured in a number of ways. If it is unsafe for the elder to walk, alarms may be used and are less dangerous. They can be used on chairs, or on the floor by the bed. When the elder moves enough the alarm sounds. Because of the great risk of injury restraints should not be used without medical orders and with an approved plan.
5. Choking/asphyxiation/aspiration. If your family member had a choking episode during meals you should inquire. Did he/she have a special diet? Was it followed? Sometimes an aide will give a resident the wrong meal.
6. Head Injuries. If your elder has a bandaged wound on the head find out not only how it happened but what was the facility response? Injury to the head can also result in serious brain injuries including concussion and uncontrolled bleeding for a resident on blood thinners.
7. Falls. Use this as your rule: Falls kill. Any fall should be investigated for cause and a plan of action. A broken hip can be the beginning of the end for an active elder. A broken bone requires surgery. The elders may not survive the surgery, the anesthesia or the subsequent consequences from being inactive. Falls are especially dangerous for a person on blood thinners.
8. Medication errors. It should not happen, but it does. Your family member should not receive another person’s medications or those that are contraindicated.
9. Wandering. Elders are often injured when they wander outside of the facility Unplanned leaving the building should never happen. Determine how it happened and what the correction plan is.
10. Anxious and Fearful. If your elder is anxious and fearful, it may be due to treatment he or she receives when nobody is around. According to McKenzie much elder abuse occurs on the overnight shift when nobody is supervising the employees or other residents.
There are number of themes running through all the above that together make an Emergency Response System:
1. Determine “what happened?” Get the facts, do not be satisfied with quick explanations that it was a freak occurrence that will never happen again.
2. “What was the facility’s response?” How fast did they act? Was the resident thoroughly evaluated and was appropriate medical treatment obtained?
3. “What is the facility’s plan to prevent it from happening again?”
4. What is your plan of action?
Once again, the moral of the above is that you must be your elder’s advocate.
Camera in the room. We note that many of the injuries happen in the resident’s room. While you cannot be there in person you can be there virtually. Put a camera in your elder’s room that you can access from your computer or cell phone. You can check and see how s/he is doing and call the facility if you notice something that needs attention. An injury incident that happens in the room will be recorded. A camera may be especially beneficial for cases of falls. Was the elder calling for help and no one came? Did it happen while an aide was in the room?
If your elder is anxious and fearful you can observe and see if anything happens at night to cause the problem. One family recorded an aide physically and verbally assaulting their parent. Do residents wander in at night? Does your elder experience hallucinations at night? Does s/he call for help and no one comes? You can spot the problem and have it addressed.
Michigan law allows you to have a camera in the room as long as you do not include other residents in your camera view, You may want to inform the facility not so much as to get their permission but perhaps your elder’s room will receive ‘gold star treatment.’
Make your plan. Determine the cause of the injury. Determine the facility’s response. Make your own plan. For each incident you will investigate what happened and what medical treatment your elder received. You will also investigate any plan they have put in place to remedy the problem. You may find that too often they treat the incident as an isolated event rather that as a symptom of a bigger problem. You may decide that your elder needs to move from the facility because they cannot provide proper care.