Tales from our files – Lessons Learned Concerning Nursing Home Care

Nursing Home Care

My legal practice is concentrated in assisting victims of nursing home negligence throughout Massachusetts and Rhode Island. Over my twenty-five year career, I believe I’ve seen nearly every conceivable fact pattern concerning neglect and abuse at these facilities. It recently occurred to me that providing examples of the problems that my clients have encountered over the years might serve a useful purpose in helping others to avoid common lapses in nursing home care.

Upon the initial admission to a nursing home, the staff is obligated to conduct an assessment of each patient to properly assess that person’s needs and to create an individualized “Care Plan” for them. If done correctly, the assessment will determine, among other things, whether an immobile patient requires assistance in “transferring” or moving from bed to chair or to the bathroom. The overall safety and welfare of the patient is the principle concern, of course. Sometimes, however, facilities are either understaffed, unprepared or simply “too busy” to properly and safely address the critical needs of their residents.

I had the honor to represent an 88 year old woman that I’ll call “Ann.” She had long been a resident of the defendant’s facility due to advanced Alzheimer’s Disease and other medical complications. Sadly, Ann was unable to verbally express herself, was non-ambulatory and remained completely dependent upon the defendant’s staff for all activities of daily living. Despite her many medical complications, Ann did not suffer from osteoporosis, however. The importance of this latter fact will become clear as you read on.

One day, Ann was being transferred to her bed with the use of a machine known as a Hoyer lift. It was immediately after this transfer that the she began to crudely express that she was in pain. Oddly, no trauma, fall or other “event” was recorded by the defendant’s employees in Ann’s medical chart. When her pain became unbearable, Ann was transferred to the hospital where she was diagnosed with a markedly displaced femur fracture with fragmentation and a massive hematoma. Her extensive injuries required immediate surgery. Ann’s family suspected that she had been dropped during the transfer on the Hoyer lift but the facility vigorously denied this. The case was further complicated inasmuch as there was no independent witness to any suspected accident. We argued that the displaced fracture of the patient’s femur, the body’s largest and strongest bone, was sufficient evidence that a trauma had indeed occurred. Moreover, we argued that the “fragmentation” (splintered bones) and “hematoma” (deep bruising) were corroborating evidence of a traumatic event that the facility had conveniently neglected to record. In response, the facility hired a medical expert who was prepared to testify at trial that Ann could have suffered her fracture by “organic means” (e.g. brittle bones in the elderly can sometimes break spontaneously-without a trauma). They cited the common occurrence of a senior suffering a rib fracture after a hearty sneeze. We successfully refuted this suggestion by conclusively demonstrating that Ann did not previously suffer from osteoporosis or other skeletal degeneration which would tend to make her bones exceedingly brittle and thus subject to fracture without first suffering a trauma. During the course of our investigation we also discovered that, even before Ann was a resident, this particular facility engaged in a systemic failure to promptly and accurately report accidents that injured their residents.

A large settlement was reached on the eve of trial, presumably because the facility was fairly convinced that a jury would likely punish them for their deception in failing to own up to their role in both causing and properly reporting Ann’s accident.

As always, a family’s best defense against nursing home neglect is both vigilance and active involvement in the care of their loved one.