Before the Fall: Case study of a nursing home incident

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This is a true story, with the names changed and facts altered slightly to protect identities.


“Gina” was married for many years to “John”, and the couple lived in a large, comfortable home. They had no children, and no relatives in the area. Gina had been a WWII bride. Both had retired after long and productive careers. John was an artist, who loved to paint and putter around the house. Gina did the cooking and kept their home. She could no longer drive a car. She depended on others to get around town.

John began to have some balance problems as he passed age 80. One day, he injured his foot and developed a problem that required surgery. Because he needed help walking after the surgery, the doctors decided to send him to a nursing home to recover. The nursing home was chosen by the hospital staff, in the county where the couple lived. John was expected to stay in the nursing home for about two weeks, mainly for physical therapy. He got a wheelchair, and used a walker.

John got confused in the nursing home. He wasn’t used to the routine. It seemed to upset him. He didn’t say much. He kept trying to get up by himself. The nurses put his wheelchair next to the nurse’s station. They told him to stay put, but he forgot to do it. He could stand up and walk a few steps, but his balance was poor. Gina was worried. She talked to the nurses about it. They reassured her that John would be fine, they were watching him. He was going to physical therapy. He was able to walk with help, using a walker.

Two days after Gina had expressed her worries about John getting up from the wheelchair by himself, John did it again, and fell on his knee. He was bruised, but fortunately, not seriously hurt. Gina was upset. She talked to the nurse when she visited the next day. “Can’t you keep him in the chair?”, she asked. The nurse told her that they had a chair alarm, and that would let them know if John tried to get up again. It would go off and give them warning, the nurse said. They showed Gina just how close to the nursing station John’s wheelchair was kept, and told her not to worry.

Gina visited at night. Before she left, she spoke to the nurse again. “I’m worried about him”, she said. “He tries to get up all the time. Can’t you put a rope around him or something? I give you permission”, Gina told the nurse. The nurse told Gina they didn’t do that. They’d watch John, the nurse told Gina. She didn’t need to worry, everything would be all right. The chair alarm was on, and if he got up, it would go off and they’d be there right away. Gina kissed John good night and went home.

Before she opened the door to her house, she heard the phone ringing. It was the hospital. John had gotten up from the wheelchair and had fallen on his arm. It appeared to be broken. They had sent him to the hospital for x-rays. He would need to be in a cast. Unfortunately, he wouldn’t be able to use the walker, because he couldn’t hold onto it with the broken arm. Gina was in tears. “What will happen to my husband?” she thought.

Gina went to see John the next morning. “Why didn’t you watch him?” she asked, furious. The nurse explained that when the chair alarm went off, the nurse couldn’t get to John in time. Gina wanted to know why they didn’t keep him in the chair, tying him in, or whatever they could do. The nurse didn’t answer her.

John had to have his arm in a cast, in a sling. He couldn’t walk, because the walker took two hands. No one seemed able to take him for a walk without the walker. He just sat in the wheelchair day after day. He grew weaker, and had difficulty standing. He grew depressed. Gina was angry. She eventually made arrangements for John to move to another nursing home, but things were not much better there. John never regained the ability to walk again. By the time his arm healed, he had lost so much strength in his legs that he wasn’t able recover that strength. He lived out his life in the wheelchair, growing more confused and frail each week. He died there, in the nursing home, never able to see his own house again.

Gina eventually sued the nursing home. She based her case on the fact that the nursing home had fair warning that John was likely to get up from the wheelchair, and they took no reasonable steps to protect him from falling. The chair alarm was totally ineffective, as it took a minute or several minutes for the nursing staff to get to where John was, and by then, it was too late.

The nursing staff could have asked John’s doctor for a doctor’s order for a seatbelt for his wheelchair, for a chair tray which would have fastened to the chair and kept him from getting up, or from any other similar device to protect him. They never did that. Why? They claimed that they didn’t want to “restrict his freedom”. Perhaps it was too much trouble to watch him more often, as they would have had to do if he did have a seatbelt or chair tray restricting him from getting up.

What do you think?


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