Choose your words wisely....

[Jo Dirt]

It is believed the nursing home where I work will be likely facing a possible lawsuit over a patient who has had a lot of falls lately. She is in her 90's and is not able to ambulate, though she can stand for transfers. She will try to either get out of bed by herself or put herself to bed and end up in the floor. The POA (who is not a relative) has become increasingly frustrated over the facility "allowing" her to fall. I have actgually had to fill out two of the incident reports on her in the last few months. I really do not believe it was the facility's fault, there are simply not enough people to hover over her every minute. We have taken every precaution we can (bed and chair alarms, low mattress with cushioned pad next to the bed, frequent reminders not to attempt to get up without assistance) but in spite of it she still has been falling. And it's nothing personal against this patient but she is as big as a cow and very clumsy.

Anyway, the most recent incident involved a minor bump to the head which resulted in a small inter (or intra) cranial bleed. She actually seems more alert and with it than she was before. We had a meeting about it. Apparently the nurse who called to report this to the POA said "the CNA dropped her." This was not what happened, but the administrator said when you have people looking to zero in on a lawsuit every word you say can and will be used against you. He went on to mention that another nurse in another report told her the reason the patient fell because we were "short" and since the patient wasn't put to bed when she was used to going she tried to put herself to bed.

Well, he didn't mention any names but this was me. I don't specifically remember telling the POA we were "short" but apparently I gave her the impression we were short staffed. The administrator said NEVER tell anyone you are short staffed, which we were not. I just wonder if this is going to come back to haunt me. I do not think this patient has suffered irreversible damage for this, but knowing how sue happy people are it just kind of eats at me.

BTW, it was the truth when I told the POA there was a call in which left us with not as much help as we usually had.

[MoopleRN]

If you had a call-in then you were, indeed, short. The NH I worked for was also very adamant that we never say we were "short". Their thinking (as I saw it) was that it implied they were too cheap to hire more staff (they were) and it just made for bad PR (it did). Nevertheless, there is almost NEver adequate staffing in NHs.

I don't see how can get dinged for saying there was a call-in. It was true. Rely on your documentation that care plans were updated for the falls/she has a hx of being impulsive. It's simply impossible to watch her 24/7/365.

[SuesquatchRN, BSN, RN]

How about care planning minimal restraints - side rails up, etc - with the POA's consent?

[Atheos]

Just a question...

I work at a private pay facility (which might be why I am under the impression that I am). When we have patients that fall constantly despite all the normal interventions it is normal to have a HHA specifically for them. Is this not the policy everywhere. Profits notwithstanding, isn't this a reasonable intervention. Shouldn't nursing homes be responsible for this?

Now I do understand that nursing homes are businesses and that businesses are about making money but isn't a nursing home responsible for maintaining adequate staffing and taking ALL reasonable steps to ensure the safety of it's residents?

Of course the OP doesn't say how the resident is falling but surely something can be done to address it. Technically if a nursing home is working short, they are at fault. We do have falls as well but we do everything possible from floor level beds to recliners to an extra aide. Maybe being in a private pay environment has spoiled me. Is my thinking unreasonable???

[RNsRWe, ASN, RN]

Administration here doesn't like anyone saying "we're short-staffed" either. They want to give the impression that there's dozens of nurses hovering about, waiting to cater to a patient's every need. It's bad PR if it gets around that there's just not enough nurses to properly take care of the number of admissions.

That said, I ALWAYS will let a demanding patient know that we're short-staffed (if we are, of course). I will be gosh-danged if I'm going to let people think I'm just incompetent, and unable to manage my time properly! I always say something like "I'll get here as quickly as I can when you need me, but please understand that I may be taking care of someone else first and it may take awhile".

No one should have said "the CNA dropped her". Poor choice of words. But I fail to see why you should be on the hook for admitting that you are not Wonder Woman and cannot possibly be in all places at all times.

[BinkieRN, BSN, RN]

We have taken every precaution we can (bed and chair alarms, low mattress with cushioned pad next to the bed, frequent reminders not to attempt to get up without assistance) but in spite of it she still has been falling. And it's nothing personal against this patient but she is as big as a cow and very clumsy.

With a patient such as this precautions are not enough. Everyone knows that patient chair and bed alarms do not go off until the patient has disconnected it by getting up and/or falling. By the time you hear the alarm it's too late, especially down a hall.

Frequent reminders to a patient who does what she wants to anyway are worthless.

It seems that the NH has the most copability in this situation. If the patient is not safe, her family should stay with her until she's asleep or should pay someone to sit with her. If the family is not willing then the NH should refuse to keep her there.

It sounds more like they're attempting to use you and a CNA as scapegoats. The ultimate responsibility is theirs regardless of what the staffing was like at the time of the incident

I would suggest they call an agency or the DON / ADON should come in and cover.

[Xbox Live Addict]

Just a question...

I work at a private pay facility (which might be why I am under the impression that I am). When we have patients that fall constantly despite all the normal interventions it is normal to have a HHA specifically for them. Is this not the policy everywhere. Profits notwithstanding, isn't this a reasonable intervention. Shouldn't nursing homes be responsible for this?

Now I do understand that nursing homes are businesses and that businesses are about making money but isn't a nursing home responsible for maintaining adequate staffing and taking ALL reasonable steps to ensure the safety of it's residents?

Of course the OP doesn't say how the resident is falling but surely something can be done to address it. Technically if a nursing home is working short, they are at fault. We do have falls as well but we do everything possible from floor level beds to recliners to an extra aide. Maybe being in a private pay environment has spoiled me. Is my thinking unreasonable???

No, this is NOT the policy everywhere. In fact, no nursing home I have ever worked at has ever assigned 1:1 care to any resident, for any reason. The only thing that would warrant that kind of care in almost any NH is an actively suicidal resident with the means to carry it out, and such a resident would probably be sent to a psychiatric facility. No nursing home is going to pay one staff member to stay with one resident for 8 hours. If the family wants their loved one to have a 1:1 sitter, they have the option to provide one, if they are willing to pay the sitter's entire wages out of their own pockets. However, most of these residents were minimal fall-risk and simply had families with deep pockets and a deep distrust of NH staff. High-risk patients do get low-rider beds with mats, as well as body alarms.

Extra staff? Out of the question in facilities whose primary source of income is money from Medicare and Medicaid. It cuts into the bottom line too much.

[Atheos]

Only asking because when I was in the Medicaid/Medicare nursing homes, I don't really have memories of excess falls. Maybe one or 2 people but we always had them covered and knew their routines...

Hmm maybe private pay has spoiled me.

[Xbox Live Addict]

If you had a call-in then you were, indeed, short. The NH I worked for was also very adamant that we never say we were "short". Their thinking (as I saw it) was that it implied they were too cheap to hire more staff (they were) and it just made for bad PR (it did). Nevertheless, there is almost NEver adequate staffing in NHs.

I don't see how can get dinged for saying there was a call-in. It was true. Rely on your documentation that care plans were updated for the falls/she has a hx of being impulsive. It's simply impossible to watch her 24/7/365.

Yep... I heard from management at every NH I ever worked at to never tell a family member that we were "short" or to give that impression. That is to cover the facility. Of course, most family members know that the facility is short-handed anyway whether you say so or not. They're not stupid or blind. They can tell that there's only a handful of staff members running after every call light, and they can see the staff members are harried. I can't tell you how many family members have told me or someone else that they felt sorry for us because we were so short-staffed.

However, it is true that lawyers have the knack for zeroing in on certain key words that can be used to ensure a nice settlement too.

[Atheos]

Also not to be judgmental but short staffing is always the NH's fault. Even if there is a call in the staffing coordinator should have multiple contingency plans and plans for if the contingency plans fall through. Of course I am speaking as a Staffing Coordinator. While nurses can be hard to get sometimes, there are always large amounts of CNAs and HHAs willing to be on PRN pools for the occasional shift here and there.

The one distinct thing I remember from my previous nursing homes is that when people called in there was 'minimal' effort to replace them and that's being generous. Many places I see consistently have holes in their schedules and barely have a PRN pool. There is never a real excuse to be short staffed unless the NH happens to be in a very small area with a small population. Even if they have to cut deals with agencies...

[Jo Dirt]

With a patient such as this precautions are not enough. Everyone knows that patient chair and bed alarms do not go off until the patient has disconnected it by getting up and/or falling. By the time you hear the alarm it's too late, especially down a hall.

Frequent reminders to a patient who does what she wants to anyway are worthless.

It seems that the NH has the most copability in this situation. If the patient is not safe, her family should stay with her until she's asleep or should pay someone to sit with her. If the family is not willing then the NH should refuse to keep her there.

It sounds more like they're attempting to use you and a CNA as scapegoats. The ultimate responsibility is theirs regardless of what the staffing was like at the time of the incident

I would suggest they call an agency or the DON / ADON should come in and cover.

Of course chair alarms and reminding a demented patient not to get up are useless, but we're dealing with beaurocracy, not common sense!

I wasn't the nurse who said the patient was dropped, but I was the one who said we were working without as many aides. In the nursing home's defense, they actually staff more than state regulations require. Just happens that call-ins always leave you in a bind.

[towntalker]

i have seen one on one care vey few times in the ltc

one was where the resident had raped another resident she was not really able to identify him and he was probably not competent to stand trial so they had him on one on one till he could be shipped out to another facility

another time was when we had a sucidal resident who was also sipped out to another place where closer care was available

depending on your census the administrator might encourage family consider some where else