The Complexity of Elderly Falls in Nursing Homes
For personal injury attorneys, differentiating the cause of falls among elderly residents in nursing homes is a task fraught with complexity and nuance. These falls can have devastating consequences, from serious injuries to tragic fatalities, and determining whether they are due to natural causes like osteoporosis or a result of nursing home neglect is paramount. This discernment is not just a legal challenge but a critical aspect of advocating for the rights and wellbeing of elderly clients.
Prevalence of Osteoporosis in the Elderly
The prevalence of osteoporosis in the elderly and its impact on fall risk is well documented. Osteoporosis weakens the bones and bone strength, causing bones to be brittle. Aging leads to a natural decrease in bone density, and osteoporis exacerbates the process. Postmenopausal women and elderly men are particularly susceptible to osteoporosis. According to findings noted in the Centers for Disease Control and Prevention, osteoporosis was found to be more prevalent in women than men and higher among adults aged 65 and over than adults aged 50–64. There is estimated to be up to a 90% prevalence of osteoporosis among nursing home residents.
Osteoporosis and Falls
Fractures are the main burden associated with osteoporosis.
- Weak bones can contribute to an increased risk of falls
- Fragile bones are more likely to break upon impact, leading to fractures after a fall
- Osteoporosis is a contributing factor to spine kyphosis (round back or hunchback) leading to poor control of posture
- Elderly resident with osteoporosis is inherently more vulnerable to falls
- Osteoporosis can likely exacerbate the severity of the impact of a fall
- Osteoporosis-related fractures can have severe consequences, especially in the elderly
- Subsequent falls with injury increases
The Challenge of Distinguishing Causes
Navigating the cause of a fall and injury can be challenging. The presence of osteoporosis can complicate matters when determining whether a nursing home long-term care facility’s negligence played a part in the fall and the resulting injury. Distinguishing between falls caused by osteoporosis and those resulting from neglect of duty requires a nuanced approach that considers both medical and environmental factors. It involves not just a review of the resident’s medical history, but also an assessment of the care facility’s practices and standards.
The complexity is further compounded by the intricate nature of elder care. Elderly residents often have multiple health issues, which adds another layer to the challenge. For instance, a resident with osteoporosis might also have mobility issues or cognitive impairments, which could contribute to the risk of falling. This multifaceted health landscape requires a comprehensive understanding of both medical and care-giving aspects.
Additionally, the regulatory environment surrounding nursing homes adds another layer of complexity. Attorneys must navigate through various federal and state regulations that govern nursing home operations and standards of care. Understanding these regulations is crucial in determining whether a nursing home has breached its duty of care or if the fall was an unavoidable incident.
It is advisable for attorneys to consider the broader context of each case. Factors such as staffing levels, training protocols, and the overall environment of the nursing home play a significant role. A thorough investigation might reveal systemic issues within the facility that contribute to a higher risk of falls, pointing towards organizational neglect.
Distinguishing between falls caused by osteoporosis and those resulting from neglect requires consideration of both medical and environmental factors. It involves not just a review of the resident’s medical history, but also an assessment of the care facility’s practices and standards.
Expert Analysis by Legal Nurse Consultants
A Legal Nurse Consultant (LNC) can provide valuable support to attorneys in evaluating the care provided by the facility. Though osteoporosis is characterized by weakened bones, a consideration is to determine whether osteoporosis is among the diagnoses of the resident. The first step for the LNC is a review of the medical records, review of the medical history and the problem list to determine whether osteoporosis is among the problems. Further review of the medical records will provide information of the prescribed medical management, if osteoporosis is among the diagnoses.
Using their clinical expertise, combined with their understanding of nursing home protocols and standards of care, LNCs can obtain valuable information during the review of the medical records which can reveal the practice of the facility. They can gain insight into the quality of care provided and identify deviations from accepted medical and nursing practices. This insight is crucial in cases where neglect is not immediately apparent but may have contributed to an incident.
Additional considerations during the analysis of the medical records may include:
- The fall risk assessment.
- Level of assistance required for activities for daily living.
- Care planning for fall prevention
- Mobility aids use
- Implementation of the plan of care for prevention of falls
- Physical therapy
- Occupational therapy
- Supervision by staff
An elderly resident with osteoporosis is inherently more vulnerable to falls, but this vulnerability can be exacerbated by inadequate care. Failure of a nursing home-long term care facility to evaluate and implement the necessary fall prevention measures is neglect of duty regardless of whether there is a diagnosis of osteoporosis.
Benefits of Use of Legal Nurse Consultants
The LNC’s role extends beyond that of reviewing medical records. They can help identify the strengths and weaknesses of a case, advise on the feasibility of legal claims, and suggest potential avenues for investigation. Their expertise can be instrumental in providing information to aid the law firm in deciding whether to proceed with the case.
LNCs provide a critical bridge between legal teams and medical experts. Recommendations of and location of experts such as orthopedic surgeons or geriatric specialists to provide insights into how osteoporosis contributed to the injuries may be required.
In sum, LNCs are not just ancillary support; they are a vital component of the legal team. If needed, they can help with trial preparation of witnesses. Their medical expertise, coupled with an understanding of legal processes, makes them an indispensable asset in unraveling the complexities of elder care cases, particularly those involving falls in nursing homes.
Learning from Real Cases
Several years ago, there was an incident involving a 90+ year old resident. Let’s call her Ms. Bee. Ms. Bee was thin, fragile in appearance, but feisty and strong. Unfortunately, Ms. Bee experienced episodic confusion. She loved to blow kisses and kiss the staff’s hands when they entered her room. During one of her confused moments of resisting care, she vigorously kicked the bed rails. Her thin, porous bones were no match for the bed rails. Ms. Bee fractured her femur. Ms. Bee’s injury was an accident, a result of her vigorously kicking the bed rails. The nursing home-long term care facility was not at fault.
In another case, let’s call her Ms. Jay. At age 80, Ms. Jay had a prior fracture of her left hip, dementia, and a diagnosis of osteoporosis. She was totally dependent on staff for all activities of daily living except for eating her meals. She was assessed to be a high fall risk and required the assistance of two for bed mobility and transferring from and into her bed. The care plan noted the requirement. Documentation in the medical records noted some occasions of transfers by one member of staff. Unfortunately, on one such occasion, she sustained a fall and a hip fracture while being transferred by one staff member. Opposing counsel argued that the fracture resulted from her having osteoporosis rather than the transfer by one staff member as there were successful one person transfers previously documented. That argument was lost!
Though in both cases there were injuries because of weakened bones, the cause differed. Though the client in the second case had osteoporosis, she was dropped by staff during the one-person transfer causing a fracture of her hip.
Ensuring Informed Decisions
The comprehensive case analysis by LNCs helps attorneys make informed decisions about proceeding with litigation, negotiating settlements, or advising clients on the best course of action, based on a comprehensive understanding of the clinical and medical aspects of the case.
Advocating with Precision and Empathy
For attorneys handling cases of elderly falls in nursing homes, collaboration with LNCs is indispensable. Their expertise ensures that every case is approached with a blend of precision, empathy, and objectivity, upholding the rights and dignity of the elderly, and defending the institution if the allegations are unfounded.
A Call to Action for Legal Advocates
Attorneys are encouraged to seek the expertise of legal nurse consultants to navigate the complexities of their cases. The addition of an LNC to the legal team can ensure a thorough objective analysis of the care and case facts. This will arm the legal team with the necessary information to advocate for justice, and ensure that the highest standards of care are upheld for our elderly population.
To enhance your legal team’s capabilities in your next nursing home case, consider partnering with a knowledgeable LNC from E. Wills Legal Nurse Consultants. Their expertise could be the key to achieving the best possible outcome for your clients.