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Nursing Home Negliegence: Part II


The Omnibus Budget Reconciliation Act of 1987 required nursing homes and skilled nursing facilities to comply with specific regulations in order to participate in Medicare and Medicaid programs. The Act, combined with heightened awareness of the neglect and abuse found all too often in facilities caring for such a vulnerable population, led to a drastic decrease in the use of physical restraints on residents. Medicare statistics show that 21.1% of nursing home residents were physically restrained on a daily basis in 1991, but only 5.5% of residents were restrained in 2007. In Pennsylvania, a voluntary program was introduced to ban the use of physical restraints altogether; 90% of all state nursing homes participated in the program and the use of physical restraints was reduced to 2.8% of residents in 2008.

Over the last 20 years the number of inpatient falls has increased. Falls are particularly devastating for people over 65 years old: in fact, from 2002-2012, over 200,000 Americans over 65 died from falls, and falls are the leading cause of death in that age group. In addition, the number of people over 65 who died after a fall reached 24,000 in 2012, almost double the number in 2002 according to the Centers for Disease Control and Prevention.


What does all this mean? While studies are quick to conclude that physical restraints do not increase residents' safety, the increase in falls and injuries during the same period of time that restraints were decreased leads to questions. No one is advocating the use of physical restraints as a method of punishment, or to make patient care easier. These abusive uses of restraints were the reasons for the movement away from the use of physical restraints (and are prohibited by federal law). But, as is so often the case with good intentions, the pendulum may have swung too far in the opposite direction and in doing so created new risks to residents.

More specifically, the refusal by many nursing homes and skilled nursing facilities to use any restraints may put the most vulnerable population--the non-mobile, wheelchair bound residents--at greater risk. Thirty-five percent of all fall injuries in homes and facilities occurs among residents who cannot walk. These fall injuries are not due to items left on the floor, or dimly lit hallways; these injuries occur due to falling out of wheelchairs, out of chairs, and out of beds. The lap trays, wheelchair belts and bed rails that could prevent some of these falls are considered physical restraints, and either are not used at all or are used in very limited circumstances.

There are two ways in which a nursing home or skilled nursing facility may address the fall risks of its non-mobile population. One is to incorporate a doctor's order for a certain physical restraint to be used in specific circumstances into the resident's care plan. A second way is to monitor the resident almost continually in order to notice when he or she may begin to fall out of the wheelchair or bed. Given the limited staffing in most facilities, this latter option seems impractical at best.

If a resident has fallen, particularly if the fall risk of the resident has already been identified and brought to the attention of the facility, then the facility may be negligent in not addressing the risk properly.


If you have a loved one in a nursing home or skilled nursing facility and they have fallen or are at risk of falling, contact Dave Thomas at The Thomas Law Firm for a free evaluation of your legal rights.

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Thomas Law Firm
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