Skilled nursing facilities must conduct an assessment of every patient when they enter the facility to determine—amongst other things, how much (if any) assistance is required for particular activities. For patients with physical limitations, there is almost universally some level of assistance necessary from staff in order for the patient to function safely. While not always a primary consideration, facilities must consider the level of assistance required when patients are in the bathroom. For patients who require the assistance of one or two staff members, the supervisory protocols must be adhered to even in situations where patients normally request privacy.
Goodbye Privacy, Hello Safe Practices
Unfortunately, there really is no such thing as privacy for a patient who requires the assistance of staff members. Even if a patient requests to be left alone, staff must adhere to the prescribed regimen. I was reminded about this tricky situation of keeping patients safe—even when they request privacy–. When I began reviewing the records on a new nursing home negligence case. The circumstances of the case are relatively common: a 90-year-old woman who was admitted to a nursing home for rehabilitation following a stroke that left her with essentially no mobility of her right side. On admission, the staff at the facility (correctly) determined that this patient required the ‘full’ assistance of two staff members for virtually all activities.
Following the Care Plan, Not The Request Of The Patient
Prior to the incident, my client (a feisty woman) requested that the two CNA’s who were assigned to care for her, take her to the toilet (even though she was incontinent and used undergarments). Contrary to the woman’s care plan, the CAN’s obliged the request and took her to the toilet where they allowed her to sit on the toilet in privacy as they left the bathroom—closing the door behind them. Not surprisingly, a short time later the CNA’s re-entered the bathroom area when they heard cries for help coming from the woman as she lay on the floor. The obvious had occurred and my elderly client lost her balance on the toilet and fell striking her shoulder and head on a nearby sink.
In the process of this unsupervised fall from the toilet, my client suffered a horrific displace fracture of her clavicle, a fractured skull and subdural hematoma. Within seconds any prospect of any type of a meaningful recovery was gone. In this case, the blame game points directly at the CNA are who were responsible for caring for this woman. However, as I anticipate that this case will require some litigation, my guess is that this facility never instructed their staff on the complete meaning of ‘full assist’— bathroom and all. Having worked on a number of cases involving incidents in the bathroom where patients have been significantly injured or killed when they fell or were dropped by staff— I think it’s important for the facility to advise patients and their families about the necessary level of assistance—how it will be implemented by staff. When patients are at least advised of what the protocol is with respect to assistance from staff during daily activities that are generally deemed private, there is much more a chance that patients comply with the assistance necessary to keep them safe.