ADLs are activities of daily living—dressing, eating, bathing, toileting, ambulating, etc. Hospital patients and many nursing home residents, either because of advanced age or poor health or both, require staff’s assistance with their ADLs. An assessment is completed by the staff on admission to determine the extent to which a resident will need the staff’s assistance with her activities of daily living. The resident’s need for ADL assistance is supposed to be documented on the care plan, and interventions or measures are developed by the staff explaining how and when that assistance will be provided to the resident. If the staff fails to document the care plan in this way, that omission can be evidence of negligence. However, most of the time the nursing home documents the care plan appropriately. In fact, when it is sued, the nursing home is quick to point out its detailed care plan for the resident. The real question, however, is whether the staff consistently implemented the care plan.
The staff’s failure to timely and consistently implement the care plan interventions often results in neglect and abuse, usually with severe consequences for the resident. Here are some examples, based on actual cases:
- a resident who requires staff’s assistance with eating and reminders to drink lots of fluids repeatedly does not get that assistance, experiences a rapid weight loss, becomes malnourished and dehydrated, and has to be admitted to the hospital for IV therapy, and while at the hospital contracts MRSA and sepsis, prolonging her stay at the hospital.
- a resident needs the staff’s help walking to the bathroom, uses her call light for 30 minutes but no one comes, so she tries to walk to the bathroom on her own and falls and fractures her hip, requiring major surgery and rehabilitation.
- a resident requires the staff’s assistance ambulating in general, yet he is allowed to wander unsupervised and falls and fractures a leg, requiring surgery, and while at the hospital, develops pneumonia and dies.
- an incontinent resident who is unable to clean himself after each incontinent episode needs staff’s assistance but doesn’t get it, and has no choice but to lay in his own feces and/or urine for an extended period of time and eventually develops a large and very painful bedsore on his buttocks, which later becomes infected.
- a bedridden resident who is unable to turn and reposition herself must rely on the staff to turn and reposition her every 2 hours to help prevent skin breakdown, but the staff consistently fails to do so and she ultimately develops a deep bedsore on her heel, which later becomes infected and develops gangrene, requiring amputation of the resident’s leg above the knee.
Many of the injuries that nursing home residents suffer could be avoided if the staff would just monitor the residents more closely. The problem, however, is that the nurses and aides are overworked because the nursing home is understaffed. Or, the staff is not adequately trained. Or, the nursing home has excessive turnover and must rely on agency staff. Whatever the reason, the residents are the ones who suffer the consequences. Tip: Gaps in a resident’s nurses’ notes for weeks or months at a time is an indication that the staff is not adequately monitoring the resident.