Dementia Care: Court Faults Assisted Living Facility.
Legal Eagle Eye Newsletter for the Nursing Profession
December 2017
It is not the final word that the resident’s admission contract with the facility was only for assisted living and expressly excluded care for behavioral problems or issues associated with Alzheimer’s disease or other dementias.
The evidence is clear that this assisted living facility routinely accepted residents with Alzheimer’s disease. When a resident’s dementia became too severe the resident was transferred to a more appropriate placement. However, that implies that the transition from moderate to severe dementia would occur while an individual continued as an assisted living resident. In fact, before she fell out of a third-story window, this resident had been sent to an inpatient behavioral center for a two-week evaluation for agitation, aggressiveness and wandering, and then was returned to the assisted living facility.
When her continued presence in assisted living was no longer appropriate, the director should have had the nursing director immediately make arrangements to get her into a placement that met her needs.
COURT OF APPEAL OF LOUISIANA November 15, 2017One afternoon an eighty-four year-old woman who was living in an assisted living apartment was found in the parking lot of the building looking for her car. She was redirected back into the building and participated in scheduled activities later that day. She was in her room at the 9:00 p.m. bed check, but was not there at 11:00 p.m. Staff searched and found her outside lying unconscious on the ground, apparently having fallen out of the third-floor window of her apartment. Her injuries included leg, hip and rib fractures and head trauma causing intracranial bleeding.
After the resident passed away two and one-half years later her sister sued the facility on the family’s behalf. The medical review panel rejected the lawsuit. However, the Court of Appeal of Louisiana reinstated it, finding that grounds existed for allegations of negligence against the facility.
Her admission contract with the facility expressly excluded behavioral services and dementia care and the facility was not licensed as a nursing home. However, the Court ruled those facts did not limit the legal duties that were owed to this resident who clearly needed a much higher level of care than simple assisted living.
Before her fall the resident’s agitation and frequent wandering had prompted a two-week stay for evaluation at a behavioral health center. The diagnosis was dementia so severe that communication with her was almost meaningless. Nevertheless she was returned to assisted living. Once this resident’s needs were known, close or constant monitoring for wandering and extra nursing services had to be provided, even if special nursing help had to be brought in, to ensure that her wandering was not a threat to her safety, while placement elsewhere was arranged.
A legal twist potentially in the facility’s favor is that the bar has been raised so that the family’s case will fail at trial with-out expert nursing testimony as to the correct diagnosis, assessment and interventions that would have prevented her fall.
In re Lyons, __ So. 3d __, 2017 WL 5473698 (La. App., November 15, 2017).More references from nursinglaw.com
http://www.nursinglaw.com/assisted-living-mobility-issues.htm
http://www.nursinglaw.com/assisted-living-fall.htm
http://www.nursinglaw.com/assisted-living-memory-care.pdf
http://www.nursinglaw.com/assisted-living-mobility.pdf