Skilled Care vs. Assisted Living: Expert Misstated Standard Of Care, Still No Negligence Found.
Legal Eagle Eye Newsletter for the Nursing Profession
September 2018
The facility is licensed for assisted living and for skilled nursing care. This patient was a skilled nursing patient and not an assisted living resident.
The facility’s medical expert opined that the facility met the standard of care for an assisted living facility. It was not an innocent typographical error for the facility’s expert in defense of this case to make reference in his written report to the much less demanding standard of care for nursing in an assisted living center as opposed to a skilled nursing facility. A skilled nursing patient’s needs are greater and the care is considerably more complex than with an assisted living resident.
That being said, the patient’s estate cannot point out how the nurses at the facility violated the standard of care through any error or omission, even accepting the more demanding standard of care for skilled nursing as opposed to assisted living. It is also not clear how the nurse’s actions or inactions contributed to the demise of this critically ill patient already on hospice care. COURT OF APPEALS OF NEBRASKA August 7, 2018
A fifty-one year-old patient was admit-ted to the facility from the hospital with a primary medical diagnosis of multiple myelomas accompanied by pancytopenia that left her very weak and debilitated. She required skilled nursing care for an infection at her chemotherapy port site. The physicians’ recommendation was for basic hospice care. A DNR order was placed in her chart.
Hours after admission she was found on the floor of her room. The nurses examined her and put her back to bed. Two days later the nurses assessed her medical situation as unstable and had her sent to a hospital emergency room. In the hospital an active subdural hematoma was discovered. It could not be operated upon because her platelet insufficiency ruled out surgery. Chemotherapy was discontinued and she was simply given pain medication until she passed away a few days later.
The patient’s long-time boyfriend, as her probate administrator, sued the facility for negligence. The Court of Appeals of Nebraska dismissed the case. The Court went to great lengths to point out that the standards for skilled nursing care are considerably more demanding than those for nursing care in assisted living. The facility’s physician expert was off the mark with an opinion that the facility’s nurses met the relatively less demanding standard for nursing care in assisted living, because this person was clearly a skilled nursing patient admitted for skilled care.
However, there still was no proof to be found that the patient actually fell in her room or that fall precautions would have prevented a fall, if in fact she fell. Her medical situation was so dire that reporting the episode to her physician, if that was not actually done, or performing nursing neuro assessments post-incident or getting her to the hospital sooner would have made any real difference in the impending inevitable outcome. Apkan v. Center, 26 Neb. App. 154, __ N.W. 2d __, 2018 WL 3733633 (Neb. App., August 7, 2018).
Additional references from nursinglaw.com
http://www.nursinglaw.com/assisted-living-dementia-care.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
http://www.nursinglaw.com/assisted-living-mobility-issues.htm