A nursing home expert witness advises on a case involving an eighty-year-old male patient who was admitted to a residential care home as an in-patient resident following a stroke. The medical records show that the patient was a vulnerable adult, who required total assistance with all activities of daily living. The patient was due to receive occupational therapy, therapeutic exercises and sensory stimulation as part of his stroke rehabilitation. The short term goal was to develop his oral motor skills. The patient’s Coumadin was to be monitored closely, as were his INR levels. On September 3rd, a data integrity issues report notified the nursing home staff of a potential issue involving the patient’s history and requiring a dietary consultation. Twice during the patient’s admission the attending physician noted that he was not being given proper nutrition. During the last weeks of his life the staff at the nursing home failed to feed the patient. On the morning of September 5th nursing home staff walked by the patient’s room and noted he was laying face down on the floor, bleeding from his head. The patient was taken to hospital via ambulance. He had sustained a large laceration to the right side of his forehead. He had old decubitus ulcers noted on her sacrum that were dressed. He was diagnosed with a urinary tract infection, dehydration and dementia. Following treatment and discharge the patient was returned to the senior living facility. The nursing home staff failed to properly document the patient’s progress and care. During the last few weeks of the patient’s life the nursing home failed to make any notes on his charts. One morning the patient was found in respiratory distress by nursing home staff. Staff called 911 and the patient was transported to hospital via ambulance. He was found to be in cardiac arrest. The patient died shortly thereafter.
Question(s) For Expert Witness
- 1. Do you have experience in running a residential nursing home?
- 2. What is the standard of care for a vulnerable patient?
- 3. What protocols are in place to prevent neglect or abuse of residents in these types of facilities?
Expert Witness Response E-007898
I am a highly experienced director of nursing for a 180 bed skilled nursing, assisted living and independent living community with over ten years of experience as a multi-state regional nurse manager. My current position involves supervision of 150 team members to include the physicians, nurse team, floor nurses, social workers, infection control, quality assurance, medical records, a commissary and recreation therapy. I spent three years as a clinical nurse specialist. I am a registered and certified nursing home surveyor. I spent many years as a regional nurse consultant and recently received a Medicare/Medicaid deficiency free survey. This is certainly a case of neglect. The physician noted improper nutrition. I would like to know if the physician ordered a dietary consult with a registered dietitian. The case summary mentions that the man has a dementing illness. This brings up questions about his level of dementia. I personally use the GDS or FAST scale. If he was in the later stages, he most likely would have lost the ability to swallow and the decision would be made to either let him die naturally or place a feeding tube. Was the resident placed on hospice or comfort care? Was he offered meals or perhaps a high calorie high protein nutritional supplement?