A True Story of an Incident in a Senior Citizen Living Site
This editor has just returned from a business trip where I visited senior citizens living sites in Florida and in the Boston area. One incident in particular needs to be brought to your attention in order to try and prevent it from happening to one of your loved ones.
Most senior citizen residences have installed an emergency pull switch or cord, which alerts the resident manager's office of some difficulty when pulled. This type of system is different from the one worn on person or voice activated. It usually involves a string on the wall of certain rooms in the dwelling. The ones we saw were located in the bathroom and bedroom, both areas of high incidents of accidents. For many seniors, this is one of the reasons they move into such residences i. e. to provide them a measure of immediate attention if an accident occurs.
In the incident we inadvertently became part of, an 88 year old female, Alice F., who had recently lost her husband after 55 years of marriage, bought a two bedroom apartment in a well-established upscale adult residential development. She had been highly reluctant to move from the apartment she had lived in for over twenty years, but felt that she needed more social activities and wanted security in event of any accident. She was an avid bridge player, a classical music piano player and an excellent scrabble player and felt the residence would give her the opportunity to pursue these interests. The residence came well recommended, because a good friend has lived there for the last two years.
Three weeks after moving in, while watering the plants on her small patio, she tripped over a heavy patio chair and fell flat on her face. She lay partly on the patio floor and partly on the rug in her apartment for an hour before she was able to drag herself to the pull cord to alert the management of the residence that she was in trouble.
The established procedure was that once the cord was pulled, someone from the staff was to phone her room immediately. If there was no answer, they were to send someone to her room to check the condition of the resident. They had a key to the room and could enter if there was no response to a knock on the door.
In her case, pulling the cord brought no response. She crawled to another cord and pulled that cord, but still no response. (The evidence of her crawling could be plainly seen in the trail of blood on her wall-to-wall rug.) Finally she got to her telephone and called her friend in the residence, who called the management and a registered nurse responded. The nurse treated her extensive wounds (cuts, abrasions and contusions) and she determined that she did not need to see a physician. Her son, the one listed as the contact person in the event of an emergency was not notified until a niece who happened to be visiting that day informed him of the incident. This was in spite of the fact that the rules required immediate notification to her son.
The following day, the family on their own volition took Alice F. to a physician who determined that she had a broken nose, contusion and abrasions all over her body. He also advised her to leave the abrasions and contusions uncovered (the nurse had bandaged them) to prevent infection. That way the wounds would heal faster with less chance of infection. You can only imagine how upset the family was in this situation. The family had urged their mother to go to the residence for safety reasons and the immediacy of response to any incident. We realize that accidents are inevitable, though they are reducible through risk management. Procedures for dealing with emergencies must be quick and efficient. Was the lack of response to the pulling of the emergency cord due the cord system being inoperable or because of neglect on the part of the staff? We urge you to have the system checked wherever a friend or loved one is a resident.
Lesson to be learned
As part of quality assurance, all senior residential community safety measures need to be checked on a periodical individual basis, especially alarm and alert systems. (We would advise all individuals who wear alert systems to periodically check these systems also.) While immediate attention needs to be given to the individual, a physician should be consulted in all cases and should concur with the steps taken to insure the health of the individual. Treating personnel must have up-to-date medical records on hand, not always relying on the patient to give them up-to-date information. A person experiencing trauma and shock is not always the most reliable source of information.
There must be a system in place to notify the person listed as "to be notified in case of an emergency" when any incident occurs. Of equal importance, medical records kept by the residence must be frequently updated, especially records related to medication taken and dosage. Here the resident needs to inform the residence and the residence needs to make sure they have a system that updates their records. We think periodic calls to treating physician office are in order or some kind of electronic system needs to be worked out with treating physician.
While some of the measures we have suggested may involve minimal cost, we believe that senior residences have a moral and ethical obligation to put them into effect in order to provide the high quality of service they promise in their marketing efforts.
Follow-up on incident
Alice F., the women mentioned above, while in great pain, appears to be doing fine. Her treating physician felt it was too late to set the nose and since the air passages seem clear, to let it heal on its own. She looks like she had just gone one challenge round in the ring with Mike Tyson, resulting in two blackened, swollen eyes, only open as slits, cuts above the eye, over the nose, abrasions on hands and knees and swelling and pain in her back. We have no idea what Mike Tyson would look like after going a few rounds with Alice F.
The residence is taking steps to tighten up on its safety and medical procedures.
We advise all our readers to be alert to possible safety issues and inform their residences of suspected problems. Become an active member of your community in this area.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
Harold Rubin, MS, ABD, CRC, Guest Lecturer
Sept. 1, 1999
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