Care homes and nursing homes accidents
There are over 350,000 elderly people living in 10,000 care homes in England. Every one of them will have particular health issues and will need access to medical and other support, such as mental health, continence and tissue health, physiotherapy, diet and nutrition services. Approximately 40% of care home residents suffer from dementia and the average lifespan from admission is only two years.
So this is a challenging environment, and the provision of services between private and state run care homes and the NHS can be patchy to say the least.
Care homes owe the same duty as a hospital, hotel or any other institution that looks after residents. But they have to do more to meet that duty because of the vulnerability of those they care for and their wide range of needs. If they fail in that duty then serious injury or even death can result.
The following particular issues need to be identified and assessed by all care homes:
Control of infection: Elderly people in care and nursing homes are particularly vulnerable to infection, which carries with it a high risk of mortality. So the premises and especially the kitchens and bathrooms need to be scrupulously clean. There must be strict hygiene policies in place to deal with food production and infection control. Staff and residents are at risk from waste and blood that is inadequately disposed of, contaminated food and medical equipment, legionella from poorly maintained water and air conditioning systems, and inadequately controlled infection in an individual patient.
Abuse: Sadly there is malpractice in some care homes and the suspicion is that it it more widespread than is acknowledged. Since the Winterbourne View abuse scandal in 2007 there have been a number of prosecutions and reports of abuse, where those employed to look after vulnerable residents have been guilty of neglect and sometimes physical assaults. If a resident is abused in this way then the care home will usually be liable for the actions of their employees. Evidence is key and care home records, witness testimony and video and photographic evidence may all play a part in uncovering the malpractice.
Avoidable accidents: Elderly residents in care and residential homes can be frail and suffering from illness or disease, so it is no surprise for there to be accidental injuries from trips, slips, falls, and other incidents. Such incidents are very common amongst elderly people who are living at home. But there is a distinction between those accidents on the one hand and avoidable injuries on the other.
For instance, an elderly person at home is very likely to check the temperature of the bath water before getting into it at home. If the job of bathing a vulnerable resident or patient is the responsibility of the care home they should have assessed the risk of burns and scalds and made sure that there are proper safety precautions in place, namely thermostatic mixing valves on the taps and care workers trained to test the water before bathing a patient. There have been several reported cases of patients being seriously injured or even killed by being bathed in scalding hot bath water.
Transfers and equipment
Another common situation involving risk of avoidable injury involves transfers. If a resident or patient is unable to transfer independently, for instance from bed to chair, their needs must be assessed and a proper system put in place. This may be a protocol for two carers to assist or may involve the use of a board or hoist. If the patient is left to their own devices or if the assistance or equipment are inadequate then there is a high risk of injury, and that injury will be caused by a negligent failure on the part of the care home.
Equipment must be properly used and the care providers trained in its safe use. A tragic example of where this can go wrong is the case in September 2012 where an elderly woman was asphyxiated in her bed between her mattress and the incorrectly fitted safety rail. Safety rails are commonplace in care homes to prevent falls, but in this case the staff weren’t properly trained in their use. The care home owners were prosecuted by the HSE and fined £180,000.