A Missouri nursing home resident who was accused of seriously injuring another resident on July 13, has now been charged with second-degree murder and armed criminal action. The charges were upgraded after the victim (Resident 2) died on July 24.
Following Resident 2’s death, the Centers for Medicare & Medicaid Services (CMS) terminated their agreement between the nursing home and the Missouri Department of Social Services.
Initial charging documents allege that Resident 1 assaulted Resident 2 in a serious and violent manner using a toilet tank lid. According to a probable cause statement, Resident 1 carried a toilet tank lid from his room to Resident 2’s room and hit him over the head with it, which caused the tank lid to break. Resident 1 continued hitting Resident 2 in the head with the tank lid, and then threw it at him. The tank lid hit Resident 2 on the arm and broke again when it fell to the floor.
Resident 2 sustained serious head and neck injuries and was airlifted to a hospital in Arkansas. He died from his injuries on July 21. According to the pathologist, Resident 2’s death resulted from the stress induced by the assault, leading to strokes.
CMS’s Medicare termination notice went into effect on July 25. Notice was also given that the provider’s agreement as a nursing facility in the Medicaid program was also terminated on the same date. According to CMS, the facility had failed to attain substantial compliance with certain Medicare and Medicaid participation requirements.
Compliance Perspective
Issue
Failure to prevent a resident from attacking another resident and failure to perform a Preadmission Screening and Resident Review (PASARR) to accurately assess a resident’s risk for aggressive behavior or provide adequate monitoring and services, may result in citations for immediate jeopardy and provision of substandard quality of care, in violation of state and federal regulations. If a facility fails to assess the effectiveness of interventions and staff do not promptly intervene to ensure resident safety during resident-to-resident altercations, then the facility did not provide sufficient protection to prevent resident-to-resident abuse.
Discussion Points
- Review policies and procedures for accurately assessing residents before and after admission for the risk of aggressive behavior and for ensuring adequate supervision and appropriate room assignment are provided based on their history and current status.
- Train staff about the risk for aggressive behavior by any resident and their responsibility to monitor and note changes or patterns of behavior that may indicate increasing aggression. Also train staff on behavioral health protocols and the importance of reporting distressing behaviors immediately to a supervisor. Teach the reporting process, including how to access the Hotline if anonymous reporting is preferred. Document that these trainings occurred and file the signed documents in each employee’s education file.
- Periodically audit the risk assessments of residents with histories of aggressive behaviors to determine if they are being monitored and if changes are being noted on their care plans. Also audit to ensure that all staff are knowledgeable of behaviors that should be reported immediately to a supervisor, and the process for reporting.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
