Wheelchair-Bound Nursing Home Resident Rolled Herself Outside to Smoke Unattended in Subzero Temperatures
When a North Dakota nursing home resident decided she wanted to smoke, she rolled her wheelchair outside in the bitter cold without staff being aware. State inspectors determined that if a member of the maintenance staff had not seen the woman and brought her back to safety inside the nursing home, she could have gotten her wheelchair stuck in a snowdrift and experienced possible frostbite within 10 to 30 minutes of exposure to the cold temperatures and 10 mile-per-hour winds. Consequently, the inspectors determined that the facility was responsible for placing the resident in “immediate jeopardy.”
The nursing home was designated a “special focus facility” due to this incident and for placing other residents in “immediate jeopardy” because of issues such as leaving a cart containing toxic cleaning solutions unattended for 17 minutes in a hallway where impaired residents wander.
In a follow-up inspection, inspectors scrutinized multiple complaints alleging insufficient staffing. The facility was cited for failing to meet the staffing needs of four of 36 residents the investigators assessed.
Comments from the residents involved complaints about having to wait for long periods of time, especially after 10 p.m., for help with going to the bathroom and being assisted back into bed. One resident claimed a staff member said, “I have a bad back. I can’t help you.”
The vice president of the facility recently reported, “We’ve since changed our smoking rules,” and “We’re now a no-smoking facility.” He said that the facility has remedied the state health department’s concerns in a way that he considers is consistent with their rules.
Compliance Perspective
Failure to prevent residents from wheeling themselves outside to smoke unattended in inclement weather, and failing to provide sufficient staffing levels to meet the care needs of residents may be viewed as placing residents in “immediate jeopardy” and provision of sub-standard quality of care, in violation of state and federal regulations.
Discussion Points:
- Review policies and procedures regarding smoking and residents’ ability to exit the building without being observed. Review the care assessment needs of residents to ensure that the level of staffing provided is sufficient.
- Train staff to be aware of the facility’s smoking policy and procedures and paying particular attention to residents who may try to leave the facility on their own—particularly when the weather is bad, and to be responsive to residents’ calls for assistance.
- Periodically audit the facility’s entrances and exits to ensure that staff are watchful for residents who may try to leave unattended for any reason. Also, periodically review the facility’s assessment regarding the staffing levels needed to provide the care required by residents and to ensure that sufficient staffing is scheduled.
