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ADVANCE Perspective: Physical Therapy & Rehab Medicine

CT Nursing Home Lawsuits Involve Lack of PT

Published June 15, 2009 11:31 AM by Lauren Fritsky

There's an interesting story out of Connecticut from this weekend. It involves a nursing home facing lawsuits for neglecting two patients, both of whom died. In the first, part of the argument is that the client did not receive "medically necessary physical therapy," though no physical therapists are named in the lawsuit.

The story contends that the first client, a 76-year-old man who originally came to the nursing home after a fall in 2005, died of an infection in his legs. Prior to his death, the man refused physical therapy, yet would get up from his bed unattended. Facility staff allegedly took to restraining the patient in bed so he wouldn't get up and hurt himself. Here's an excerpt:

Kyle Wininger said her father didn't want to stay in bed, so he'd ring the bell for help. When it didn't come, he'd get up even though his muscles didn't work properly.

"So he would try to get out of bed and he would fall on the floor," she said. Staff clipped a wire to the front of his shirt that went off if he moved, she said.

"They didn't particularly care for my father," Kyle Wininger said. "He was loud and he was obnoxious and I'm sure there must have been someone there that he didn't care for, because if he didn't like you, he didn't like you."

Many of you have worked with a patient at some point or another who didn't want to do physical therapy or follow instructions, regardless of the setting you're in. How do you handle patients who refuse therapy or refuse to do it as instructed? What would you have done as the physical therapist in this man's case?


Was this man confused?  If he was that is a contributing factor for his refusal.  Also if the Price is Right is on a lot of patients will refuse therapy as well as a favorite soap opera.  

Desiree, is three days enough time?  Some will decide after three days to d/c, however we should be available everyday because maybe on the fourth day he would want therapy.  If therapy is not offered everyday how do we know he does or does not want it.  

If the patient does not like the particular therapist is also a contributing factor.  Were other therapists available to assess the patient.

Patient care does not start and end with the CNA's.  If a therapist takes ownership in a faciity they will see a need and fill the void (within reason).  Walking a patient to the rest room when asked is within reason.  You don't need to assist with everything else as long as nsg knows where the patient is.

If therapy is ordered and is not provided who is a fault?  

Karen June 19, 2009 10:30 PM

I would document his refusals and inform the charge nurse,possibly come back at a later time.If he still refuses after more than 3 days,i prb.would d/c him from skilled PT services. while under my care,i would try to explain to him why skilled PT services are warranted,but also keep in mind that it is the patients right to refuse..everything should be well documented. as far as the resident needing help,the CNA should attend to the patient,so it sounds like negligence on the nursing aspect.

desiree, PT - ms. June 15, 2009 10:53 PM
san marcos CA

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