A patient falls because of a bad decision he made by getting up without calling for assistance or using an assistive device. The facility may see on a yearly survey that they did not provide adequate care for the resident even though all safety procedures were in place and documented.
What will not show up on survey is a patient with lung cancer who chose to smoke while at the facility and is now actively dying. Should the facility be at fault for not protecting the patient who developed cancer through bad decision-making? No? Why then are they at fault for a patient who falls because of bad decision-making?
Would the facility be at fault if a patient came back to the facility intoxicated after being out with family or friends? The patient is an adult and should be able to make informed decisions. However, the medication the facility provides to the patient may impair those decision-making abilities, and yet the facility would still allow the patient to exit the facility even though they know the implications.
Should we, as therapists, ever allow a patient to walk free and independent in the facility? What if that patient fell and accused us of malpractice because we did not warn him of the potential of falling at 3 a.m. in the bathroom with the lights off? Or we did not warn him that the medication he is on will cause dizziness and blurred vision? Would we rethink the phrase "independent mobility" in a patient?