Billerica woman struck by car on Christmas dies

BILLERICA – A 79-year-old Billerica woman who was struck by a car on Boston Road on Christmas night has died from her injuries.

Insook Choi was transported to Lahey Clinic in Burlington, where she was pronounced dead, police said.

On Wednesday at 7:43 p.m., Billerica police responded to a car crash involving a pedestrian at 770 Boston Road, between Cook Street and Allen Road. While en route, police learned that the victim was seriously injured and that good Samaritans had initiated lifesaving measures.

Within minutes, police officers, fire personnel and advanced emergency medical personnel arrived and took over.

Police said the driver remained at the scene and cooperated.

It appears the woman was crossing an undesignated area of Boston Road that was poorly lit when the accident occurred, according to police. There have been no citations or charges issued.

“We’re still looking to see if speed was a factor. There’s no reason to believe alcohol was involved,” said Deputy Chief Roy Frost. “That area is not meant for crossing, and it’s not extremely bright down there. This was an unfortunate accident.

“We’ve had a lot of pedestrian accidents in general,” he added. “This type of stuff is unfortunately happening.”

On Thursday, many people on Facebook wrote that the woman’s death is a “tragic loss.” In addition, some Facebook users said that stretch of Boston Road is dangerous.

“My prayers are with everyone involved. People need to be more careful on that road,” wrote Kristen Marie.

“So sad for all involved! It is really dark in that area. The poor woman and the poor driver and the first responders. Sad ending to Christmas,” commented Dawn Ransom Ringer.

“Very very sad! No safe sidewalks/crosswalks are common in Billerica… Somebody needs to make these areas safe before another tragedy happens!” Nicole Nanci wrote.

Billerica Selectmen Chairman Dave Gagliardi called the incident “unfortunate” and “tragic.” He said that Boston Road, Route 3A, is in the state’s jurisdiction, and the state Department of Transportation decides what sections to work on.

“We try to push every year for some work to get done, but every community is making pushes as well,” Gagliardi said. “MassDOT determines what needs are the greatest.”

Sidewalks could be coming to a different part of Boston Road in the next few years. As mitigation for the Middlesex House of Correction $37 million expansion project, the state would support constructing sidewalks on Boston Road from O’Connor True Value Hardware to the Shops at Billerica. This does not guarantee funding, only the state’s “full cooperation in support of the town.”

Choi lived at 4 Pinegrove Ave., according to the Town Clerk’s Office. The address is about a half-mile from where the accident took place, or a seven-minute walk, according to Google Maps.

Wednesday’s crash happened in front of the Jade Pacific restaurant on Boston Road. A man who answered the phone at the restaurant on Thursday said Choi had no connection to the restaurant and had not eaten there on Christmas.

Boston Road was closed for three hours between Allen Road and Cook Street for an accident investigation. The restaurant remained open.

A Massachusetts State Police reconstruction team was called in to assist.


Nursing Home Negligence

Falls in Nursing Homes

Litigators who work with cases involving long term care know how significant the issue of falls can be. Falls are the leading cause of injury and death by injury in adults over 65. Approximately half of the 1.6 million nursing home residents in the U.S. fall each year, and a report by the Office of the Inspector General found that about 10% of Medicare skilled nursing residents experience a fall resulting in significant injury; and, more than 1/3 of hospital falls result in injury. In the rehab setting, rates are often higher – for example, fall rates among stroke patients have been shown to be very high. Immobility and falls can lead to poor outcomes.

Fear of falling is defined as a geriatric syndrome. It not only occurs in older adults who have fallen, but in those with impaired mobility and is associated with decreased physical ability and depression. Care of older adults requires that clinicians be aware of the myriad of issues related to falls including knowledge of this syndrome, increased risk and interventions needed to prevent injury related to falls.

Just about every resident in a long term care setting, including assisted living and sub-acute rehab, is at risk for falling. Between medications, functional and medical issues and advancing age, older adults in most settings are prone to falling.

There are well established standards of care related to fall prevention; but, as I continue to review records related to issues like falls, I am amazed at how often these basic standards are not being practiced. The basics of a fall prevention program include assessment and ongoing reassessment of risk, ensuring a safe environment, medication review, providing therapy as needed, individualized interventions, and staff education.

Basic nursing practice includes assessment, planning (Care plan), putting interventions in place and then evaluating outcomes to determine if those interventions are appropriate and effective. Assessment includes completing fall risk assessments on admission and then as needed. Very often, the fall risk assessments completed by nurses in LTC are inaccurate. The tools utilized in long term care typically include these risk factors: history of falling, use of ambulatory aids, gait/balance issues, medications, secondary diagnoses (i.e. diabetes) and mental status. Care planning is the next step in nursing care - it is the standard of care that as the resident’s status changes, assessments and care plans must be updated, and often, are not. For example, with each fall, there should be updates, or if there is a new diagnosis, i.e. stroke, or worsening dementia, updated interventions should be put into place, with ongoing evaluation of effectiveness.

Care planning and interventions very often are generic and not individualized. For example, a toileting schedule that includes only after meals and before bedtime may not be appropriate. If a resident has issues with constipation or incontinence, this may lead to the need for more frequent toileting to prevent falls. The “make certain call bell is within reach” for residents with dementia is an example of a generic intervention. Older adults with dementia may not recognize a call bell or remember to use it. The debate about use of bed and chair alarms go on – they are a part of an individualized care plan, not a solution to preventing falls. Often, I see delays in putting interventions in place, i.e. with the resident who is incontinent NOT being put on a toileting plan immediately. The other common issue I see when reviewing records is the lack of updating care plans as the resident’s status changes – with every fall, with worsening dementia, physical decline, or new medical diagnosis (i.e. Parkinsonism).

Nurses reviewing records need to pay attention to the MDS, risk assessments, care plans and Interdisciplinary notes with attention to where the standard of care is not being met.
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