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Elderly woman killed crossing Mass. Ave. in Arlington

ARLINGTON — From his home along Massachusetts Avenue, Larry Roop heard a loud thump from the corner, breaking the evening quiet. No squealing brakes or shattered glass. Just an ugly thud.

“It’s a terrible sound,” Roop said. “I knew someone had been hit.”

Roop said he rushed outside to find an elderly woman lying in the road, critically injured. She had been struck by a car around 10 p.m. Thursday as she used a walker to make her way across the wide street.

She was barely conscious, her breathing ragged. Roop and an employee of a nearby convenience store held her head and tried to comfort her.

“We said: ‘We’re here. We’re here,’ ” Roop recalled from the scene Friday morning. “We told her help was coming.”

Paramedics rushed the woman to the hospital, where she died. She was later identified as Elba Ortiz-Delgado, 77, of Boston.

“She was fighting, and I thought she was going to make it,” said Roop, who found out Friday morning that she had died. “It’s very sad.”

The driver, Paul S. Giragosian, also of Arlington, was cited for failing to yield to a pedestrian in a crosswalk and for driving without a license. The crash is under investigation, and additional charges may follow, police said.

“Those charges will likely be upgraded,” said Frederick Ryan, Arlington’s police chief.

Giragosian, 67, was not impaired, Ryan said, and stopped after the accident. Investigators will seek to determine whether he was speeding.

“This is a heartbreaking experience for the victim’s loved ones and for the community,” Ryan said.

Maureen Stephens, who arrived at the scene just moments after the accident, said Giragosian and his wife were distraught.

“They were besides themselves,” she said. “I can’t even imagine what they are going through.’’

Stephens, an Arlington resident who knows the couple, said they told her they never saw the woman. They were driving home from the mall after Christmas shopping, she said.

Police said they were not sure what brought Ortiz-Delgado to Arlington. But Stephens and other residents said they had often seen the woman walking through the neighborhood, collecting cans for deposit money.

“I feel horrible about it,” Stephens said.

She was slight of build and seemed to speak little English, they said. She wore several layers of ragged clothing to stay warm.

No one knew her name or where she lived in Boston. Officials at two major Boston homeless shelters said they did not know Ortiz-Delgado.

Giragosian, who could not be reached for comment, has a lengthy driving record. He has been involved in three crashes in which he was found to be at fault and has been cited for speeding five times, according to state records. In 2001, he was cited for reckless driving in Connecticut.

His license expired in June.

Pedestrians said that crossing the busy, broad street — by Orvis Road near the Capitol Theatre — is almost always difficult, even with the crosswalk. Drivers often zoom through the crosswalk without slowing, they said.

“Drivers aren’t trained to slow down,” Roop said. “It was just a matter of time.”

On Friday, many cars drove through the crosswalk without stopping, even when pedestrians had started across. Some that did stop were honked at from trailing cars.

At night, pedestrians face even greater danger, neighbors said.

Red, hand-held flags have been placed at the crossing to give pedestrians greater visibility. But on Friday, they went unused.

Doris Shoer, 81, waited patiently on the curb to cross. She had navigated the street many times before and knew cars could not be trusted to stop, so she waited until the light down the street turned red, and the road was relatively clear.

“You’re still taking a chance,” she said.

Source: bostonglobe.com


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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