MYFox9 had an article about the Minnesota Department of Health’s investigation into the wandering death of a resident who froze to death.  The investigation revealed that the Jones-Harrison assisted living facility was guilty of neglect in the death of a patient who wandered outside last November.  The cause of the patient’s death was listed as hypothermia from cold exposure.

Staff carelessly lost track of the woman with dementia on the evening of Nov. 21.  The family member said when she arrived at Jones-Harrison on the morning of Nov. 22, police had still not been called and the patient hadn’t been seen inside the facility in 16 hours. Staff members were unable to locate the woman and were confused about her whereabouts before finding her around 10:30 a.m. the next morning frozen, with no pulse, near a parking garage. 

The report concluded that the resident walked through a gate door that was left open.  A maintenance worker leaving around 4 p.m. the day of the incident left the gate unlocked. The worker admitted to leaving it unlocked for his own convenience, using it to get to quickly get to his car in the cold weather.  There was no explanation why another staff member did not see that the gate was unlocked or how the resident was able to leave the facility without anyone noticing.

The nursing home did not effectively manage its resident register to keep tabs on patients, and staff did not initiate the missing persons protocol in a timely manner.

 

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