Case Study 25: Autumn Park: Case Study/Discussion Questions

By this time, Puce had severe edema in her legs because of poor circulation. The edema caused her legs to weigh about 50 pounds each. This increased the risk of caregivers being injured repositioning her legs in her wheelchair or when operating her Vera lift. If the edema persisted, her skin would break down, causing open, weeping wounds. If this happened, she would have to be hospitalized.

California regulations require a residential care facility to give residents 30-day notice to move out if the facility feels it can no longer provide the care a resident needs. Also, state regulations allow a facility to refuse a former resident’s request to return to it if, after hospitalization, the facility determines it cannot provide the care the resident requires. The regulations state that a resident in such a facility must have skilled health professionals take care of any open wound, skin tears, or pressure ulcers. Hospitalization may be needed to receive such care, or the facility may have an exception from the state that a home health nurse will care for the resident until the wound heals.

As Douglas reviewed Puce’s file, he felt his hands were tied. If Autumn Park gives Puce notice, she will sue Autumn Park under the Americans with Disabilities Act. Puce also threatened to call the local media about Autumn Park’s treatment of a handicapped resident. Therefore, Douglas had made certain he told the state licensing official Autumn Park can care for Puce, but not to her unique expectations. Puce needed custodial care not skilled nursing care. Yet, Puce was a victim of her own circumstances since she could not afford the one-to-one care. Community care licensing agents had evaluated Puce. They agreed that Puce was not appropriate for a CCRC and needed a higher level of care.

Douglas also thought about what the ARC corporate staff had told him. They stated that anything is better than negative publicity about Autumn Park or its parent, ARC. “Do what it takes to provide her care; avoid a lawsuit and negative publicity at all costs.”

At the meeting with Puce, Douglas plans to offer her three options:

  • Get the level of care she needs from sources such as home health
  • Move to a facility with more skilled care
  • Get 12 hours of one-to-one care daily at a cost of $7,000 a month


  1. Are there other options Douglas should suggest to Puce?
  2. The state licensing official reviewed the assessment of Puce and agreed the care she needs is beyond that available in a CCRC. Should Autumn Park appeal the state’s decision regarding the exception that was made earlier?
  3. How does Douglas protect his staff and further the goals of Autumn Park while meeting the directive from corporate to avoid a lawsuit and negative publicity “at all costs”?
  4. Identify the process failure(s) that allowed Mildred Puce to be admitted to Autumn Park. Develop an action plan to prevent similar failures in the future.
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