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Woman hammers nails into her head; Maplewood assisted-living facility faulted

Woman pounded nails into her head that weren't detected for a month. 

A young Somali woman with psychiatric disorders and a history of self-injury was hospitalized with serious injuries last fall after she hammered two nails into her scalp, nails that stayed undetected for nearly a month.

State health regulators blamed poor oversight at the Twin Cities care facility where she lived.

Salams Care Residential LLC, which operates a small assisted-living facility in Maplewood, was found responsible for neglect for failing to provide adequate supervision of the resident, who had to have the nails surgically removed from her skull and undergo weeks of medication, according to a Minnesota Department of Health investigation released this week.

The 21-year-old resident, who also has an intellectual disability, was taken to the hospital in October after a suicide attempt. Physicians there noted swelling around her forehead, and a brain scan revealed two “foreign bodies extending from the scalp,” which were later determined to be nails. The woman told a doctor that she inserted the nails into her skull a month earlier using the heel of her shoe. A surgeon had to remove part of her skull to extricate the nails, and she required four weeks of intravenous antibiotic treatments, the state report said.

The woman told a social worker that she obtained the nails simply by walking to the care facility’s garage.

The disturbing case underscores the need for stronger rules around the admission of residents to assisted-living facilities, a large and fast-growing segment of the long-term care industry, some advocates said. Once designed almost exclusively for seniors, these facilities have begun caring for a more diverse mix of clients, including younger people with serious mental illnesses and developmental disabilities.

A state law passed last spring would license Minnesota’s 1,200 assisted-living facilities for the first time, starting in August 2021. Elder care advocates are pushing for new standards that would require the facilities to conduct a comprehensive health and behavioral evaluation for every new resident to prevent them from ending up in facilities where they will be underserved and at risk.

“There were major, major warning signs here that could and should have been detected” through a preadmission health evaluation, said Eilon Caspi, a gerontologist and adjunct faculty member at the University of Minnesota’s School of Nursing. “It is a miracle that this incident did not end up in a more serious tragedy.”

Ibrahim Sheikh, administrator of Salams Care, said staff members underestimated the severity of the woman’s mental health problems when she moved into the facility last spring to be closer to relatives in St. Paul. As her behavior became more and more abusive, toward herself and others, the facility’s staff struggled to find her a different home that could provide a higher level of oversight. However, the woman’s history and frequent interactions with police made other facilities reluctant to accept her. That resulted in her staying at the five-room Maplewood facility longer than anticipated, Sheikh said.