MDH Substantiates Nursing Home Neglect at Three Links Care Center After Resident Suffers Serious Injury
By Attorney Kenneth LaBore
Minnesota Nursing Home Neglect Attorney
The Minnesota Department of Health (MDH) has issued a substantiated maltreatment finding against Three Links Care Center, a nursing home located in Northfield, Minnesota, after a resident suffered a serious fall from a mechanical lift that resulted in a new fracture. According to the State Rapid Response Investigative Public Report, MDH determined the injury was caused by caregiver neglect, and that the facility—not just individual staff—was responsible for the maltreatment. [h54507322m | PDF]
Overview of the MDH Investigation
MDH conducted its investigation under the Minnesota Reporting of Maltreatment of Vulnerable Adults Act (Minn. Stat. § 626.557) after receiving allegations that a resident fell from a mechanical lift during a transfer performed by two caregivers. The investigation concluded on February 5, 2026, with MDH substantiating neglect and finding the facility responsible. [h54507322m | PDF]
The investigation included:
- Review of resident medical and care records
- Review of incident reports and internal facility investigations
- Review of staff training and personnel files
- Interviews with nursing staff, unlicensed staff, administrators, medical providers, and a family member
What Happened to the Resident?
The resident was a vulnerable adult residing in a skilled nursing facility with significant medical conditions, including:
- A prosthetic right hip with surrounding fracture
- History of stroke
- Type II diabetes
- Hemiplegia
The resident required two‑person assistance for transfers using a mechanical lift and a specialized hourglass (orthopedic) sling, as documented in the care plan. [h54507322m | PDF]
During a transfer from the resident’s wheelchair, staff raised the resident approximately two inches off the chair. When the wheelchair was removed and the resident was turned, a sling loop became disconnected, causing the resident to fall to the floor, strike his head, and land on his side. [h54507322m | PDF]
Although initial emergency room assessments did not identify a fracture, the resident was later diagnosed with a new femur fracture, which treating physicians stated had to have resulted from the fall. The injury delayed surgery, increased complications, and worsened the resident’s overall health. [h54507322m | PDF]
Key Finding: Lack of Training on Specialized Lift Equipment
MDH determined the fall occurred because staff were not properly trained on the hourglass sling used for the resident’s transfers.
Specifically:
- The hourglass sling has four sets of loops, including duplicate black loops at different levels
- Staff attached mismatched loop levels, creating slack in the sling
- Both caregivers involved stated they had not received training on the hourglass sling
- Personnel files contained no documentation showing training on this sling type for either caregiver [h54507322m | PDF]
MDH concluded that while staff followed the general care plan and used the correct lift equipment, the facility failed to provide adequate training and supervision, making the incident preventable.
MDH Determination: Substantiated Neglect
MDH formally concluded:
- Neglect was substantiated
- The facility was responsible for the maltreatment
- The failure was not an accident
- The facility failed to act in the best interest of the vulnerable adult by not ensuring staff were properly trained on the equipment required for safe transfers [h54507322m | PDF]
MDH also issued a licensing correction order finding that Three Links Care Center violated residents’ statutory right to be free from maltreatment under Minnesota law. [h54507322m | PDF]
Why This Case Matters
Mechanical lift injuries are one of the most common and most preventable causes of serious harm in Minnesota nursing homes. Facilities have a legal duty to:
- Properly train staff on all equipment used for resident care
- Ensure staff competencies match residents’ individualized care needs
- Protect residents from avoidable harm during routine activities like transfers
When nursing homes cut corners on training or supervision, vulnerable residents pay the price.
Legal Help for Nursing Home Neglect in Minnesota
If your loved one was injured in a Minnesota nursing home due to:
- Improper use of mechanical lifts
- Inadequate staff training
- Falls resulting in fractures or head injuries
- Substantiated MDH maltreatment findings
You may have a valid nursing home neglect claim.
Attorney Kenneth LaBore represents families across Minnesota in cases involving nursing home abuse and neglect. These cases not only seek justice for injured residents—but also help protect others from future harm.