Not all falls are preventable, but many are. A nursing home must use all available measures to prevent falls. If a fall is preventable, and a nursing home fails to take the appropriate steps to prevent it, that is considered abuse and neglect.
Preventing falls always includes three steps. First, the nursing home must perform a comprehensive assessment to identify each resident’s risk of falling. Second, based on that assessment, the nursing home must create a care plan that identifies specific measures to prevent the resident from falling, such as alarms and increased supervision. Third, the nursing home must actually implement the plan that has been created.
If the nursing home fails to carry out any of these steps and a resident is injured, that is considered negligence.
Falls are common in nursing homes. There are approximately 1.6 million residents in nursing homes in the United States. Half of those residents fall every year. That means that 800,000 nursing home residents fall each year.
Approximately 1 of 3 residents who fall will fall at least two more times during the year. Many of these falls are preventable with reasonable care.
On average, a nursing home with 100 residents reports between 100 and 200 falls yearly. Many more falls go unreported, making the number much higher.
The elderly are fragile. Falls often have serious and even deadly consequences, especially in frail nursing home residents. One in every 10 residents who fall has a serious injury. Around 65,000 patients suffer a hip fracture each year in a fall. Hip fractures are one of the most feared injuries in nursing homes. It is estimated that as many as 58% of residents who suffer a broken hip at a nursing home die within the year.
The most common injuries we see that result in lawsuits for falls are:
Even when residents who fall do not die from their injuries, fall-related injuries decrease the resident’s quality of life. Residents who fall often develop a fear of falling that leads to self-imposed restrictions on activity, causing the resident to become deconditioned and at an increased risk of falling again.
Residents who are not seriously injured in a fall often suffer:
Each of these changes increases the risk of falling again, putting the resident at risk of serious injury or death.
Falls among nursing home residents are usually the consequence of a combination of risk factors. Some risk factors are considered intrinsic, meaning they are specific to the individual resident. Other risk factors are considered extrinsic, meaning they are part of the external environment.
Intrinsic Risk Factors
Intrinsic risk factors include:
Although intrinsic risk factors such as underlying medical conditions cannot be eliminated, they can be managed in a way that reduces the resident’s risk of falling. Medical management conditions can be improved through appropriate evaluation and treatment.
Extrinsic Risk Factors
Extrinsic risk (environmental) factors can also be addressed to improve safety. Extrinsic risk factors include:
Most falls at nursing homes are preventable. While there may be rare instances where no one could foresee a resident falling, in the vast majority of cases, the resident has demonstrated a risk for falling.
All preventable falls are caused by some combination of (1) a failure to perform a comprehensive fall risk assessment, (2) a failure to create an appropriate care plan that includes fall prevention measures, and/or (3) failing to implement the measures on the care plan.
Preventing falls always begins with a fall risk assessment. A fall risk assessment is necessary to both determine whether a resident is at risk for falling and why a resident is at risk for falling.
At a minimum, a fall risk assessment should include an evaluation of whether the resident has any of the following:
These fall risk factors are considered cumulative. The more of these risk factors a resident has, the higher the risk of falling.
A fall risk assessment should be conducted upon admission to the facility. It should also be conducted anytime the resident is hospitalized and reenters the nursing home. The best practice is to perform a fall risk assessment every month–although this is rarely done in nursing homes.
There are dozens upon dozens of potential fall interventions. Every risk factor identified in a fall risk assessment should be addressed by at least one fall intervention.
Fall interventions available to nursing homes include:
For every fall risk, there are numerous potential interventions. Nursing homes must be proactive in identifying fall risk factors and implement remedial measures. If an intervention does not work, then the nursing home must immediately add new interventions to prevent falling.
It is not enough to assess a resident and identify fall interventions. Nursing staff must carry out the plan of action. Nursing homes are often neglectful in this aspect of care.
Nursing homes must train their staff to respond appropriately when a patient falls. Many lawsuits are brought because nursing staff fail to respond to a fall, increasing the harm to the resident. There are several standard responses to a fall that must be met but often are not.
Many falls are unwitnessed because they happen in a patient’s room or because the facility is short-staffed and there is no one around to see it. If a fall is unwitnessed, nursing staff should assume the worst. They should approach the patient with the expectation that the patient fell from a standing height and suffered a serious injury.
Only a registered nurse is permitted to assess and evaluate a resident after a fall. Because of budgeting to increase profits, many nursing homes are woefully short on registered nurses and use almost exclusively licensed practical nurses. Licensed practical nurses are exactly that, “practical nurses.” They have less education and training than registered nurses and are permitted to carry out or practice at the direction and under the supervision of registered nurses. While only a registered nurse can assess a patient, because of a lack of resources provided to the facility by corporate ownership, licensed practical nurses are left to carry out this critical function.
If there is any sign of injury or suspected injury, including if the fall is unwitnessed, the resident should remain on the ground during the assessment. Sudden movement can cause severe pain if there is a fracture. In addition to causing pain,and potentially life-threatening injuries can occur. To prevent further complications, the appropriate care and assessment must be conducted immediately. If a nursing home fails to properly respond to a fall, this is considered abuse and neglect, and may form the basis for a lawsuit.
