By Sally Damm

There is a grave societal concern when a matured person experiences a fall, but if that falls occurs in a nursing home there is added fear and alarm. After all, didn’t placement in the nursing home provide the security of no more falling? Falls are a common occurrence among elderly citizens, when looking at the statistics, it is enough to cause concern for alarm, especially when factoring in the number of falls that could have otherwise been avoided.  As a nursing home administrator expert witness, I can also say with confidence that falls are an issue that can arise in nursing home litigation.

Per the Centers for Disease Control and Prevention (CDC) one out of five falls causes a serious injury such as broken bones or a head injury. Each year, 2.8 million older people are treated in emergency departments for fall injuries. Over 800,000 people a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture. Each year at least 300,000 older people are hospitalized for hip fractures. More than 95% of hip fractures are caused by falling, usually by falling sideways.

Falls are the most common cause of traumatic brain injuries (TBI). These facts reflect the total falls recorded in the older population. Falls will occur in any location, any time of the day and any one can fall.

Many nursing facilities have fall programs in place. Nursing home residents generally have poorer health than senior citizens who live in in their own home or with a loved one. Thus, nursing home residents may be more prone to falling and accidents. While not all falls and injuries can be prevented, it is critical to have a systematic process of assessment, intervention and monitoring that result in minimizing fall risk. According to the Centers for Disease Control and Prevention (CDC), around 16 to 27% of nursing home falls are a result on environmental hazards.

Nursing home residents should receive a holistic approach in care planning and approaches to prevent falls. In addition, employees, visitors, families and volunteers should report, remove or correct environmental hazards in a timely manner. Environmental hazards can consist of improper lighting, slippery floors, congestion in bedrooms, common areas, and hallways and debris in walkways. The use of inappropriate or broken equipment can also be a problem. Faulty bed rails and incorrect bed height accounts for close to 30 percent of nursing home falls nationwide.

The survey (inspection) process for Skilled Nursing Facilities (SNFs) and Intermediate Care Facilities (ICFs) in the United States (US) is controlled by the Centers for Medicare & Medicaid Services (CMS). The following are actions that may reduce falls and should be reviewed during the certification process.

  • Complete with each resident an approved risk assessment which includes past accidents and falls, medications taken, and general physical health.
  • Assign sufficient number of staff in the facility to address the resident needs
  • Staff members should be properly trained
    • during orientation,
    • have an on-going program of education on fall prevention strategies, and
    • teach staff the dangers involved when a resident does fall and possible negative outcomes.
  • Exercise programs and activity events:
    • Including physical movement emphasizing maintenance and/or improvement of the resident’s abilities,
    • address the unavoidable decline immediately with flexible approaches
    • restorative therapy training for all department staff in a solid cross training environment
  • An aggressive monitoring of drugs types and use. There has been an array of drugs associated with an increased fall risk. Since drugs are a modifiable risk factor, close monitoring for side effects, individual responses, periodic drug review and immediate response to negative outcomes in older adults should be incorporated in a fall prevention program.
  • QIS survey forms provide a strong review of fall risk prevention. Facility staff in all department can ask, answer and respond appropriately with corrective measures.
  • Ensure interventions to prevent falls are in place in bed, while seated, and ambulating.
    -Is the resident in a low bed? Is there a fall mat?
    -Is the resident positioned properly to prevent sliding/falling?
    -Does a resident who transfers or ambulates independently have proper footwear (e.g., rubber-soled shoes)?
    -Is the resident engaged in activities or supervised by staff?
    -Are the resident’s needs addressed that contributed to a fall (e.g., toileted in a timely manner)?
    -Is the call light in reach? Does staff respond in a timely manner?
    -Is PT, OT, or restorative therapy provided?
    -If a personal alarm is used, is it on? Is it appropriate (e.g., using it in a w/c when the fall was from bed)? Is it working? Is the length of the cord short enough to alert staff of an attempt to get up (not that the resident is on the floor)? Does staff respond quickly if the alarm sounds?
    -If restraints are used, are they applied correctly?
    -For an independent resident who has had falls to/from the bathroom: Is the lighting adequate? Is the pathway clear? Are assistive devices provided?

Injuries from falls account for roughly 36 percent of potentially preventable visits to the hospital emergency room by nursing home residents. Nursing home falls frequently cause a disability, functional decline, reduced independence, and reduced quality of life for an elderly person. Residents with a fear of falls may also experience feelings of helplessness, loss of function, depression, anxiety, and social isolation. It is important to take precautions, both in and out of a nursing home facility, to prevent elderly falls, fractures, and injury.

Direct care staff, (those who touch the resident in their assigned position) can have a critical influence on resident quality of life and safety. Nursing home staffing levels must create an environment that allows staff to be attentive to the actions required to prevent falls. A nursing home administration expert witness may be helpful in analyzing whether staffing was sufficient and appropriate fall preventive measures were taken in a situation.

Sally Damm is a multiple-award winning nursing home and long term care administrator. She has 30+ years administrative experience including being the head administrator of two different facilities. Ms. Damm is Licensed Nursing Home Administrator, Qualified Assisted Living Administrator, Licensed Social Worker Associate, Preceptor and long-term-care support and services expert witness.