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Falls & Injuries in Nursing Home

Falls are common in nursing homes and assisted living facilities. Among people 65 years and older, they are the leading cause of injury and deaths.

Each year in the United States, nearly one third of older adults experience a fall. Of the 1.6 million residents in U.S. nursing facilities, approximately half fall annually. And 33% of those who have already experienced a previous fall, will experience 2 or more within the same year.

While they are common occurrences, nursing homes and assisted living communities should provide staff training through Fall Prevention Programs due to the severe injury-related consequences that may occur among frail elderly residents significantly decreasing their quality of life and ability to function.

Facilities must meet the medical needs of their residents, many of whom may be prone to issues such as poor balance or cognitive difficulties which put the resident at risk for falling related injuries. The law requires facilities to maintain certain standards regarding patient safety and care. Unfortunately, homes do not always follow these standards, many times with irreparable harm. When this occurs, families need an attorney who intricately understands the law so when a facility fails to protect a patient they are held accountable for their negligence.

FAQ about Injuries and Falls

We are here to help. Our attorneys can answer your questions and offer straightforward guidance regarding your concerns.
What are the main contributors to falls in a nursing home?

It is estimated that a third of falls among nursing home residents result from  hazards within a facility.

  • Recently mopped floors
  • Inadequate lighting
  • Defective wheelchairs
  • Incorrect bed height
Should the nursing homes use restraints to prevent falls?

Routine use of restraints does not lower the risk of falls or fall injuries. They should NOT be used as a fall prevention strategy (Capezuti et al. 1996). 

Restraints can actually add to the risk of fall-related injuries and deaths (Rubenstein et al. 1994). Limiting a patient’s freedom to move around leads to muscle weakness and reduces physical function (Rubenstein et al. 1997). 

Since federal regulations took effect in 1990, nursing homes have reduced the use of physical restraints (Rubenstein et al. 1994). Some nursing homes have reported an increase in falls since the regulations took effect, but most have seen a drop in fall-related injuries (Ejaz et al. 1994). 

Can I sue a home who let my mother or father fall?

The Nursing Home Reform Act (NHRA) established federal regulations to ensure adequate staffing and safety measures in nursing homes. It also outlined the comprehensive rights of residents. When nursing home or assisted living staff fail to minimize residents’ risk factors for a fall and an injury occurs, their negligence may warrant a lawsuit.

I was told falls can't be prevented in nursing homes, is this true?

While it is absolutely true that falling among the elderly is common, the facilities have to properly assess patients for fall risk, continually assess them through an ongoing care plan if their situation changes, and do all they can to prevent falls from happening.  Preventing falls before they happen is absolutely the responsibility of the nursing home.

Facilities must identify risk factors and then reduce those specific risks.  They should not take a kitchen sink approach to fall prevention or really any other interventions one might implement for our elderly or frail loved ones. One of the reasons they shouldn’t throw every intervention out there is because some interventions get in the way of others. For example, one intervention might be placing the residents’ bed in a low position with a mattress on the floor to prevent injury from falling out of bed. This can be an effective intervention if your resident is rolling out of bed but not nearly as effective if your loved one is getting up in the middle of the night due to urinary urgency to go to the bathroom and tripping on that mattress in the middle of the night! Staff must identify a risk factor and then plan for that risk factor.

There are 4 distinct areas for risk of falling that should be addressed in a care plan : environmental, medication adjustments, alarms, quasi restraints (belts, lap buddies, wedge cushions, and side rails). 

Who is most at risk for falling?

Here are some of the most common risk factors for falls. If your loved one has any of the following, falling must be specifically addressed in a care plan by the facility: 

1) Gait dysfunction/muscle weakness

2) Previous falls

3) Alzheimer’s disease, Parkinson’s, or other central nervous system disorders.

4) Blood pressure/Orthstatic hypotension

5) Incontinence

6) Lack of exercise

7) Vision Problems

8) Individuals who need Wheelchair or Bed Transfers.

9) Environmental hazards – The same things that would trip us can trip our elderly loved ones.

10) The “tools” of walking (ex. shoe fit, cane length etc,

11) Medications

Broken Hips and Other Fall-Related Injuries

There is now a wealth of information on why falls happen in nursing homes and assisted living facilities and how to properly document those events so they don’t happen again.  While accidents do happen, the majority of falls are preventable.

According to the Agency of Research and Healthcare Equality, the lead Federal agency charged with improving the safety and quality of healthcare for all Americans, past history of a fall is the single best predictor of future falls. In fact, 30-40% of nursing home residents who fall will do so again within a year.

Therefore, it is crucial for staff to respond quickly and effectively after a fall.  The backbone of a Falls Management Program for Caregivers and Staff includes the following eight steps:

  1. Evaluate and monitor resident for 72 hours after the fall.
  2. Investigate fall circumstances.
  3. Record circumstances, resident outcome and staff response.
  4. FAX Alert to primary care provider.
  5. Implement immediate intervention within first 24 hours.
  6. Complete falls assessment.
  7. Develop plan of care.
  8. Monitor staff compliance and resident response.

Unfortunately, many falls go unreported and a care plan is never established.

Case Example for Fall-Related Injury

Rose is a 72 year old widow living in the nursing home for the past 3 years with relatively little difficulty. She had a minor stroke a few years back which caused relatively minor neurologic damage on the left side of her body causing her to have a slight drag in that foot. At the same time she is on anti-coagulants and anti-hypertensives for her high blood pressure. Since the stroke she has slowed considerably from her fairly active lifestyle. Unfortunately, in the third year of her residency she has a fall resulting in some bad bruising. Two weeks later she has another. This time she goes to the hospital where she is diagnosed with a urinary tract infection for which she is medicated with antibiotics. Fortunately, the x-rays were negative for fracture. When she gets back to the nursing home after a 3 day admission in the hospital she rises from her seat in the dayroom during an activity session staggered a few steps and her left leg buckled. She fell. This time she fractured her pelvis. She underwent a surgery that required the use of three metal screws into her already brittle pelvis. Rose attempted physical therapy but never regained the same level of function, stopped attending activities and began spending considerably more time in bed. She eventually developed a sacral decubitus ulcer and from the inactivity and lying on her back. She also developed multiple bouts of pneumonia. She died 10 months later.

This may sound outrageous but its a lot more common than you might think. In fact 4 percent of hip fracture patients die during their initial hospitalization; 24 percent die within a year of the injury; and 50 percent lose the ability to walk forever. (Rodrigues J, Sattin R, Waxweiler R: Incidence of hip fractures, United States, 1970-83. Am J Prev Med 1989; 5:175-181. Ray N, Chan J, Thamer M, Melton L: Medical expenditures for treatment of osteoporotic fractures in the United States in 1995. Report from the National Osteoporosis Foundation, J Bone and Miner Res 1997; 12: 24-35. Wolinsky F, Fitzgerald J, Stump T: The effect of hip fracture on mortality, hospitalization and functional status: A prospective study. Am J of Public Health 1997; 87:398-403. ) 

That is why it is critical for facilities to prevent falls the best they can.  And when they fail to do so, that the victims and their families are justly rewarded for the facilities negligence.

If you or your loved one have fallen in a nursing home, give us a call for a FREE Case Evaluation at (703) 726-8188.

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