Preventing Nursing Home Fall Injuries

What should you do when a nursing home administrator calls to inform you that a family member suffered a fall in the nursing home? The immediate concern should be making certain that your family member has been thoroughly examined to rule out serious injuries. The nursing home’s initial response to the fall is important because a fall can lead to devastating consequences if not treated promptly. If a serious injury has occurred, it is important to know how and why the fall happened.

Good nursing homes are vigilant about protecting residents from falls. And for good reason. According to the Centers for Disease Control, about 1,800 nursing home residents die every year as a consequence of a fall. In 2013 alone, 2.5 million older adults were seen in an emergency room following a fall. The most common fall related injuries requiring emergency room care were bone fractures, lacerations and traumatic brain injuries. Such injuries can lead to functional decline, reduced quality of life, depression and social isolation.

Many falls are preventable with quality nursing home care. Nursing homes are required to have a fall prevention program. The program must include three important components:

• An assessment of every patient to determine his or her risk of falling;
• A list of interventions intended to reduce the risk of a fall;
• A list of interventions intended to reduce the risk of serious injury in the event of a fall

Nursing homes must evaluate every new resident for his or her risk of falling. This is called a fall risk assessment. An assessment that reveals a high risk for falling should trigger a host of interventions aimed at preventing and minimizing the effect of falls. Some of the interventions include an adjustable height bed, floor mattresses, non-slip socks, and assistive equipment such as a walker or cane. If the resident is unable to ambulate independently, the fall risk assessment will specify how many staff members are required to assist the resident while walking or during transfers.

Accidents happen when the nursing home fails to carry out the fall prevention program properly and consistently. For example, it is common for injuries to occur when a staff member attempts to move a resident alone despite the risk assessment clearly requiring two staff members for every transfer. Sometimes a fall is unavoidable but the injury could have been prevented or minimized. For instance, a resident with poor bed mobility is at risk for falling or rolling out of bed. A fall from a lowered bed onto a floor mattress is unlikely to produce any significant injury. However, the resident may suffer a hip fracture or worse if the staff forgets to lower the bed or neglects to place the mattresses on the floor.

The nursing home should update the fall risk assessment from time to time to address the resident’s changing functional mobility. If the patient is prescribed a new medication that causes symptoms of dizziness then the fall risk interventions should be altered to protect the patient from the increased risk of falling.

Generally, nursing homes that are understaffed have a higher rate of resident falls. This is simply because there are too few nurses and nursing assistants to carry out the fall prevention program consistently from day to day. If you have a family member who is a nursing home resident, be watchful for any signs that the nursing home is understaffed. The first sign that the nursing home needs more staff is an unsanitary facility.

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