Serious Injuries from Nursing Home Falls
Unfortunately, nursing home falls are
very common. About 10% to 20% of those falls result in serious injuries.
Centers for Medicare & Medicaid Services (CMS) defines a fall in
a nursing home facility as a “failure to maintain an appropriate
lying, sitting, or standing position, resulting in an individual’s
abrupt, undesired relocation to a lower level.” This includes
when a resident loses balance, trips, slips, stumbles, or falls for
any reason at the facility.
Nursing Home’s Liability For Resident
One of the secrets that nursing homes do not want you
to know is that they are liable for resident falls.
A nursing home’s liability is higher for residents who fall and
are seriously injured when negligence was involved.
Falls Due to Nursing Home Negligence
If the fall occurred because of any of the reasons
below, the facility should be held responsible. Many falls are preventable
and happen due to negligence.
1.) Understaffed Facilities
Many nursing homes are understaffed. In many cases, the certified nursing
assistants are understaffed, underpaid, and overworked. When employees
call in sick or are absent, the employees who are working must pick
up the slack, leaving them burdened with too much to do, including paperwork.
This overabundance of work and tasks leave the employees with an inability
to provide attentive care to every resident. This leads to neglecting
residents, and in particular, residents who are at risk of falling.
Safety of all residents, especially those prone to falls, is crucial
and should be a priority.
2.) Poorly-Trained Staff & Lazy
Poor training leaves employees / staff members without the necessary
and required skills to accurately monitor and care for all residents,
especially those who are at risk of falling and suffering an injury.
Tragically, whenever an injury is serious enough, it can lead to death
for these at-risk and age-fragile residents. Necessary training includes
proper and mandatory transfer techniques. Transfer techniques help staff
safely transfer patients out of bed and into a wheelchair and from a
wheelchair back into bed. Staff is trained on when and how to monitor
patients who have a high risk of falling. At most nursing homes, as
in many businesses and institutions, there is a mixture of hard-working
staff members who are dedicated to the safety and care of their residents,
as well as the lazy staff members who seem to be there to pass the time
and collect a paycheck. This poses a serious problem because the hard-working
staff members, who are having to pick up the slack, results in less
time devoted to the care of the residents. Strong management and supervisory
skills seem to be lacking in many facilities. They are necessary to
oversee and ensure everyone is performing as required.
3.) Failure to Closely Monitor
All nursing homes are legally required to assess residents for fall
risks when they are first admitted. These potentialities are based on
medical history and constantly updated throughout their stay depending
on their physical/mental condition. Performing a fall risk assessment
should be done when designing a resident’s care plan to promote
health and safety. When these assessments are done incorrectly or not
completed, a resident could have a higher risk of falling.
Once a nursing home resident is determined to have a high risk of falling,
it is the duty of nursing home staff members to keep an eye on him/her
at all times. Staff should always be on-hand to provide assistance as
well, such as when the resident needs to get out of bed or out of a
wheelchair. Serious falls may occur if the staff leaves a high-risk
resident unattended for just a few minutes.
Any time a resident falls at a nursing home, even if they are not seriously
injured, another fall risk assessment should be completed immediately
because the next fall could be serious or even fatal.
Nursing home personnel needs to keep in mind that some
residents with severe dementia and/or those who lean out of their wheelchairs
often should not be left unattended or unsupervised in their room. For
example: A woman who had a previous history of a brain bleed three years
earlier with severe dementia developed an obsession for picking up things
off the floor. One day, she fell out of her wheelchair and sustained
a laceration on her forehead. Fortunately, she did not have a brain
bleed. But the family was very concerned about her risk of falling again
because they knew the next fall could be more serious and possibly fatal.
Family members expressed their concerns, but the staff would not take
them seriously. Five days later, this resident was left unsupervised
and unattended in her room. She fell out of her wheelchair in a similar
way as before and broke her neck. Sadly, she suffered with complications
from the C2 fracture and passed away six weeks later.
For residents who are deemed as high risk of falling
out of their wheelchairs but safe in their beds, they should never be
left alone in their wheelchairs. If no one can be in the resident’s
room to watch him/her, the staff could look at two options: Keep the
resident in front of the nurses’ station where someone can watch
her/him or place him/her in an activity room or another room with other
high risk residents and where there is constant supervision from the
4.) Malfunctions or Misuse of Equipment
This refers to equipment that is designed to protect residents from
falls, such as walking aids, Hoyer lifts, and bed rails. When these
things are defective, broken, or not used, there is a much higher risk
for falls to occur. Nursing homes should conduct inspections of equipment
to always ensure the equipment being used is in proper working order.
5.) Errors When Transferring Residents
One wrong move when a resident is being transferred out of
bed into a wheelchair, or out of a wheelchair into a bed, or onto a
toilet, or into a shower/bath can result in a serious fall. Many of
the residents lack strength, flexibility, or coordination to prevent
a fall. In many cases, the guidelines require that no less than two
staff members move a resident in beds or from beds and other equipment.
6.) Medication Errors
Giving a resident medication, the wrong medication, wrong dosage, or
missing a dose can have disastrous consequences that would increase
a resident’s risk for falling. For example, a resident's blood
pressure could drop, making him or her feel lightheaded, which can result
in poor balance and coordination.
Serious Injuries After a Nursing
Here are some serious injuries from falls:
- Hip and femur fractures requiring emergency
surgery, if possible (Some fractures
have occurred and were impossible to repair, which resulted in lifelong
dependency on others for movement and transfer.)
- Broken arms, elbows, knees, and other orthopedic
- Closed-head and traumatic brain injuries,
including brain bleeds
- Cervical fractures
- Facial injuries, including damaged teeth
and orbital fractures
Residents may survive a fall, which could result in
permanent injuries or a significant decline in health over the following
months / years. It is harder for an elderly person to recover from serious
injuries compared to that of a younger person.
Unfortunately, many of the serious fall-related injuries often lead
to the resident’s death. When this occurs, medical examiners will
note “an accident” on the Death Certificate was a contributing
cause of death.
Any time a resident sustains a serious injury from a fall, especially
if it leads to permanent disability, decline in health, or death, the
resident’s family member(s) is encouraged to report the fall to
the inspection agency in the relevant state, which oversees nursing
homes, guidelines, and practices. In addition, the family member(s)
should consult with an attorney for advice and appropriate legal remedies.
The amount of resulting pain, dependency, health decline, confusion,
and a lower quality of life suffered by a nursing home resident is inconceivable
and intangible. A fall or risk of fall should be unacceptable for ALL
nursing homes and definitely unacceptable for the resident’s family
members or guardians.