Nursing Home Falls & Fractures

Why Falls Happen in Nursing Homes

Nursing home falls are expected by families to be prevented. Falls are predictable and largely preventable when proper care planning and supervision are in place. Yet they remain one of the leading causes of injury and death in nursing facilities.

Residents who fall often have identifiable risk factors. Federal regulations require nursing homes to assess these risks upon admission and develop written care plans to address them. When falls still occur, it usually indicates that the care plan was inadequate or—more commonly—was not followed.

Fall Risk Factors

Nursing homes must assess and monitor for these common risk factors:

• Weakness or gait dysfunction (difficulty walking)
• Confusion or dementia
• Neurological disorders
• Vision problems
• Incontinence (urgency to toilet)
• Medications that increase fall risk

How Nursing Homes Prevent Falls

When a resident is assessed as a fall risk, the facility must develop a comprehensive care plan. Effective prevention measures include:

• Physical or restorative therapy to improve strength and balance
• Assistance or supervision while walking
• Placement near the nurse’s station for visibility
• Bed alarms or chair alarms to alert staff when resident tries to move
• Low bed positioning and padded floor mats
• Scheduled toileting to reduce incontinence-related urgency
• Medication review to reduce fall-risk drugs
• Clear pathways free of tripping hazards
• Proper footwear and assistive devices (canes, walkers)

Consequences of Falls in Nursing Homes

Nursing home residents fall differently than healthy younger adults. Many have osteoporosis (brittle bones), making fractures likely even from minor falls.

Hip Fractures

Hip fractures are extremely common and serious. They often require surgery, lead to permanent loss of mobility, and frequently result in death. A resident who was walking before a fall may never walk again.

Brain Bleeds

Falls can cause subdural hematomas (bleeding in the brain) even when there are no obvious signs. Residents on blood thinners like Coumadin are at even higher risk. Brain bleeds can be silent and fatal. This is why facilities must conduct a “72-hour fall watch”—continuous monitoring after any fall—to catch bleeding before it’s too late.

Complications & Wrongful Death

Many nursing home fall cases become wrongful death cases. Death may result from the fracture itself, post-surgical complications, or delayed detection of injuries like brain bleeds. These deaths are preventable with adequate care.

How We Investigate Fall Cases

Unlike slip-and-falls in stores, most nursing home falls are not accidents. We examine the full care planning process to expose negligence:

• Assessment failures: Did the nursing home properly identify fall risk? Does the assessment match the resident’s actual condition?
• Care plan deficiencies: Is the plan adequate and detailed? Does it address all identified risks?
• Implementation failures: Was the plan actually carried out? We review incident reports, staffing logs, and documentation for gaps showing neglect.
• Failure to revise: When a fall occurs, does the facility revise the plan? Repeated falls suggest a plan that was never adequate or never executed.

We also investigate post-fall care. After a fall, residents must be monitored for complications like brain bleeds. Failure to conduct proper monitoring or to seek timely medical attention can turn a treatable injury into a death.

Results in Fall Cases

Falls are among the most common cases we handle. Here are examples of results achieved for families: