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Nursing Home Falls

By some accounts, every elderly person in America will fall at least one time over the course of the next two years. Many of these falls cause injury and some will even cause death.

In the nursing home setting, many clients and their families focus their attention on tying a specific number of falls to a facility’s responsibility. There really is no magic number of falls necessary to establish neglect or negligence. Each case is unique and the facts and circumstances surrounding the injury must be considered.

In determining a nursing home’s fall related liability, it is important to determine not just the actual number of falls that occurred prior to the injury, but to look at the situation as a whole. Taking a look at a resident’s “fall risk assessment” completed by the facility on admission should help determine what safeguards should have been in place to prevent falls. In the case of multiple falls, it is important to look to see if a new assessment was completed after each fall. In other words, the facility’s action after a fall are just as important as the circumstances surrounding the fall itself.

Falls in nursing homes occur for variety of reasons. Some of the more common causes for fall are:

  • Muscle weakness and walking or gait problems.
  • Hazards in the nursing home-wet floors, poor lighting, improper heights, improperly maintained wheelchairs, equipment left out of place.
  • Medications-drugs that effect the central nervous system, such as sensitive anti-anxiety drugs (psychoactive drugs).
  • Improperly fitting shoes or incorrect walking aids.
  • Frequent use of restraints.
  • Inadequate staffing levels that fail to provide sufficient assistance to residents.

Each year, 1.8 million Americans over the age of 65 are injured in falls. According to the centers for disease, control and prevention, some rebound as if the injury never happened. But to some, the fall sets off a downward spiral of physical and emotional problems – including pneumonia, depression, social isolation, infection, blood clots and muscle loss – that becomes too much for their bodies to withstand.

Upon admission to a facility, a nursing home has an obligation to conduct an assessment of every resident to determine their risk levels for fall. A resident is at a high risk of falling when they have cognitive difficulties, physical difficulties, suffer from dizziness or are bedbound. In order to lessen the risk of falls, precautionary measures to prevent a resident’s fall may include:

  • The use of the guardrails on the beds.
  • The use of an alarm system to alert staff if the resident leaves their beds.
  • The lowering of the bed itself to minimize the risk of injury from falling from an elevated height.
  • An adequate number of staff to provide assistance.
  • Moving a resident closer to the nurses’ station to increase supervision.
  • More assistance in ambulation.

While Federal and State laws may specify a minimal staffing ratio, the fact remains that many nursing home residents who are at a high risk for falling need significantly more attention than the bared-bone staffing requirements. Nursing homes residents’ with dementia, Alzheimer’s, and low blood pressure are particularly susceptible to falls.

According to Charlene Harrington, a University of San Francisco, California Professor, who has studied nursing home staffing “only 5% of nursing homes around the US has adequate staffing”. What happens to the 95% of nursing home residents, who are exposed to chronic under-staffing, poor employee training and high staff turnover? More than 1,800 people die each year in nursing home falls.

In 2005, the last year for which statistics are available, 433,000 people over 65 were admitted to hospitals after falling, and 15,800 died as a result of the fall. Broken legs and broken hips are common. One in five hip – fracture patients over the age of 65 die within a year after surgery, according to the CDC; one and four have to spend a year or more in a nursing home. When younger people fall, they tend to break their wrists catching themselves, but in older people, who have slower reactions and less upper/body strength, the weight more often falls on their hips or heads. Any underlying conditions like heart disease or respiratory problems, increase the chances of a downward health spiral.