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by Jeffrey J. Downey, Esq.
“Growing old is humbling and it takes effort to accomplish this stage of life with dignity.” – Kilroy J. Oldster
Falls suffered by the elderly population pose one of the highest preventable risks for injury/death in nursing homes. In fact, according to the Agency for Healthcare Research and Quality, out of the 1.6 million nursing home residents in the United States, at least half of them (approximately 800,000 people) have an incident of falling while they are supposed to be under medical supervision. To make matters worse, out of the 800,000 who experienced a preventable fall, approximately 500,000 will experience a second fall. As a result, approximately 65,000 patients suffer a hip fracture each year, which is considered a high-risk injury, which significantly increases a patient’s risk of death.
Falls occurring in nursing homes and assisted living facilities can result in serious injury to elders and corresponding legal liability for the facility. Many falls are if the facility promptly identifies an individual’s risk factors for falling and puts in place an appropriate prevention care plan to stop falls before they occur.
Risk Factors for Falling
Risk factors for falling increase with age and may be greater for women than men. Typical risk factors for falling include the following:
- A prior history of falls
- Dementia, Alzheimer’s disease, or other neurological condition
- Incontinence, which can result in frequent trips to the bathroom
- Decreased bone density or muscle weaknesses
- Recent hospitalization causing physical limitations or disorientation
- Vision or ambulation problems
- Medications that can cause confusion or disorientation
- Unsafe environment, including slippery or wet floors, rises in carpets, or other obstacles
Nursing homes are required to retain trained professionals who are knowledgeable in assessing risk factors for falling. They are obligated to put fall prevention protocols in place to prevent serious injury or death.
Standards of Care for Assessment, Care Planning and Fall Prevention
Most nursing homes are required to follow OBRA 1987, regulations setting minimum standards of care for nursing homes that receive federal funding. Some regulatory standards that apply to fall prevention include the following:
- OBRA §483.25(d) mandates that the resident environment remains as free of accident hazards as
- 483.20(k) Resident assessment. The facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident’s medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment.
- OBRA §483.25(d) requires that “each resident receives adequate supervision and assistance devices to prevent accidents.”
- OBRA §483.30 provides that “the facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident as determined by resident assessments and individual plan of care.”
- 483.20(d) Resident Care Plans. The facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident’s medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment.
At the time of admission, the standard of care requires that every resident of a long-term care facility get thoroughly evaluated for risk factors for falling. If that assessment shows that the resident is at risk for falling, a fall prevention care plan should be put in place immediately.
A care plan is a multi-disciplinary tool where various specialized disciplines (nursing, physical therapy, occupational therapy, physician, recreation aids, etc.) get together to come up with a multi-disciplinary approach to the problem. A care plan for fall prevention may include the following interventions:
- Keeping the floor free of debris or dangerous objections
- Keeping call bell in reach of the patient
- Providing an opportunity for physical activity to strengthen a patient’s muscles and prevent
early onset atrophy through physical therapy
- Providing gait (walking) orientation and training through physical therapy or restorative therapy when physical therapy is no longer available
- Evaluating whether medications are causing lethargy, disorientation, or dizziness
- Providing medications to help prevent the loss of bone density
- Aiding with ambulation (or mobility) to ensure that the resident get from one place to another as safely as possible
- Implementing routine toileting schedules so a patient does not have to get up from bed to go to the bathroom by himself or herself. Also, a patient should feel comfortable informing staff of any restroom needs at any time because the whole point of long-term facilities is to ensure that their loved ones can remain as independent as possible
- Bed alarms to alert the staff when the resident is getting up without needed assistance
- Frequent checks by nursing staff or placement of resident where he can be monitored by staff in a safe environment (i.e., a staffed activity room)
- Providing a low bed or bed with floor pads and safety cushions
- Bed rails on the beds for patients who, because of dementia, insist on getting out of bed without using the call bell. Bed rails should have safety cushions to prevent patient entanglement.
- Perimeter mattress for the bed, which is not considered a restraint
- Hip protectors or pads to cushion a patient during a fall
- Wheelchair alarms to alert staff when a resident is getting out of a wheelchair
- Wedge cushions to prevent a resident from sliding out of a wheelchair
Nursing homes and assisted living facilities should have access to various devices that allow residents to ambulate and move around safely even without assistance. Such devices include a Merri-walker, which surrounds the patient so that he or she can move throughout the nursing home safely. Long-term facilities should be vigilant in re-evaluating a patient’s risk factors for falling as they may increase during a resident’s prolonged stay at the nursing home.
A Call to Action
“When it comes to human dignity, we cannot make compromises.” -Angela Merkel
It is always a good idea to be proactive in the care of a nursing home resident. That’s been a lot harder to do these last few years with Covid-19 visiting limitations, explains nursing home attorney Jeffrey Downey.
If you have questions about whether a nursing home is properly protecting your loved one from suffering a fall, ask the charge nurse or supervisor what services are included in the care plan to prevent falls. Share your views in a constructive way and ask if you can participate in the next care plan meeting. If you’re not the power-of-attorney for the resident, you may have to get permission to participate or get appointed as co-power of attorney, to assist in the health care decision-making process.
If your loved one has suffered a fall resulting in serious injury or death, you may want to have your case evaluated by an attorney experienced in handling fall cases.
Mr. Downey has been handling negligence cases for over 30 years and has a wealth of legal experience in this area. His case results speak for themselves. His staunch advocacy has resulted in numerous case precedents supporting the civil prosecution of elder neglect and abuse cases. Call the office today for a free consultation.
No attorney’s fees are charged unless there is a settlement or recovery, so call now as all claims are subject to time limits or statutes of limitations.
Jeffrey Downey, Representing clients in Virginia, Maryland, and Washington DC
The Law Office of Jeffrey J. Downey, PC
8270 Greensboro Drive, Suite 810
McLean, VA 22102
Phone: 703-564-7318 or 703-564-7357
Email: jdowney@jeffdowney.com
On the web at Jeffdowney.com