Legal Liability for Falls in Nursing Homes and Assisted Living Facilities

By Jeffrey J. Downey, Esq.

Falls are a major source of injury in both nursing homes (SNFs) and assisted living facilities.  In nursing homes as many as 48% of the residents suffer a fall annually.  About 1 in 10 falls cause serious injury.  This article addresses the issue of when a facility can be held legally liable for such falls under our civil justice system.

All nursing homes and assisted living facilities are required to undertake an assessment of fall risks when a patient enters the facility.  If that patient is deemed to be a high fall risk, the facility must implement a care plan to prevent falls.  In the assisted living facility, the staff creates a service plan, which is the same as a care plan in a skilled care facility.

There are many conditions that place a resident at risk for falls.  They include the following:

1. Prior history of falls
2. Dementia or Alzheimer’s disease
3. Memory loss and/or confusion
4. Difficulty performing ADLs (activities of daily living)
5. Unsteady gait or poor balance
6. Certain medications like pain meds, sedatives, antidepressants, anti-seizure, opioids and high blood pressure meds
7. Mental illness causing agitation or restlessness
8. Incontinence that can result in patient’s self-toileting
9. Recent injury like a hip fracture or stroke
10. Environmental factors like wet floors or lack of staff assistance

Since demented patients typically lack safety awareness, they are always at an  increased risk for injuries in nursing homes, including falls and other adverse outcomes, like pressure wounds and infections.  Caring for elderly individuals suffering from dementia in nursing homes, particularly in Virginia, extends far beyond mere staffing issues. While the numbers and qualifications of staff play a pivotal role, recent studies from the University of California, Irvine studies emphasize the necessity of a multifaceted approach to ensure the safety and well-being of these vulnerable residents. This article explores the factors contributing to the risk of fall injuries in nursing homes.

Understanding the Impact of Staffing and Training Dynamics

There is a direct connection between staff numbers and the quality of care in nursing homes. Patients in nursing homes that are understaffed are more likely to suffer injuries from falls, as well as other adverse outcomes, i.e., infections, bed sores, medication errors and wrongful death.

However, proper staff training is as important as the numbers of staff. As highlighted in a study from the University of California, Irvine, published on January 8, 2024, merely increasing staff numbers falls short of addressing the care quality disparities. The study, which garnered attention in SCIENMAG, underscores the need for specialized training, an easily navigable environment, and staff stability to adequately cater to residents with dementia.

The Critical Role of Specialized Training

Studies emphasize that dementia patients require more than routine physical care. They need empathetic understanding and specialized handling, attainable through proper training and experience. Increasing staff numbers without equipping them with necessary training is a waste of resources.  

Standards of care for fall prevention

“Standard of Care is a term of art in the legal industry.  It refers to the standards required by a reasonably prudent healthcare provider under the same or similar circumstances.  In long-term care cases both regulations (42 C.F.R. 483.25(h))  and community practice standards set the standard of care for fall prevention.   A nursing home  must undertake an initial fall assessment and put in place a fall prevention plan to provide a safe and secure environment, which includes staff supervision and assistive devices to prevent accidents and injuries.

If a healthcare provider fails to undertake a proper fall risk analysis, then that provider is negligent.   If the provider fails to put in place a proper fall prevention care plan, then that provider is negligent.  In the context of a malpractice case, the Plaintiff must prove that the negligent conduct at issue was proximate cause of the fall.  In other words, one must prove that if a proper fall prevention plan was put in place, it would have likely prevented the fall.

Often patients who are debilitated and/or demented require physical assistance with toileting.  If a care plan required a two person assist for toileting and the patient fell because there was only one person helping, the facility should be found liable for that fall.

Sometimes patients who require assistance with toileting will get up on their own to self-toilet.  Sometimes they get up on their own because the staff has not responded to a call bell request.  Where a staff member ignores a request for patient assistance, that will provide important evidence of negligence.  However, the facility may argue that the resident never triggered the call bell or that they didn’t wait for the staff member to arrive.  It’s important in these situations to obtain staffing schedule and the log for call bell response times.  Not all facilities maintain these logs, but they can provide important evidence of negligence and lack of adequate staffing.

Facility Defenses – we can’t restrain the resident

In most situations, absent an emergency, a facility cannot use restrains to tie a resident to a chair or bed.  Often defendants argue that since they can’t restrain a resident, most falls are not preventable.  

However, there are many ways a facility can use less restrictive measures than restraints.  For example, for patients in wheelchairs, the staff can use a special cushion which makes it difficult for the patient to get up or fall out of a wheelchair.  For demented residents, the facility can place a removable activity board that attaches to the front of the wheelchair, similar to what you might see being used for a child.   If the patient is getting up out of bed the facility can place a bed alarm to alert the staff when the resident is trying to get up.  Facilities can also use a perimeter mattress which is not a restraint but prevents the patient from easily getting out of bed.

In short there are a variety of ways to limit fall risks in nursing homes which are limited only by the training and imagination of the staff.  If your loved one has suffered a fall in a nursing home or assisted living facility that has caused injury, call our office for a free consultation and case evaluation.

The Law Office of Jeffrey J. Downey prosecutes nursing homes and assisted living facilities for the neglect and abuse of elderly patients.  Jeffrey Downey has over 35 years of experience handling malpractice cases.  Contact our office today for a free consultation. 

You will speak directly to an attorney, always.

We handle cases in Virginia, Maryland and Washington D.C.

Email: jdowney@jeffdowney.com

Phone: 703-564-7318 On the web at Jeffdowney.com