Falls

Posted: February 5, 2017 | Last Updated: February 8, 2017

Nursing Home Falls are Common, and Deadly

According to the Centers for Disease Control and Prevention, about 1,800 older adults living in nursing homes die each year from injuries related to falls, such as broken bones and head trauma.[i] Given that only about 10% to 20% of nursing home falls cause serious injuries, and only 2% to 6% cause fractures, the reality is that far too many older Americans are falling in nursing homes.

This is not limited to nursing homes, either.  The Agency for Healthcare Research and Quality found between 700,000 and 1 million hospital patients fall each year. Between 30% and 51% of those patients suffer a serious, “reportable” injury.[ii]

When a nursing home resident falls, the result can include traumatic injuries, disability, functional decline, and reduced quality of life.  What’s worse, the resident may now have a much more severe fear of falling that can cause depression, additional functional decline, a sense of helplessness, or isolation.

If you would like to discuss your loved one’s situation, injuries, or death at a nursing home, call us at 844-529-4253.

Are Nursing Home Resident Falls Preventable?

Although not every nursing home falls is caused by neglect, the Centers for Disease Control and Prevention has identified a number of things nursing homes can do to help prevent falls, such as reviewing prescribed drugs to assess their risk (some drugs can make a person dizzy, disoriented, or lose their balance), installing grab bars so the resident is able to steady their self, and better training for nursing home staff.

A resident fall can be a sign of other health problems the resident may have.  People in nursing homes are generally frailer than older adults living in the community.  They may have more chronic conditions, more difficulty walking, and need a higher level of care.  They may also have thought or memory problems, need assistance with activities of daily living (things like getting dressed, grooming, and hygiene), or need help getting around.

All of these factors are linked to an increased risk for falls.[iii]  It is a nursing home’s job to identify, assess, and respond to these risks to minimize the chance of a fall.  When a nursing home does not do its job, and as a result, the resident is injured in a fall, the nursing home should be held accountable for the harm that results.

What are the Most Common Causes of Nursing Home Falls?

The Centers for Disease Control and Prevention has collected and reviewed research regarding nursing home resident falls, and concluded the following factors are the most common causes of nursing home falls:

  • “Muscle weakness and walking or gait problems are the most common causes of falls among nursing home residents.”
  • “Environmental hazards in nursing homes,” including “wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs.”
  • “Medications” that “increase the risk of falls and fall-related injuries.”  This includes sedatives and anti-anxiety drugs, which can affect the resident’s cognitive ability or balance.  It is not just taking the medications, but changing them, that can present a serious risk of falls: “Fall risk is significantly elevated during the three days following any change in these types of medications.”
  • Problems with walking or transferring, such as “difficulty in moving from one place to another (for example, from the bed to a chair), poor foot care, poorly fitting shoes, and improper or incorrect use of walking aids.”

If you would like to discuss your loved one’s situation, injuries, or death at a nursing home, call us at 844-529-4253.

How Can We Prevent Falls In Nursing Homes?

When it comes to preventing nursing home falls, there are three levels to consider:  fall prevention interventions implemented at the organizational, staff or patient level.

While families tend to consider only the patient level—is the nursing home providing the resident with appropriate care to prevent a fall?—there can be a breakdown at the organizational or staff level that makes providing adequate care difficult or impossible.  It doesn’t matter if the right interventions are in place if the staff caring for your parent does not get the information, training, or time needed to implement them.

I most often have cases involving that type of breakdown: the right interventions on paper, but the staff was not given the message, or the opportunity, to properly implement them.

Fall interventions include:

  • Educating and training nursing home staff to understand fall risk factors and prevention strategies.
  • Improving the nursing home environment to make it easier for residents to move safely, such as grab bars, raised toilet seats, lower-height beds, and hallway handrails.
  • Assessing prescription medications for the potential risks of falling, and ensuring minimal use to accomplish the medical goals.
  • Assessing resident fall risk thoroughly and regularly.
  • Assessing what happened and how to correct the issue after a nursing home resident fall to improve the system and the resident’s underlying medical conditions.
  • Nursing home resident exercise programs to improve balance, strength, walking ability, and physical functioning.
  • Tool such as bed and wheelchair alarms, floor mats, two-person assists with transfers and bed mobility, non-slip footwear.

Notably, routine use of restraints does not lower the risk of falls or fall injuries, and are not considered a fall prevention strategy. As the Centers for Disease Control and Prevention explains:

  • “Limiting a patient’s freedom to move around leads to muscle weakness and reduces physical function.”
  • Most nursing homes “have seen a drop in fall-related injuries” since anti-restraint regulations were implemented.
  • “Direct injury from bedrails appears to be due to outmoded design or incorrect assembly; bedrails do not appear to increase the risk of falls or fall injuries.”[iv]

If you would like to discuss your loved one’s situation, injuries, or death at a nursing home, call us at 844-529-4253.

Does a Resident Fall Mean a Nursing Home was Negligent or Neglectful?

If a resident falls and is seriously injured in a nursing home, the nursing home is responsible if the fall occurred because it:

  • Failed to properly evaluate the resident’s risk of the resident falling
  • Failed to provide adequate assistance to address the risk of the resident falling
  • Dropped, pushed, rolled the resident out of bed, or abandoned the resident in a situation in which the resident should not have been left alone (such as in a chair or on the toilet when the resident has poor sitting balance)
  • Hired unqualified employees or provided insufficient training
  • Failed to develop an adequate care plan based on the resident’s condition and needs
  • Failed to regularly reassess and modify the resident’s care plan
  • Failed to provide care in accordance with the resident’s care plan

Every nursing home that accepts Medicare payments must follow the Federal Regulations regarding caring for nursing home residents, 42 CFR sec. 483 et seq.  Under these regulations—and there are Ohio nursing home counterparts—require facilities to “ensure that  . . . [t]he resident environment remains as free of accident hazards as possible; and [e]ach resident receives adequate supervision and assistance devices to prevent accidents.”

Federal nursing home regulations and their Ohio counterparts also require nursing homes to provide every resident with an assessment done when they enter the facility, and regularly updated thereafter, including whenever there is a significant change in a resident’s medical condition.

This assessment must include a written plan of care (“care plan”) which describes the functional capacity of the resident and their fall risk.  The nursing home must take appropriate action to address those risks, such as supervise the resident and provide safety devices to prevent fall injuries.  That means full consideration of the resident’s health issues, including:

  • Mobility limitations
  • Loss of strength or balance
  • Medications that can cause dizziness, drowsiness, or poor reaction time
  • Dementia or other cognitive limitations, and
  • Impaired vision or dexterity.

The care plan should also include any assistive devices necessary to provide adequate care to the resident and keep them reasonably safe from falls, including:

  • walkers and other mobility aids
  • assessment of safe height for beds, chairs, and toilets
  • positioning of grab bars and rails

If the nursing home fails to comply with these or any of the myriad other regulations, and a resident is injured, the nursing home is responsible for the harm that results.  If you would like to discuss your loved one’s situation, injuries, or death at a nursing home, call us at 844-529-4253.

How Do You Prove Nursing Home Neglect or Negligence Caused a Resident Fall?

It can be difficult to prove exactly how a fall occurred without an attorney experienced in nursing home fall cases.  This is not simply a slip-and-fall case.  There are specific state and federal requirements for assessing and addressing nursing home resident fall risk.

Some of the sources of evidence I use when investigating and building the case in a nursing home fall include:

  • Physical and occupational therapy records. (How much physical or cognitive assistance did the resident need to walk, stand, transfer, brush her teeth, etc.? Was she needing more or less assistance over time?  How was this being communicated to nursing staff?)
  • Nutritionist and social worker notes.
  • Video and photographic evidence—which can require a fight to get, including visiting the scene to establish what cameras exist and what they saw.
  • Other residents’ as witnesses of the fall, the resident’s abilities and needs, nursing home staffing levels, etc.
  • Current and former nursing and physical therapy staff members.
  • The nursing home’s history of fall and other resident injury events.
  • The nursing home’s financial and staffing picture. (Was it, or the national chain parent, putting profits above patient safety?)
  • The nursing notes and nursing aide records showing who did what, when (or, at least, what they say they did).
  • Family and friend knowledge.
  • State Medicaid and Federal Medicare records, rules, and regulations.
  • Deposing the Director of Nursing and Administrator, and often corporate representatives up the chain of command that really control the purse strings and staffing levels.
  • The resident’s memory or statements, if they survived and were lucid. (I’ve seen highly suspect “statements” attributed to a resident after a deadly head trauma the resident was likely unable to make.)

Every nursing home fall case is different, but nursing homes are all too often the same: putting money into profits instead of adequate care, usually by cutting staff and staff pay (resulting in high staff burnout, turnover, stress, and mistakes).

If Your Loved One Was Injured or Killed From a Nursing Home Fall

To learn more about how we investigate and prosecute nursing home lawsuits, look at our nursing home lawsuit section.

If you would like to discuss your loved one’s situation, injuries, or death at a nursing home, call us at 844-529-4253, or fill out the contact form.  There’s no commitment or obligation, the call is free, and I’m happy to share my experience and knowledge.  I can promise you I will be candid and direct.  While we are very selective about the cases we take, I always try to help by at least answering questions and explaining the law on Ohio nursing home lawsuits.

 

[i] “Falls in Nursing Homes,” Centers for Disease Control, available at http://www.cdc.gov/homeandrecreationalsafety/falls/nursing.html

[ii] http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html

[iii] Ejaz FK, Jones JA, Rose MS. Falls among nursing home residents: an examination of incident reports before and after restraint reduction programs. Journal of the American Geriatrics Society 1994;42(9):960–4.

[iv] http://www.cdc.gov/homeandrecreationalsafety/falls/nursing.html

How do I Hire You to be my Ohio Falls Lawyer?

The first thing to do is complete the contact form at the bottom of this page. That way, you can put in details that we can review before we schedule a phone call.

You can also call us at 216-777-8856 if you prefer.

You will likely not speak to us immediately, but will schedule a phone or in-person meeting. Why? Because we’re busy working on the important cases other families have entrusted to us. Just like we would not constantly take phone calls when we’re entrusted to work on your case.

You should also gather all the records and papers you have from the medical providers, go back and look for dates, names, and events that happened, and otherwise prepare to discuss the case. We’ll have a meeting and, if it seems like a case we’d be a good fit for, we’ll move into an investigation phase.

Once we’ve investigated, we’ll candidly tell you what we think about what happened, whether the medical provider is to blame, and what we think about the strength of the case.

Fair warning: we only take on clients whose cases we believe have very strong merits. We’re not lazy—the cases are still very complex, difficult, and expensive—but the risk to your family of being drawn into a difficult process with little chance of a positive outcome is not something we do.

Which means when we do take on a case, our reputation tells the other side this is a serious case we believe in.

If for whatever reason we do not take on the case, and we think there is some merit to the case, we’ll try and help you find a lawyer who might take it on.

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