My elderly parent recently had a fall while staying in a nursing home, and I'm concerned about what steps our family should take next. Thankfully, there don't appear to be any serious injuries, but I want to make sure we're handling the situation properly. Should we request a copy of the incident report and medical records? Is it a good idea to ask the nursing home how the fall happened and what changes they'll make to prevent it from happening again? At what point should families consider filing a complaint or seeking legal advice if they believe the fall may have been caused by negligence? I'd appreciate any advice or experiences from others who have dealt with a similar situation.
Is you mother a fall risk? How did the fall occur? Did the staff follow policy and procedures according to state law?
Sadly, many elderly experience falls and it is the nature of aging, dementia and becoming frail. But not all are do to negligence of the facility. Restraints can not be used and many elders are not mentally capable to remember they are not able to walk or are unsteady and need assistance.
I would ask to see the incident report. Ask for a copy if you wish.
What is important is what steps were followed after the fall.
What steps will be taken to help prevent another fall. But know that another fall will probably happen at some time.
You mention negligence.
That may be very difficult to prove. Even if an Aide, CNA, or Nurse is standing RIGHT next to a person that does not prevent a fall. (although a person can "minimize" a fall by helping the fall to happen safely. Stopping a fall can do more damage and cause more injury than allowing a safe, controlled fall)
The fact that there are no serious injuries you just be thankful and hope that another incident does not occur.
By law restraints cannot be used. If they were allowed, there may be fewer Falls. I was lucky to have a RN in the family. I would ask her if I should complain or not. LTC is not perfect. I had a problem with Moms bra being put on. She had to have it otherwise she broke out in Yeast infection which was easier to prevent than cure. My daughter explained the aides schedule to me. Where did I put her bras, in the drawer next to her bed with her socks. That was the problem. Aides dress from the top down so by the time they saw the bra Mom was fully dressed. They don't have time to undress her because they have other residents that need to be dressed by breakfast. I am OCD and would put her clothes in sets. So, I started hanging the bra with each set. They never combed her hair right. So I carried a brush and hairspray with me. You need to pick your battles.
I cared for my late husband at home until his death and there were many times that he fell when I was near him or in the other room, and I knew that it wasn't my fault or because of something I didn't do ie. some kind of neglect.
Falls are as common in facilities as is eating and drinking, and yes there should be an incident report that you should be able to look at, but you have to understand that all facilities have many people to look after and they can't be everywhere every minute and that for many reasons falls will happen.
I know that there's a member on here whose mother fell over 90 times while in a very nice memory care and never once did she blame the facility but accepted the fact that her mother was a fall risk and that the facility was doing the very best they could.
If your elder rolled out of bed, there's a solution for that.
If your elder gets up out of bed in the middle of the night, there's some possible solutions for that.
Slipping in the shower? There are solutions for that.
None of the solutions come with 100% no-fall guarantees, however.
But if your elder has cognitive or memory impairment and thinks they can get up and walk when they can't... there's not really a solution for that -- even in their own homes. Sometimes elders have a medical incident that causes them to fall (BP, vertigo, Parkinsons, TIA, seizure, etc). You will find that it is unrealistic to think that every fall in a facility is due to negligence. MOST are not due to negligence. I'm not even sure what negligence in this instance would look like, considering elder facilities are occupied by residents who can be uncooperative, forgetful, lacking judgment, stubborn, physically compromised and demented. The only 100% safety may be restraints, but there are reasons why facilities are very very reluctant to use these, even though it is legal in most states.
Yes, you can call an ambulance-chasing lawyer who will glady take your money.
I wouldn't get lawyers involved at this point. The staff is human and may be defensive to have these things interfered with by a lawyer. I am sorry to say it, but these are the prople who are caring for the patients and accusing them of negligence for something as
common as falls may alienate them from the patient and the family.
You need to be realistic about the situation. If a pattern of falls develops, it may be worth investigation. Maybe they need a different approach or level of care. Just don't rush into accusations of improper care until you know the facts.
They would call me after every fall. They would examine him after his fall and let me know he was okay. They would tell me what they were doing to prevent falls-like putting a pad on the floor or lowering his bed closer to the ground or putting triangular shaped cushions next to his body in the bed under the sheets to make it harder for him to get his legs over the side.
Falls happen.
I'd say, ask them to let you know after he falls. Ask if they checked him over and if there were any injuries. Ask if there is anything they could be doing to help prevent the falls.
Don't just accept that falls happen. Get the incident report and go from there. What is the patient-to-aide ratio in the facility your parent is in? Some facilities are better staffed than others. Residents in a NH will get better care and attention if the staff knows that they have family on the outside keeping an eye on things.
"A major Harvard study of more than 4,700 negligence claims against nursing homes found that 61% of closed claims resulted in a payment to the plaintiff, while another similar study of over 5,200 closed claims found about 66% resulted in payment. Those payments include settlements as well as verdicts—they do not mean the plaintiff won at trial.
Falls are the single most common allegation. In those same studies:
About 26% of all nursing home negligence claims involved falls, making falls the most common basis for lawsuits.
What makes a fall case strong?
A fall by itself is not negligence. Nursing homes are not insurers of residents' safety. Frail elderly residents fall even when appropriate precautions are taken.
Plaintiffs usually must prove something like:
- The resident was known to be at high risk for falls.
- The facility failed to follow its own care plan.
- Staff ignored physician orders.
- Required supervision wasn't provided.
- Call lights went unanswered.
- Bed or chair alarms were disabled or ignored.
- The resident wasn't assisted with transfers despite needing assistance.
- Understaffing contributed to the fall.
- The delay in discovering or treating the resident worsened the injury.
Cases involving death
Cases become significantly stronger when there is evidence that:
- the fall caused a hip fracture or brain bleed,
- there was a delay in diagnosis,
- the facility falsified records,
- staff failed to monitor the resident after the fall, or
- there is documentation showing the facility ignored known risks.
One thing families often misunderstand. People sometimes assume:
"Mom fell in rehab, therefore the facility is liable." Legally, that's not enough. The question becomes:
Did the facility act reasonably under the circumstances?
If they performed appropriate assessments, created a care plan, provided the required assistance, and the resident still fell, there may be no negligence.
Conversely, if records show repeated ignored fall risks or failure to follow the care plan, the likelihood of a successful claim increases substantially.
If you lose, you may be responsible to pay the facility's legal fees (this varies by state). "
The facilities don't have the manpower to do visual checks every 10 or 15 minutes so they drop the bed to the floor and put a gym pad next to the floor for those that are fall risks.
We are dealing with this now. The lady I help care for 4 hours a week probably has stage 4 alzheimers. She slipped and fell in a mud puddle. She has a very bad break of her ankle and foot. She spent 9 days in the hospital and is now at rehab and can put no pressure on that foot until it heals.
The problem is she does not understand that she can't walk and that she cannot put pressure on that cast.
She has only been in rehab about 3 days. Since she does not understand she can't get out of the wheel chair and walk she is parked in the wheel chair next to the nurses station when she is not in PT. My boyfriend noticed in her room during the day when she was in her bed they parked the wheel chair directly next to the bed and on the other side the bed table had been pulled away from the wall and positioned next to the bed to block her getting out.
In Florida we have a lot of laws to protect seniors and seniors have agency.
In my friend's situation if she falls it will be due to declining brain power. i.e. She does not understand that she should not stand on the broken foot.
As seniors are no longer tied to wheel chairs and no longer tied into beds there are risks every day.
It does not hurt to ask how the fall happened.
Forty years ago restraints would have been used a lot. Strong meds would have also been used.
You can request that your loved one be parked in a wheel chair next to the nurses station for additional monitoring. That is what they are doing with my friend.
I think the best protection against falls are strong muscles. You can request PT to strengthen muscles and help with balance.
When there is mental decline it is much more difficult to protect from falls.
Not sure if your loved one is female or male.
From my post below the 77 year old woman who broke her foot and ankle was out working in her garden with her husband. They do this every day. The woman slipped in a mud puddle and fell and had a bad break of her foot and ankle. Her husband was with her. I don't know how one would have prevented this.
My next door neighbor is 78 years old. She was walking across the Hilton parking lot at 4:00 pm to meet people in the lobby. She tripped across a parking lot bumper and crashed to the ground and broke her right hand and her left shoulder. Two college students carried her inside and called her brother. She ended up getting a shoulder replacement. Neither her hand nor her shoulder will ever be pain free.
If your loved one did not break any bones I'd ask how the fall happened and go from there.
Understand that if you are elderly there are everyday risks in getting around.
When Mom had late stage Alzheimers she could still walk and stand with a CNA. The problem was when they stood too long she would squat to the ground. Technically that would be called a fall.
Generally the nursing home will use transfer belts if your loved one is a fall risk and they also use the hoyer lifts that are like forklifts for a senior.
1. Have PCP order PT to strengthen muscles and balance.
2. Walk with your loved one in the hallways if they can stand and walk. Let them use their walker. Those who can stand and walk (even with a walker) have stronger muscles and are less of a fall risk.
3. Evaluate what meds your loved one is on. Many meds increase fall risk.
Mom's PCP refused to put her on sleeping meds as he said they raise the fall risk.
4. Eating enough protein to keep muscles strong.
5. If your loved one is strong enough to stand and walk (even with a walker) walk around the halls with them on your visits instead of sitting in the room.
I'm sorry you went through this.
this is perfect advice. My routine with my Mom is to walk at every visit.
avoid meds that cause dizziness. My Mom takes melatonin at night instead of a sleep aid. Seems to be working. Also got her off of gabapentin and one of her blood pressure meds. She is so much better. Going on 4 months without a fall. I count it a victory.
Yes, ask how it happened, and whether they were checked out by a medical facility, which, I think, is what they usually do by sending a resident to the nearest hospital ER to make sure there is no sign of concussion, broken bones or internal bleeding.
It wouldn't hurt to ask what the NH protocol is for preventing falls and reporting falls. Some NH's require all residents to use a wheelchair. And they should be noting the incident in the patient's file, and responding with medical care to rule out any unseen damage.
It is possible that someone in the nursing home acted negligently and caused or allowed this to happen. I remember one time reading a sad story of a nursing home resident who was being pushed in their wheelchair by a staff member.
The resident's feet caught on the floor, causing them to tumble out head first onto the floor, and died. That tells me the staff member was traveling too fast and not properly monitoring the patient in their care.
After I read that, I always made sure to push my husband slowly in his wheelchair, because he would sometimes put his feet down to try and stop.
Falling may be a normal part of aging but nursing homes are supposed to be equipped with staff and safety measures that prevent falls. Yes, an accident and falls can happen, but they should be extremely rare. If nursing homes had to pay out damages the way insurance companies have to when a car accident happens or someone gets hurt on your property, you would see very few falls and accidents happening in nursing homes. As it is the 'industry standard' for care and safety in American nursing homes is so low that it is beyond shocking. In fact, it is absolutely disgusting.
Start holding care facilities responsible for resident safety and see how many less falls happen in nursing homes. Make all healthcare non-profit and watch how fast the quality of care and patient safety increases. Take the money, greed, and potential profit out of something and see how good it becomes.
I’d request in person meeting with Nursing Director to find out exactly how your loved one fell and request incident report. However, I doubt you’ll be successful in getting it. They say it’s an internal document.
Good luck and hugs 🤗
I would definitely request a detailed copy of the incident report, along with all relevant medical records. Read the report carefully to make sure it accurately reflects what happened.
Next, ask the nursing home to explain exactly how the fall occurred and what specific changes they are putting in place to help prevent it from happening again. If you believe the facility was negligent, consider filing a complaint with your state’s long-term care ombudsman or nursing home advocate. It is helpful to include supporting medical records and any other documentation you have.
After a few days, once you have a clearer picture of your loved one’s condition—including whether there has been any change in cognitive or physical status—you can decide whether further action, including consulting an attorney, is appropriate.
Most importantly, taking action isn’t just about your loved one. It may also help prevent another resident from experiencing the same thing.
A Plug-and-Play Email Template
You can copy, paste, and fill in the blanks to send to the
Nursing Home Administrator and Director of Nursing (DON):
Subject: URGENT: Medical Record Request & Post-Fall Care
Plan Review – Resident: [Parent's Name]
Dear Administrator and Director of Nursing,
I am writing regarding the fall involving my [mother/father], [Parent's Name], on [Date of Fall]. While I am relieved the hospital found no acute injuries, I am formally requesting a review of the preventative measures in place at the time of the incident to ensure compliance with federal care standards.
Pursuant to federal resident rights (42 CFR § 483.10), please provide a complete copy of [Parent's Name]’s medical records for the 48 hours surrounding the fall, specifically including:
The nursing shift notes and post-fall assessment.
The physical/occupational therapy evaluation following the incident.
The individualized Care Plan showing the specific fall-mitigation interventions that were active at the time of the fall.
Please let me know a time this week when we can review the updated, amended Care Plan to ensure proper interventions are now in place to prevent future incidents.
Thank you,
[Daughter's Name]
[Phone Number]
[Email Address]
FYI
Master Reference List for Caregivers
State Regulations & Rankings: AARP Long-Term Services State Scorecard (ltsschoices.aarp.org)
State-by-State Nursing Data: AARP Nursing Home Quality & Safety Dashboard (aarp.org/nhdashboard)
Objective Inspection Scores: Medicare Care Compare (medicare.gov/care-compare)
The Federal Red-Flag List: CMS Special Focus Facility Directory (cms.gov -> search "Special Focus Facility List")
National Advocate Directory: National Consumer Voice Ombudsman Locator (theconsumerview.org/get_help)
Hold them accountable.
While a nursing home may not be 100% responsible for residents' falls, it is important that you know what their (level of) responsibility is and how they hold themselves accountable in different situations / emergency situations. Could range from another resident harassing another resident to what your parent experienced. I hope that s/he is okay? Did they have x-rays, sent to emergency room? What medical follow up did they get.
My friend (I was his fiduciary handling every aspect of his life for 6 years; knew him for 18 years) fell out of bed (perhaps twice - its been a few years ago). Nursing homes cannot legally offer RESTRAINT railings that would keep a person from falling out of bed; the legally acceptable bed railings are very low.
I went through this when he first arrived ... figuring it all out.
- The 'best' they could offer is a 'very thin' mat on the floor next to the bed to 'cushion' the break / fall. Basically nothing if an elderly person, 90, who can't stand up/walk in his own.
For other situations, i.e., no water available - and more, I worked with an Ombudsman and reported this nursing home to their licensing board.
Nursing home was given AMPLE time to deal with the situation(s) before being reported.
- Once reported, they send a representative unannounced to observe / see what is going on. On that visit, friend had water and/or whatever else I was concerned about. They may make two unannounced visits and that's it... if everything seems to be in order.
Keep accurate records: date, time, situation, who you spoke to and follow up.
You may need this if legal action is taken. And, in any case, you need accurate accounting / records of whatever is going on.
You might want to check into another nursing home.
Find out their legal responsibilities, which are likely the same as other nursing homes. Depending on the fees you are paying, the care may (or may not) be better, with more adequate staffing / accountability.
1. Get your questions 'lined up' / written (do not rely on memory)
2. Talk to the administrator and perhaps together with 3. Talk to dept manager
4. Get their written report of incident or accident.
5. If they are not keeping you informed of anything out of the daily routine, ask them to notify you (immediately, as hopefully they did in this situation).
6. Get a copy of their contract or whatever paperwork you signed which shows exactly what (care) the facility is responsible to do, legally.
Gena / Touch Matters