A fall can cause serious injury to a nursing home resident or hospital patient, especially elderly residents because they are susceptible to fractures, especially hip fractures. A fractured hip requires major surgery and extensive rehabilitation, and can cause permanent disability and even death in elderly residents.
Most nursing homes and hospitals take the position that the elderly are going to fall at one point or another, and that the goal is not to prevent all falls because that is impossible. Our position, however, is that we do not expect nursing homes and hospitals to prevent all falls. But what we do expect and insist upon is that preventable falls not occur. A preventable fall is one that could have been prevented had the staff provided proper care to the resident. The following are some examples of preventable falls:
Failure to provide toileting assistance. Many residents are continent and just require a little assistance from the staff getting to the bathroom. A resident typically presses a call light button to request assistance, but many times no staff person responds. This can continue for 15 to 20 minutes (or longer) until the resident, who just can’t wait any longer, attempts to walk to the bathroom unassisted and then falls. The fall could have been prevented had the staff timely provided the resident with assistance to the bathroom. Tip: On one of your visits, try entering your family member’s room without the staff knowing. Press the call light button and see how long it takes the staff to respond.
Improper transfers. Preventable falls can also occur during transfers—usually transfers from a bed to a wheelchair. These falls can occur when the aide who is assisting the patient out of bed fails to lock the wheels on the wheelchair. Or, the aide puts the bed’s side rails down and then leaves the patient unattended to do something else and the patient falls to the floor. Or, only one aide is available to transfer the patient when two aides are required and the patient falls during the transfer. These are all preventable falls.
Medication – Related falls. Some preventable falls occur when the staff administers medications improperly. This can occur, for example, when a nurse mistakenly gives a resident the wrong dosage of his medication, and the resident falls shortly thereafter. Or, a nurse for whatever reason fails to give a resident her required daily medication, and the resident later falls. Or, a nurse administers a resident his medication knowing that the medication’s side effects include dizziness and weakness, yet there is no supervision provided to the resident who later falls because she was dizzy and weak. All of these falls could have been prevented had the staff followed proper protocol when administering medications.
Infection – Related falls. Many times a preventable fall occurs because of an infection that the patient contracts at the hospital or nursing home. For example, if a patient develops a urinary tract infection that goes unnoticed by the staff (despite its obvious symptoms), then that undiagnosed and untreated urinary tract infection can cause an alteration in the patient’s mental status, which in turn, can result in the patient falling. The fall could have been prevented had the staff timely diagnosed the urinary tract infection and treated it.
Most preventable falls occur because the staff failed to provide adequate supervision of the resident; or the nursing home was understaffed; or the staff was not properly trained. When a fall occurs, the nursing home should call the family and advise them of the fall. Tip: When you are called, ask questions—when did the fall occur; how did it happen; and whether there were any injuries. If possible, visit the resident the same day you are called to see for yourself what the injuries are. Ask the resident how the fall occurred, and ask the caregivers who were on duty at the time how the fall occurred and whether there were any injuries. Tip: If you suspect an injury, insist that the resident be sent to the hospital for x-rays and an evaluation. In our opinion, some nursing homes are reluctant to send a resident to the hospital for an evaluation after a fall because of what the hospital might find—i.e. not just an injury from the fall, but evidence of neglect as well, such as a bedsore; a bad infection; old bruising; an old fracture of unknown origin; dehydration; malnourishment; etc.