Fall Prevention: Nursing Home Obligations
In last week’s blog we looked at some of the key risk factors for falls in nursing homes. But what prevention and intervention strategies should facilities be implementing? What are their legal obligations regarding such strategies? When and in what circumstances should you consult an elder abuse attorney?
Reducing fall risks in care facilities requires a multifaceted strategy that combines environmental adjustments with personalized care planning. Effective fall prevention hinges on evaluating each resident’s unique risk factors, applying tailored interventions, and regularly reassessing their condition to adjust care plans accordingly. These strategies range from straightforward preventive steps to more advanced solutions.
Let’s look at some of the most common fall prevention and intervention practices in turn.
Comprehensive Risk Assessment
Conducting a detailed fall risk assessment is essential to identifying at-risk residents. Facilities should carry out these assessments upon admission and at regular intervals.
Key components of fall risk assessments include:
- Physical and Cognitive Evaluation. Assessing balance, mobility, muscle strength, and cognitive ability.
- Medical History Review. Evaluating the resident’s health conditions, medication regimen, and any past falls.
- Environmental Review. Identifying potential hazards within the resident’s surroundings.
- Monitoring. Updating assessments regularly, especially following health changes, illnesses, or medication adjustments.
The Centers for Medicare & Medicaid Services (CMS) offers a list of risk factors requiring thorough evaluations using clinical records, interviews, and direct observation.
Hazard-free Environment
Improving lighting and decluttering helps to create a safe space tailored to the resident’s mobility needs. Assistive devices should be within easy reach to reduce fall risks.
Promoting Mobility
Residents who remain sedentary for long periods are more susceptible to muscle weakness and instability. Physical therapy and supervised walking – with walkers or canes where appropriate – help promote strength and coordination.
Bed Height & Bedside Mats
Lowering bed height can significantly reduce the severity of injuries in the event of a fall. Beds should be set to allow residents to sit with their feet flat on the floor. For high-risk individuals, padded bedside mats can further soften the impact of a fall.
Non-Slip Footwear
Non-slip shoes or socks help to prevent slips, particularly on smooth or wet surfaces.
Technology
Pendants or wristbands enable residents to signal for help during emergencies. Some devices include motion sensors that automatically alert staff in the event of a fall. These tools enhance safety without restricting mobility — though they may not be ideal for residents with memory impairments who may forget how or when to use them. Alongside wearable tech, bed and chair alarms alert staff when a resident tries to move unassisted, allowing for immediate intervention. Silent alarms that notify staff without disturbing the resident may be preferable as they are less intrusive, reducing the potential for anxiety or panic.
Toileting Plans
Unsupervised bathroom use (often due to understaffing) is a common contributor to falls. A scheduled toileting routine tailored to each resident’s needs can help minimize the risk of falls. Plans should be documented and updated regularly.
Bedrails
The use of bedrails – even when requested or consented to by the resident – is controversial. While they may prevent some falls, they also introduce risks like entrapment or injury if a resident tries to climb over them. That families often request bedrails due to their concerns about fall risk only serves to underscore the facility’s responsibility to implement other effective safety measures.
Supervision
Close monitoring is vital for residents at high risk of falling. This can include:
- Placing residents near nursing stations
- Increasing staff presence during high-risk times or activities
- Video monitoring
- Providing 1-on-1 supervision during critical periods
Newly admitted residents may be particularly vulnerable and should receive increased attention as they adjust to their environment.
Medication Review
Some medications—such as sedatives, antidepressants, and blood pressure drugs—can elevate fall risk. Regular medication reviews allow for adjustments or discontinuation of high-risk drugs when appropriate. Reviews also decrease the risk of medication errors.
Exercise and Physical Therapy
Tailored exercise programs focusing on strength, balance, and coordination can improve mobility and help prevent falls. These may include physical therapy sessions or group classes depending on the resident’s condition.
Vision and Hearing Checks
Impairments in vision or hearing can contribute to missteps and falls. Routine assessments and the provision of glasses or hearing aids help mitigate these risks.
Foot Care
Proper foot care, including treatment for bunions, calluses, or other conditions that affect gait and balance, is vital. Access to podiatry services ensures ongoing attention to foot health.
Hydration and Nutrition
Maintaining adequate hydration and proper nutrition supports overall strength and well-being. Monitoring intake can help prevent fatigue, dizziness, or weakness that may lead to falls.
Other Targeted Interventions
Facilities often use additional tools such as:
- Wedge cushions
- Wheelchair trays
- Anti-tip devices
- Self-release seat belts
- Pommel cushions
- Lap buddies
These interventions are selected based on the resident’s individual needs and care plan.
Managing fall risk in California nursing homes is a critical issue for healthcare providers and policymakers. Improvements in the number and quality of staff and more efficient use of technology can help reduce errors and improve overall care standards.
If your loved one has suffered a fall in a California nursing home and you suspect elder abuse or neglect, a dedicated elder abuse attorney can help you navigate the legal system. For a free consultation with an elder abuse attorney in Los Angeles, San Francisco/Bay Area, or Sacramento, contact Dudensing Law here.