While some falls cannot be avoided, many falls are preventable. Poor lighting is a frequent cause of falls. Facilities may fail to provide adequate lighting levels or fail to turn on lights when walking a resident to the restroom at night time. Many nursing home residents suffer from vision and cognitive deficits that make low levels of lighting even more difficult to navigate. Low lighting levels are often coupled with a cluttered, messy environment. Nursing home rooms are often cramped; when the staff attending to these rooms allow for clutter to build, they can quickly become fall hazards to residents. Another common fall hazard is wet floors. These falls are frequently the result of custodial workers who fail to follow safety guidelines. Lastly, missing or broken equipment can be the cause of preventable resident falls. Sometimes the nursing home fails to provide for necessary fall prevention equipment, such as anti-tippers or feet rests on wheelchairs. Other times, the resident’s furniture is wobbly or in general disrepair. Any of these preventable environmental factors can be the cause of a preventable resident fall that results in significant injury or disability.
Some falls are the result of lack of quality clinical care and supervision. It’s well known, for example, that medications are one of the most common causes of falls in older adults. Psychotropics, or medications that affect brain function, is one class of medications that can increase fall risk. This class includes anti-anxiety medications, sedatives, and antidepressants. Opioid pain medications and anticholinergics are other medications in this class that have been shown to increase falls in nursing home residents. A second class of medications that affect blood pressure, such as antihypertensive medications or alpha blockers, can also increase fall risk. It’s critical that the resident’s care team, including their attending physician, pharmacist, and nurses, frequently review medications for appropriateness and make adjustments to reduce the risk of falls in this vulnerable population.
Residents who become deconditioned from lack of exercise or movement are also at higher risk for falls. It’s very common to see residents sitting idle in wheelchairs and beds for hours on end in nursing homes. Unfortunately, when these residents are not provided opportunities to move, they become physically deconditioned and are less able to move under their own effort. An attempt made to move or ambulate by a deconditioned nursing home resident can quickly result in a preventable fall.
Facilities that neglect to provide necessary levels of falls management support and resident supervision can be culpable for preventable falls. The facility is responsible to assess a resident’s fall risk upon admission, quarterly, or with change in condition. They are expected to put specific, individualized interventions into place to mitigate and reduce the resident’s falls risk. These interventions may include increased supervision through 30-minute rounds, toileting at night time, ensuring all equipment is functioning properly, or medication review. Unfortunately, many facilities do not provide an adequate system of falls management to prevent falls and fall related injuries.
If your loved one suffered a fall that you believe was preventable due to environmental factors, medications, deconditioning, or supervision by the nursing team, it’s urgent that you consult counsel to discuss your concern and your legal options. No resident deserves the pain and debility that can result from a preventable fall; it’s your advocacy for your loved one that can help make things right.