Falls and Fractures

What constitutes a “fall”?​

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According to the Centers for Medicare and Medicaid Services (“CMS”), a fall is defined as an event where a resident unintentionally finds himself or herself on the ground. Absent evidence to the contrary, when a resident is found on the floor, the resident is considered to have fallen.

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What are common injuries seen among residents who fall?

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Falls can be catastrophic for elderly residents. Common injuries include hip fractures, broken femurs, ankle fractures, broken arms, spinal cord injuries, head lacerations, subdural hematomas, and brain bleeds.

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What complications might occur after a fall?

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Oftentimes, many elderly residents are too frail to undergo surgical intervention, thereby forcing them to live their remaining days suffering in excruciating pain. For residents who are believed to be capable of handling surgery, recovery is often slow; and, many times, residents never return to their prior level of function and ability to enjoy life.​

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Falls can also lead to a downward spiral resulting in a "failure to thrive". Residents who were previously mobile may become immobile, thereby increasing depression and loneliness. Other residents who are unwilling to accept immobility may try to ambulate and fall again, exacerbating the original injury, and causing new injuries.

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Can falls be prevented?

Most falls are preventable. Upon admission, a facility should screen a resident for his or her risk for falls. This is commonly done through a fall risk assessment that considers a resident’s mental status, history of falls, ambulation, continence, vision, gait/balance, blood pressure, medications, and diseases/ailments (e.g., vertigo, Parkinson’s disease, Alzheimer’s/Dementia, Hypotension, strokes, loss of limbs, seizures, arthritis, osteoporosis, etc.). Based on the above factors, the facility should assign the resident a fall risk score and tailor an appropriate plan of care to prevent the resident from suffering falls. The facility must review and update the care plan on a regular basis to meet the needs of the resident and when there is a change in the resident’s condition. The interventions must also be carried out in a timely manner.

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What should happen after a fall?

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After the fall, the facility should conduct a “post-fall” assessment to determine what medical and/or nursing interventions might be necessary. This may include, but not be limited to, a neurological assessment, a head-to-toe skin check for signs and symptoms of bruises that might identify the location of further injuries, assessing for signs and symptoms of pain in the lower and upper extremities, and taking the resident’s vitals. A “post-fall” assessment should have regular follow-ups. In consultation with the resident’s physician, the facility must also determine whether X-rays are warranted and whether the resident should be transferred to the hospital for a higher level of care. In addition, the facility should investigate the circumstances surrounding the fall and make the necessary care plan updates and associated care adjustments.

If you or a loved one suffered a fall and sustained an injury at a nursing home or assisted living facility, contact the experienced attorneys at FIDJ, before it’s too late.

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*The information contained herein is not, and must not be construed as medical advice.