A fall is not an accident — it is an incident to be analysed
You get a call, or hear it in passing at the next visit: "she had a fall, she's fine." That is not an answer. Falls and major injury from falls are a quality indicator providers must collect and report — and a fall must be assessed, documented and followed by a change to the care plan. A fall causing serious injury can also be reportable under the Serious Incident Response Scheme: ask whether it was.
The first question, the one that changes everything
"Was she seen falling, or found on the floor?"
An unwitnessed fall means nobody knows how she fell, whether she hit her head, or how long she was down. It is the highest-risk situation and demands more investigation, not less.
The first 24 hours
- a full assessment: level of consciousness, pain, hip and shoulder range, bruising;
- if she struck her head, neuro observations — and if she takes an anticoagulant (apixaban, rivaroxaban, warfarin), medical review even if she seems fine: a bleed can declare itself hours later;
- an X-ray where there is pain, inability to stand, or a foot turned outward (a hip fracture is missed more often than families expect);
- lying and standing blood pressure;
- an incident report completed — ask for written confirmation and that it appear in the progress notes.
The six causes to rule out
- Medications. The first preventable cause: sleeping tablets, benzodiazepines, antipsychotics, blood pressure drugs — and above all the total count. Ask the GP for a Residential Medication Management Review: it is funded and can be requested.
- Infection. In an older person a urinary tract infection often shows up as sudden confusion and unsteadiness, with no fever.
- Postural hypotension — blood pressure dropping on standing. Two minutes to measure, often fixed by adjusting a drug.
- Eyesight. Glasses lost, broken, or years out of date.
- Footwear and feet. Backless slippers, smooth soles, overgrown nails, foot pain: ask for a podiatry review.
- The environment. Call bell out of reach, no night light, bed too high, floor just mopped, a cluttered path to the bathroom.
The bed rails trap
If rails are offered "for her safety": rails do not prevent falls, they make injuries worse. A confused person who wants to get up climbs over and falls from higher, and entrapment between rail and mattress has caused deaths. Rails are also a restrictive practice: they require assessment of alternatives, informed consent, documentation in the care plan and regular review.
Ask instead for: a low-low bed, a fall mat on the side she exits, a sensor night light, a movement sensor if appropriate, and a clear path to the bathroom.
What you can require
- an updated falls risk assessment and a revised care plan — not the old one re-signed;
- a medication review;
- a physiotherapy assessment: strength and balance work genuinely reduces falls; immobilising someone increases them;
- a bone health review (vitamin D, osteoporosis treatment): what you are preventing is the fracture;
- a written night-check plan: how often, by whom, what is checked;
- notification of every fall, including those without injury.
When falls repeat
Two falls in a month means the plan is not working. Ask for a care plan review meeting. If nothing changes, OPAN offers free advocacy and will help you put it in writing, and the Aged Care Quality and Safety Commission takes complaints from anyone, including anonymously.
If the home cannot supervise at night
Ask for the number: how many staff for how many residents overnight. Care minutes are reported per home — check them alongside the star rating. If the staffing cannot cover her, the placement is mismatched to her risk.
Curalune Care Help (A$109) puts together, usually within 24 business hours, a shortlist of 3 to 5 homes that fit — with the questions to ask about night staffing, falls prevention and restrictive practices.
*General information, not medical advice. After a head strike, particularly on anticoagulants, seek medical review without waiting.*