The call lasts forty seconds. "Your mum had a little fall last night, she is fine, we just wanted to let you know." You hang up relieved — and you have learned almost nothing.
A fall is not an isolated mishap. It is clinical information. A first fall sharply raises the odds of the next one, and a fall nobody analyses repeats itself. What you ask in the first 48 hours changes what happens next month.
1. Ask these straight away
Ask on the phone, calmly, and write the answers down with the date.
- Exactly when, and where? A 3 a.m. fall in her room on the way to the toilet is a completely different problem from a 3 p.m. fall in the lounge.
- Was she found on the floor, or did someone see her fall? "Found" means nobody knows how long she was down there. It is the most important question and the least often asked.
- Who assessed her, and when? A care worker, the RN on duty, the GP?
- Was she checked for a head injury or a fracture — and if not, on what basis was that decided?
- Is she in pain, and what was she given?
- Is this the first time? Ask for the number of falls in the last three months. The answer is almost always higher than you expected.
- What has changed since? If the answer is "nothing", you know what the rest of this week is for.
Two specifics matter. A hip fracture does not always stop someone walking — impacted fractures get missed for days. And if she takes an anticoagulant, a head injury needs a much lower threshold for a scan. Say so explicitly, and ask what neurological observations were ordered.
2. Check the numbers yourself
Australia has something most countries do not: the National Aged Care Mandatory Quality Indicator Program. Every residential provider must report, every quarter, on a set of clinical indicators — including falls and major injury from falls, pressure injuries, use of restrictive practices, unplanned weight loss and medication management.
That data is published per service on My Aged Care. You can look up her home and compare it to the national average before you speak to anyone. Walking into the meeting with the home's own reported falls rate changes the conversation completely.
Alongside it
- The Aged Care Quality Standards require the provider to deliver safe and effective personal and clinical care, including falls minimisation, and to assess and plan for her risks.
- She must have a care plan that is reviewed after a fall, and you are entitled to see it and to be part of the review as her representative.
- Since 24/7 registered nurse coverage became a requirement for residential services, the question "who was the RN on duty at 3 a.m.?" is a fair one to ask.
- The Serious Incident Response Scheme (SIRS) requires providers to report certain serious incidents, including neglect and unexpected death. If she was left on the floor, or the call bell went unanswered, that is not just a fall.
3. What a real post-fall review looks like
A fall filed as "an accident" is a missed opportunity. A proper review hunts for causes that can actually be changed:
- Medication. The biggest single lever. Sedatives, sleeping tablets, antidepressants, blood pressure and diabetes medicines all raise the risk. Ask for a Residential Medication Management Review — a pharmacist review funded through the MBS, which the GP can request. The question is specific: "What can we reduce?"
- Lying and standing blood pressure. Three minutes, and it explains a large share of falls.
- Vision and hearing. When was the last eye test? Are her glasses the right prescription — and can anyone find them?
- Feet and footwear. Nails, corns, backless slippers: nobody has looked at her feet explains why this dull detail is a serious falls factor.
- Strength and balance. A physiotherapy review, a walking frame that is actually the right height, daily movement rather than a weekly group.
- The environment and the night. Lighting, bed height, grab rails, the route to the toilet, the call bell within reach — and above all how long the call bell takes to be answered at night.
- Infection and dehydration. A urinary tract infection causes confusion and falls in older people and is not always looked for.
4. What may be offered that is not a solution
Bed rails. They do not reduce falls; they increase the severity of the ones that happen, because the fall is from higher up.
Restrictive practices. A belt, a chair that prevents standing, a sedating medication given "so she does not get up" — these are restrictive practices under Australian law. They require assessment, documented alternatives, a behaviour support plan, and informed consent from her restrictive practices substitute decision-maker. They are a last resort, time-limited and reviewed, and they are never a substitute for night staffing. If a new medication appears after a fall, ask what it is, what it is for, and when it will be reviewed. Use of restrictive practices is also one of the published quality indicators — you can check it.
"We will move her closer to the nurses station." Helpful, but it is not a falls review.
5. Repeated falls mean something else
Three falls in two months is not bad luck. It usually signals one of four things: medication that needs changing, an undiagnosed condition, a level of supervision the home cannot provide overnight, or fear of falling that stiffens her walking and causes more falls in turn.
That is the point to request a formal case conference — the facility manager, the RN, the GP if possible, you — in writing, with a date. And to ask the question that matters: "With the staffing you have overnight, can you supervise her safely?" The honest answer, when it comes, tells you whether this is still the right home.
6. If nothing changes
In order, in writing at every step
- The facility manager, by email, with dates and facts.
- The provider's formal complaints process — every approved provider must have one.
- OPAN, the Older Persons Advocacy Network — 1800 700 600: free, independent advocacy, including help writing the complaint and sitting in on the meeting. Use it before you need it.
- The Aged Care Quality and Safety Commission — 1800 951 822. Complaints can be made confidentially or anonymously.
- Police, if there is any question of neglect or assault.
7. Stay or move?
Moving disorients, particularly with dementia, and it is not the first answer. But if the falls repeat, if overnight staffing cannot deliver the supervision she needs, and if nothing changes after a written request, then looking elsewhere is not disloyalty. It is the logical next step.
Run both tracks at once — the complaint on one side, alternatives on the other.
Curalune Care Help (A$109) puts together, usually within 24 business hours, a shortlist of 3 to 5 homes matched to her area and care needs — with contacts, a message ready to send and the questions to ask about night staffing and falls prevention.
*General information, not medical advice. Admission, fees and availability are always confirmed by the providers and the responsible bodies. In an emergency, call 000.*