A fall is not an accident — it is an incident to be analyzed
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. A fall must be documented, investigated and followed by a care-plan change — falls are among the indicators homes report, and provincial standards require a post-fall assessment.
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 checks — and if she takes an anticoagulant (apixaban, rivaroxaban, warfarin), medical evaluation 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 and the fall recorded in the chart — ask for confirmation in writing.
The six causes to rule out
- Medications. The first preventable cause: sleeping pills, benzodiazepines, antipsychotics, blood pressure drugs — and above all the total count. Ask for a medication review by the physician and pharmacist.
- Infection. In an older adult a urinary tract infection often shows up as sudden confusion and unsteadiness, with no fever.
- Orthostatic 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 Glasses lost, broken, or years out of date.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 foot care referral.
- The environment. Call bell out of reach, no night light, bed too high, floor just washed, a cluttered path to the bathroom.
The bed rails trap
If side 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 — Health Canada has warned about it. Rails are also a restraint, and provincial legislation restricts their use and requires consent and review.
Ask instead for: a low bed, a floor mat on the side she exits, a sensor night light, a movement alarm 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; immobilizing 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. Request a care conference rather than waiting for the annual review. If nothing changes, the residents' and family councils have legal standing, and your province's long-term care complaints line and patient ombudsman take reports.
If the home cannot supervise at night
Ask for the number: how many staff for how many residents on nights. It is the figure least often volunteered and the most revealing. If it cannot cover her, the placement is mismatched to her risk.
Curalune Care Help (CA$99) 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 restraint policy.
*General information, not medical advice. After a head strike, particularly on anticoagulants, seek medical evaluation without waiting.*