The phone call
"Your mother had a fall. She's fine, she's back in her room." That is usually the whole message. It is not enough, and you are entitled to considerably more than that — starting with whether anyone actually assessed her.
Falls are the single most common serious incident in long-term care. They are also, to a large extent, preventable: the majority happen on the way to the bathroom, in the evening or overnight, to residents whose medications, footwear or mobility aids were working against them. So the point of the next 48 hours is not to accept reassurance. It is to establish what happened, what was assessed, and what changes as a result.
The clinical questions, in the first 24 hours
Ask these directly of the nurse in charge, and ask for the answers to be documented:
- Was her head involved, and is she on a blood thinner? This is the question that matters most and the one families forget. An older adult on an anticoagulant who strikes their head can bleed slowly and look completely normal for hours or days. If she is anticoagulated and hit her head, the answer is not "we'll monitor" — it is a neurological assessment and a conversation about imaging.
- Has a fracture been ruled out? Not "she can walk." Hip fractures are missed in people with dementia because they do not report pain the way you expect. Ask whether she can bear weight, whether the leg is shortened or turned outward, and whether an X-ray was considered.
- How was pain assessed? If your mother has dementia, "she says it doesn't hurt" is not an assessment. Staff should be using an observational pain tool — grimacing, guarding, changed breathing, agitation. New agitation after a fall is very often untreated pain.
- Why did she fall? The honest answers are usually specific: she was trying to get to the toilet and nobody came; she stood up too fast on a new blood-pressure medication; her walker was on the other side of the room; the floor was wet. "She's unsteady" is a description, not a cause.
- Was there vital-sign monitoring afterwards, and for how long?
The paperwork that has to exist
A fall in a licensed long-term care home is not an informal event. There must be an incident report, the fall must be documented in the clinical record, and the home is required to notify the resident's substitute decision-maker or family. Where a fall results in injury, provincial rules generally make it a reportable critical incident to the ministry — meaning the province learns about it, not just the home.
Ask, in writing: "Was an incident report completed for the fall on [date]? Was this reported to the ministry as a critical incident, and if not, on what basis?" You may not be given a copy of the internal report, but you are entitled to your mother's clinical record, and you are entitled to know what the home concluded and what it changed.
One more thing worth doing before your next care conference: look up the home's falls rate. Falls are among the quality indicators collected for Canadian long-term care and published publicly. A home well above the provincial average is telling you something structural — usually about staffing at night — that no individual incident report will.
What has to change afterwards — the care plan, not the promise
A verbal "we'll keep an eye on her" is worth nothing in six weeks when the staff on shift have changed. Request a care conference and ask for these to be written into the care plan:
- A medication review by a pharmacist. This is the highest-yield intervention and the least requested. Benzodiazepines, antipsychotics, sedating antihistamines, and blood-pressure medications recently started or increased are the usual culprits. Ask specifically: which of her medications increase falls risk, and can any be reduced or stopped?
- A toileting schedule. If she fell going to the bathroom, the answer is proactive, timed assistance — not a promise to answer the call bell faster.
- A post-fall review of the physical set-up: bed height, footwear that fits and has a back, walker parked within reach on her stronger side, night lighting, clear path to the bathroom.
- Physiotherapy assessment for strength and balance, and vitamin D if she is not already on it.
- A re-scored falls risk assessment with a date, and a review date.
What you should refuse
If the home's answer to a fall is a bed rail, a lap belt, a chair that she cannot get out of, or a sedative "to settle her at night" — push back, and put your objection in writing. Least restraint is the standard across Canadian long-term care legislation: restraints require clinical justification, consent, documentation and review, and they are not a substitute for supervision. Bed rails in particular carry entrapment risk and do not reliably prevent falls; a resident determined to get up will climb over one, and fall from higher.
Sedation is the version of this that families miss, because it does not look like a restraint. If a new antipsychotic or sedative appears after a fall, ask what condition it treats and what the plan is for stopping it.
If the answers do not come
- Put your questions in an email to the director of care and the administrator, with a date. That creates a record; a hallway conversation does not.
- Escalate to the province's long-term care complaint or action line, which takes family complaints directly and can trigger an inspection.
- The patient ombudsman or equivalent, where your province has one, for complaints the home has not resolved.
- If the pattern continues — repeated falls, no plan, no staffing at night — that is not a clinical problem you can fix from outside. It is a reason to look at another home.
If you have reached that point
Two falls in a month with no change to the care plan is information. If you would rather not spend your evenings phoning around while you are still dealing with this one, we will do that part. Tell us the region, your mother's care needs and what went wrong here, and you get a shortlist of homes worth calling, for CA$99. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. Start here
This article is general information for families, not legal or medical advice. Reporting duties and residents' rights differ by province and territory. If you are worried about an injury right now, speak to the nurse in charge or seek medical assessment. Curalune does not allocate beds and does not guarantee availability.