She fell in the long-term care home: the six questions, and what has to be reported

The phone call

"Your mom had a fall, we got her up, she's fine." You thank them, hang up, and the question you did not ask stays with you: how did it happen?

Then it happens again. And by the third time you realise nobody ever told you what changed after the first.

Start from something honest: falls happen in homes that are doing a good job. An older person who walks sometimes falls; one who never falls is often one who no longer gets up, and that is not a good outcome. The question is not the fall — it is what happens next.

Two things that are not internal matters

• Falls are a publicly reported quality indicator for long-term care in Canada, and in several provinces the figures are published home by home. So the conversation does not have to rest on impressions: "How does this home's falls rate compare with the provincial average, and what is the falls program?"
• A fall causing serious injury is generally a reportable critical incident. Provincial legislation requires licensed homes to report defined incidents to the ministry, and inspections follow from them. Ask: "Was this reported as a critical incident, and on what date?"

Those two questions place the conversation somewhere other than reassurance.

What should follow every fall

• An immediate assessment: consciousness, pain, weight-bearing, suspected head injury — with particular care on blood thinners, where even a modest knock needs evaluating.
• An incident record: date, time, location, circumstances, who was present, what was done.
• A search for the cause. Most causes are modifiable: a sleep medication started recently, a drop in blood pressure on standing, a urinary infection, poor footwear, outdated glasses, a call bell out of reach, an unlit path to the bathroom.
• A revised care plan, and a care conference to go through it. As substitute decision-maker you are entitled to be part of care planning.
• Notifying you — not just a courtesy call.

The six questions to send

1. "Where and how did the fall occur, and who was present?"
2. "What assessment was done immediately afterwards, and by whom?"
3. "Has a medical cause been ruled out — blood pressure, infection, a recently started medication?"
4. "What is her falls risk assessment, and when was it last updated?"
5. "What changed in the care plan as a result?"
6. "How many falls has she had in the last six months?"

The last one changes everything. One fall is an event; three falls in two months is a number, and a number calls for something other than reassurance.

The link nobody makes

If the fall followed soon after a sleep medication, sedative or antipsychotic was started, both belong in the same message. In older adults those drugs increase falls — and the first thing to ask for is the scheduled pharmacist medication review, brought forward, not a bed rail.

While you are there, ask who the attending prescriber is. Where the family physician and the home's physician each assume the other is reviewing, nobody is.

The answer not to accept

The most common is a restraint: a bed rail, a lap belt, a chair she cannot rise from. It is the quickest response and the worst. Restraint does not prevent falls — it moves them and worsens them, alongside immobility, loss of strength and distress.

And homes operate under a least-restraint obligation in provincial legislation: minimising restraint is a legal duty, not a philosophy. Any restraint requires a physician order, consent from the substitute decision-maker, a time limit and review.

Ask instead what alternatives were tried: a low bed, a floor mat, night lighting, a clear path to the bathroom, a medication review, physiotherapy for strength and balance, proper footwear — and whether the behavioural support team has been brought in, where restlessness at night is part of the picture.

If the fall caused serious harm

• Request the records, including the incident report and the care plan before and after.
• Have her assessed outside the home and get the findings in writing.
• Photograph and date any bruising or injury.
• Use the provincial reporting line for long-term care, which triggers inspection rather than negotiation, and then the provincial or patient ombudsman.

The practical point

Look up the home's falls figure before the meeting, and ask whether a critical incident was reported. Do not ask whose fault it was: ask what changed in the care plan and how many falls there have been in six months. Get falls and medications reviewed together. And treat any restraint as requiring an order, consent and a review date.

If the answers show the risk is not being managed, Curalune Care Help gives you the starting point: 3 to 5 suitable homes matched to the real situation within 24 working hours, with contact details, links and a ready-to-send message to all of them at once. CA$99, one-off. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. Start here

Critical incident reporting requirements, published quality indicators, least-restraint and consent legislation, inspection processes and complaint routes are set province by province and are revised regularly; each home also has its own policies. Never stop or change a medication yourself: speak to the attending prescriber and the pharmacist. Free help is available from the care coordinator for your region and provincial seniors advocacy services. This article is general information and is not medical or legal advice. Curalune does not allocate beds and does not guarantee availability.