The call lasts forty seconds. "Your mother 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 right 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 bathroom 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 PSW, the RN on duty, the attending physician or nurse practitioner?
- 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 far lower threshold for imaging. Say so explicitly, and ask what neurological checks were ordered.
2. What the home has to do — and what you can check
Long-term care is provincially regulated, so the names differ, but the structure is the same across Canada.
- Critical incident reporting. A fall that results in a transfer to hospital or a significant injury is generally reportable to the ministry within a short, fixed deadline. Ask directly: "Has this been reported as a critical incident?" The question alone signals that you know the system exists.
- The RAI-MDS assessment and the care plan must be updated after a significant change. You are entitled to see the care plan as her substitute decision-maker, and to request a care conference rather than waiting for the annual one.
- Public quality data. Falls in long-term care are a publicly reported indicator: CIHI publishes home-level results, and several provinces publish their own inspection reports and quality scorecards. Look up her home before the meeting. Walking in with the home's own reported falls rate changes the conversation.
- The family council. Where one exists it has legal standing to raise systemic issues — night staffing among them. If there is no family council, you can ask to start one.
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 pills, antipsychotics, blood pressure and diabetes medicines all raise the risk. Homes have a contracted pharmacy service and scheduled medication reviews — ask for one now, and ask the specific question: "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 exam? 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 assessment, a walker that is actually the right height, daily movement rather than a weekly group.
- The environment and the night shift. Lighting, bed height, grab bars, the route to the bathroom, the call bell within reach — and above all how long the call bell takes to be answered overnight.
- Infection and dehydration. A urinary tract infection causes confusion and falls in older adults and is not always looked for.
- Behavioural supports. Where restlessness or exit-seeking is driving the falls, most provinces fund a specialist behavioural support team the home can bring in. Ask whether they have been consulted.
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. They count as a restraint in most provincial frameworks and require assessment and consent.
Restraints. Provincial law is restrictive: restraining a resident is permitted only in narrow circumstances, with consent, documentation and review — and never for staff convenience. A sedating medication given "so she does not get up" is a chemical restraint. If a new drug appears after a fall, ask what it is, what it is for, and when it will be reviewed.
"We will move her closer to the nursing 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 care conference 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 Director of Care and the Administrator, by email, with dates and facts.
- The home's formal complaints process — homes are required to have one and to respond within a set time.
- The provincial long-term care complaints or action line, which triggers an inspection. Complaints can be made without the home's knowledge.
- The provincial patient or health ombudsman, where one exists, once the home's process is exhausted.
- 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 — and in a system with waitlists, a transfer is rarely quick. But if the falls repeat, if overnight staffing cannot deliver the supervision she needs, and if nothing changes after a written request, then asking to be placed on the transfer list for another home 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 (CA$99) 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 homes and the responsible provincial bodies. In an emergency, call 911.*