The phone call
"Your mum had a fall, we got her up, she's fine." You thank them, put the phone down, 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.
The duty most families have never heard of
This is the lever, and it has a name: the duty of candour. Registered providers are legally required to act in an open and transparent way, and where a notifiable safety incident occurs, to tell the relevant person what happened, provide an account, apologise, and follow it up in writing.
An apology is expressly not an admission of liability — which removes the reason homes often give for saying nothing.
So if a fall caused serious harm, the question is not whether they will explain. It is: "Please confirm whether this is being handled under the duty of candour, and send me the written account."
What should follow every fall
- An immediate check: consciousness, pain, weight-bearing, suspected head injury — with particular care if she is on anticoagulants, where even a modest knock needs assessing.
- An incident record: date, time, place, what happened, who was present, what was done.
- A search for the cause. Falls have causes, and most are modifiable: a sleeping tablet started recently, a drop in blood pressure on standing, a urinary infection, unsuitable footwear, out-of-date glasses, a call bell out of reach, an unlit route to the toilet.
- A revised care plan. If the plan is unchanged after a fall, nothing was learned from it.
- Telling the family — not just a courtesy call.
The six questions to send
- "Where and how did the fall happen, and who was present?"
- "What check was done immediately afterwards, and by whom?"
- "Has a medical cause been excluded — blood pressure, infection, a recently started medicine?"
- "What is her falls risk assessment, and when was it last updated?"
- "What has changed in the care plan as a result?"
- "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 requires something other than reassurance.
The link nobody makes
If the fall followed soon after a sleeping tablet, a sedative or an antipsychotic was started, both belong in the same email. In older people those medicines increase falls — and the first measure to ask for is a structured medication review by the home's named GP practice, not a bed rail.
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 makes them worse, alongside immobility, loss of strength and distress.
If it is proposed, ask what alternatives were tried: a low bed, a crash mat, a night light, a clear route to the toilet, a medication review, physiotherapy for strength and balance, proper footwear. And remember any restriction of liberty needs a proper legal basis, including a DoLS authorisation where it applies.
When it stops being an internal matter
If the fall caused serious injury, providers must submit statutory notifications to the regulator — serious injuries and deaths among them. And where neglect is a possibility, this is a safeguarding matter for the local authority, which you can raise directly without going through the home.
In parallel: request the records, have her examined outside the home, photograph and date any bruising, and put your concerns to the manager in writing with a date. If that fails, the home's complaints process, then the Local Government and Social Care Ombudsman, which covers independent providers as well as councils.
The practical point
Do not ask whose fault it was: ask what changed in the care plan, and how many falls there have been in six months. Ask whether the duty of candour applies and request the written account. Get falls and medicines looked at together. And refuse a bed rail as the first answer.
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. £69, 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
The duty of candour, statutory notification requirements, safeguarding procedures, restraint and deprivation of liberty safeguards and complaint routes differ across England, Scotland, Wales and Northern Ireland and are revised regularly. Never stop or change a medicine yourself: speak to the GP. Free advice is available from Age UK, Citizens Advice and your council's adult social care service. This article is general information and is not medical or legal advice. Curalune does not allocate places and does not guarantee availability.
