A fall is not an accident — it is an incident to be analysed
You get a phone call, or you are told in passing at the next visit: "she had a fall, she's fine." That is not an answer. A fall in a care home must be recorded, reported internally and assessed — and you are entitled to know what was done, in what order, and by whom. Serious injuries are also reportable to the CQC and, under RIDDOR, to the HSE.
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 lay there. It is the highest-risk situation and the one that demands more investigation, not less.
The first 24 hours: what should already have happened
- a full check: level of consciousness, pain, hip and shoulder movement, bruising;
- if she hit her head, neurological observations — and if she takes an anticoagulant (apixaban, rivaroxaban, warfarin), medical assessment 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 outwards (a hip fracture can be missed in someone who does not complain);
- lying and standing blood pressure;
- an incident form completed — ask for confirmation in writing.
The six causes to rule out
- Medication. The first preventable cause: sleeping tablets, benzodiazepines, antipsychotics, blood pressure drugs — and above all the sheer number of medicines. Ask the GP for a structured medication review.
- Infection. In an older person a urinary tract infection often shows up as sudden confusion and unsteadiness, with no fever.
- Postural hypotension — blood pressure dropping on standing. It takes two minutes to measure and is often fixed by adjusting a drug.
- Eyesight. Glasses lost, broken, or two years out of date. A banal cause with a large effect.
- Footwear and feet. Backless slippers, smooth soles, overgrown nails, foot pain: ask for a podiatry review.
- The environment. Call bell out of reach, no night light, bed too high, floor recently mopped, a cluttered route to the toilet.
The bed rails trap
If rails are offered "for her safety", know this: rails do not prevent falls, they make the consequences worse. A disoriented person who wants to get up climbs over and falls from higher. They are also a form of restraint, requiring assessment, documented justification and regular review — and where someone lacks capacity, proper authorisation.
Ask instead for: a low or ultra-low bed, a crash mat on the side she gets out, a sensor night light, a movement sensor that alerts staff when she stands, and a clear route to the toilet.
What you can insist on, in writing
- an updated falls risk assessment and a revised care plan — not the old document signed again;
- a medication review;
- a physiotherapy assessment: strength and balance work genuinely reduces falls, while immobilising someone increases them;
- a bone health review (vitamin D, osteoporosis treatment): what you are preventing is the fracture, not only the fall;
- a written night-time checking plan: how often, by whom, and what is checked;
- the family informed of every fall, including those with no injury.
When falls repeat
Two falls in a month means the plan is not working. If the answer stays "she's just unsteady", ask for a written meeting with the manager and the clinical lead. Where it goes no further, raise a safeguarding concern with the local council — a fall pattern with no action taken is neglect, and you do not need proof to raise a concern.
If the home cannot supervise at night
Someone who gets up alone at night needs adequate night staffing. Ask for the number: how many staff for how many residents between 9pm and 7am. It is the figure least often volunteered and the most revealing. If it cannot cover her, the home is mismatched to her level of risk.
Curalune Care Help (£69) puts together, usually within 24 working 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 assessment without waiting.*
