A fall is not an accident — it is an incident to be analyzed
You get a phone call, or you hear it in passing at the next visit: "she had a fall, she's fine." That is not an answer. A fall must be documented, investigated and followed by a care-plan change — federal requirements expect the facility to provide adequate supervision and assistive devices to prevent accidents, and falls with major injury are a publicly reported quality measure on Care Compare.
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 was down. It is the highest-risk situation and demands more investigation, not less.
The first 24 hours: what should already have happened
- a full assessment: level of consciousness, pain, hip and shoulder range, bruising;
- if she struck her head, neuro checks — and if she takes an anticoagulant (apixaban, rivaroxaban, warfarin), medical evaluation 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 outward (a hip fracture is missed surprisingly often in someone who does not complain);
- lying and standing blood pressure;
- an incident report completed — ask for confirmation in writing, and ask that the fall appear in the chart.
The six causes to rule out
- Medications. The first preventable cause: sleeping pills, benzodiazepines, antipsychotics, blood pressure drugs — and above all the total count. Ask for a medication review; the consultant pharmacist reviews medications monthly and you can ask what that review said.
- Infection. In an older adult a urinary tract infection often shows up as sudden confusion and unsteadiness, with no fever.
- Orthostatic hypotension — blood pressure dropping on standing. Two minutes to measure, often fixed by adjusting a drug.
- Eyesight. Glasses lost, broken, or years out of date.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 consult.
- The environment. Call light out of reach, no night light, bed too high, floor just mopped, a cluttered path to the bathroom.
The bed rails trap
If side rails are offered "for her safety", know this: rails do not prevent falls, they make injuries worse. A confused person who wants to get up climbs over and falls from higher, and entrapment between rail and mattress has caused deaths — the FDA has warned about it for years. Rails are also a restraint, and residents have the right to be free from unnecessary physical restraints.
Ask instead for: a low bed, a floor mat on the side she exits, a sensor night light, a bed or chair alarm if appropriate, and a clear path to the bathroom.
What you can require
- an updated falls risk assessment and a revised care plan — not the old one re-signed;
- a medication review;
- a physical therapy evaluation: strength and balance training genuinely reduces falls; immobilizing 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-check plan: how often, by whom, and what is checked;
- notification of every fall, including those without injury — you can ask for this in writing as a standing request.
When falls repeat
Two falls in a month means the plan is not working. If the answer stays "she's unsteady," request a care plan meeting — you have the right to participate. If nothing changes, the long-term care ombudsman (free, independent) and the state survey agency both take reports, and staffing data is on Care Compare.
If the facility cannot supervise at night
Someone who gets up alone at night needs adequate night staffing. Ask for the number: how many aides for how many residents on the night shift. It is the figure least often volunteered and the most revealing. If it cannot cover her, the placement is mismatched to her risk.
Curalune Care Help ($89) puts together, usually within 24 business hours, a shortlist of 3 to 5 facilities 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 evaluation without waiting.*