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 analyzes 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 dayroom.
- 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 CNA, the charge nurse, the physician?
- Was she evaluated for a head injury or a fracture — and if not, on what basis?
- 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 from 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 neuro checks were ordered.
2. The facility is required to tell you — immediately
This is not a courtesy. Under the federal nursing home regulations at 42 CFR 483.10(g)(14), the facility must immediately inform the resident, consult the physician, and notify the resident representative when there is an accident resulting in injury, a significant change in condition, or a need to alter treatment significantly.
"We did not want to worry you at night" is not compliance. Neither is finding out three days later.
Also in play
- F-Tag F689 (free of accident hazards / adequate supervision) is one of the most frequently cited deficiencies in the country. The facility must identify her fall risk, put interventions in the care plan, and revise them after each fall.
- Her MDS assessment and care plan must be updated after a significant change. You have the right to attend the care plan meeting — and you can request one rather than waiting for the scheduled date.
- You have the right to review her medical record, generally within 24 hours of asking (with copies within two working days at a reasonable charge).
The sentence that works: "I am requesting a care plan meeting this week, and I would like to review the incident documentation and the nursing notes for that night."
3. What a real post-fall review looks like
A fall written up as "an accident" is a missed opportunity. A proper review hunts for causes that can actually be changed:
- Medication. The biggest single lever. Sedatives, sleep aids, antipsychotics, blood pressure and diabetes medicines all raise the risk. Ask for a pharmacist medication regimen review — federal rules already require a monthly one. The question is specific: "What can we reduce?"
- Orthostatic vital signs. Lying and standing blood pressure takes three minutes and 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: foot care in a nursing home explains why this dull detail is a serious falls factor.
- Strength and balance. A therapy evaluation — after a fall, skilled PT is often justified, and the facility should be screening for it, not waiting to be asked.
- The environment and the night shift. Lighting, bed height, grab bars, the route to the bathroom, the call light within reach — and above all how long the call light takes to be answered at night. Night shift staffing and falls sets out the questions.
- Infection and dehydration. A urinary tract infection causes confusion and falls in older adults and is not always looked for.
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. Federal rules treat them as a potential restraint requiring assessment, consent and alternatives.
Restraints. Residents have the right to be free from physical or chemical restraints imposed for discipline or convenience. A sedating drug given "so she does not get up" is a chemical restraint, and antipsychotics in particular carry a boxed warning for older adults with dementia. If a new medication 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 nurses 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 facility cannot provide overnight, or fear of falling that stiffens her walking and causes more falls in turn.
That is the point to ask the question that matters: "With the staffing you have on nights, can you supervise her safely?" The honest answer, when it comes, tells you whether this is still the right facility. Staffing data is public — check the facility on Medicare Care Compare and look at nurse hours per resident day and turnover, not just the star rating.
6. If nothing changes
In order, in writing at every step
- The Director of Nursing and the Administrator, by email, with dates and facts.
- The facility grievance process — every nursing home must have a grievance official and must respond in writing.
- The Long-Term Care Ombudsman for your state: free, independent, on the resident's side, and often the fastest way to change behavior. Every state has one.
- The state survey agency, which licenses and inspects the facility. A complaint survey is unannounced.
- Adult Protective Services if there is any suggestion of neglect — a resident left on the floor, call lights unanswered.
7. Stay or move?
Moving disorients, particularly with dementia, and it is not the first answer. But if the falls repeat, if night staffing cannot deliver the supervision she needs, and if nothing changes after a written request, then looking elsewhere is not disloyalty. It is the logical next step. Note that a facility cannot discharge a resident simply because the family complains — the discharge rules are narrow and appealable.
Run both tracks at once — the complaint on one side, alternatives on the other.
Curalune Care Help ($89) puts together, usually within 24 business hours, a shortlist of 3 to 5 facilities 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 or legal advice. Admission, rates and availability are always confirmed by the facilities and the responsible agencies. In an emergency, call 911.*