Falls in Nursing Homes Are Never “Just Part of Aging”
Falls are common in older adults, but they should never be dismissed as normal in a nursing home. According to the CDC, more than one in four adults age 65 and older falls each year, and falling once doubles the chance of falling again. Falls are also the leading cause of both fatal and nonfatal injuries in older adults. In a nursing home, every fall deserves a serious review to determine whether it was truly unavoidable or whether missed assessments, poor supervision, medication issues, or unsafe conditions played a role.
Why Are Falls So Serious in Nursing Homes?
Falls can lead to broken bones, head injuries, loss of mobility, and a sharp decline in quality of life. According to the HHS Office of Inspector General data snapshot, Medicare-enrolled nursing home residents experienced 42,864 falls resulting in major injury and hospitalization during a one-year period from July 2022 through June 2023. Of those residents, 1,911 died while hospitalized. Medicare and enrollees paid more than $800 million for the resulting hospital care, and most of those hospitalizations involved bone fractures.
These numbers show why nursing home falls cannot be brushed aside as minor incidents. They often involve serious trauma, lengthy hospital treatment, and long-term consequences for residents and families. The CDC’s falls facts page also reports that older adult falls lead to about 3 million emergency department visits and about 1 million hospitalizations each year, and that falls are the most common cause of traumatic brain injuries in older adults.
Why Falls Happen in Nursing Homes
Aging alone can affect balance, strength, vision, and reaction time. Nursing home residents often face additional fall risks because many live with dementia, stroke, weakness, mobility limitations, depression, insomnia, or other medical conditions that make movement less safe. A 2023 systematic review and meta-analysis published in the Journal of the American Medical Directors Association found that falls among nursing home residents are highly prevalent, with a pooled incidence of 43 percent across prospective studies. The review also found strong associations with prior falls, impaired activities of daily living, insomnia, and depression. Additional associated risk factors included poor balance, walking aids, antidepressants, benzodiazepines, antipsychotics, anxiolytics, polypharmacy, dementia, unsteady gait, hearing problems, and male sex.
Facility conditions also matter. Residents are more vulnerable when communication breaks down, supervision is inconsistent, transfer help is delayed, medications are not carefully reviewed, or environmental hazards are allowed to persist. That does not mean every fall proves neglect. It does mean nursing homes must take known fall risks seriously and respond to them with individualized care.
What the OIG Data Shows About Known Fall Risks
One of the most important findings in the OIG data snapshot is that the risk was usually visible before the fall happened. Nursing homes had identified one or more fall risk factors for 98 percent of residents before the serious fall that led to hospitalization. The most commonly identified factors were balance problems at 92 percent, psychotropic medication use at 69 percent, a fall before nursing home entry at 30 percent, and at least one fall since admission at 29 percent.
The same report found that 63 percent of residents hospitalized after a fall with major injury were cognitively impaired, and 78 percent were functionally impaired. In other words, many of the residents suffering the most serious falls were already the very people most in need of close supervision, meaningful care planning, and consistent follow-through.
Common Causes and Contributing Factors
Common contributors to falls in nursing homes include:
- Muscle weakness and deconditioning
- A history of prior falls
- Cognitive impairment, dementia, or delirium
- Medications that can cause sedation, dizziness, or blood pressure changes
- Poor balance and unsteady gait
- Problems during transfers, including bed-to-chair and toileting assistance
- Unsafe environmental conditions, such as clutter, wet floors, poor lighting, or missing grab bars
- Sleep problems, depression, and untreated mobility limitations
What Facilities Are Required to Do
Federal regulations require nursing homes to keep the resident environment as free of accident hazards as possible and to ensure that each resident receives adequate supervision and assistive devices to prevent accidents. This standard appears in 42 C.F.R. § 483.25(d) and CMS guidance under F689. In practice, that means facilities should assess fall risk, create an individualized care plan, put concrete prevention steps in place, and revise the plan after a fall or near miss. A fall should not simply be charted and forgotten. It should trigger a review of what happened, why it happened, and what needs to change.
What the Data Suggests About Staffing and Facility Quality
The OIG snapshot also found that lower RN staffing levels and lower overall star ratings were associated with higher fall rates. Short-stay residents had much higher fall rates than long-stay residents when measured per resident day, with 27 falls per 100,000 resident days during short stays compared with 7 during long stays. The report also found higher fall rates among older residents and female residents. These findings do not prove that staffing or star ratings caused any specific resident’s fall. They do reinforce a common-sense point: facility quality, supervision, and staffing are not just administrative issues. They can affect whether risks are recognized early and whether residents get the help they need to stay safe.
Examples of Reasonable Fall Prevention Steps
Reasonable fall prevention measures may include:
- Keeping proper footwear, walkers, and other assistive devices within reach
- Making sure call lights are working and answered promptly
- Providing regular toileting assistance
- Using safe transfer techniques and lift devices when needed
- Keeping walkways clear and lighting consistent
- Reviewing medications that may increase fall risk
- Updating the care plan after any fall or near miss
- Providing closer supervision for residents with cognitive or functional impairment
How Can You Tell If a Fall May Involve Neglect?
Not every fall is proof of malpractice or neglect. But many falls can be reduced when the care plan is appropriate and staff actually follow it. Warning signs of a preventable fall may include:
- No current fall risk assessment in the chart
- No meaningful care plan despite known risk factors
- Alarms, walkers, or other assistive devices not being used as planned
- Long delays in answering call lights
- Repeated hazards on the unit, such as wet floors or obstructed walkways
- Poor documentation about how the fall happened
- No change to the care plan after a prior fall
- Known medication risks that were never addressed
When these issues are present, it may suggest a breakdown in the standard of care rather than an unavoidable accident.
What To Do If Your Loved One Falls
If your loved one falls in a nursing home, focus first on medical safety. Seek prompt evaluation for head injury, hip pain, new confusion, or weakness. Then document what happened. Write down the date, time, location, and names of the staff involved. Take photographs if appropriate. Ask to review the care plan and request a care plan meeting focused on fall prevention. Request copies of incident reports, nursing notes, vital signs, imaging, and other relevant records. If you believe neglect may be involved, you can also report concerns to the appropriate Arizona agencies.
When Does a Fall Become a Malpractice Case?
A nursing home fall may support a malpractice or neglect claim when the facility failed to recognize a known risk, failed to implement reasonable interventions, failed to supervise the resident appropriately, or failed to respond after warning signs or prior falls. Examples may include ignoring transfer needs, failing to address medication side effects, leaving assistive devices out of reach, failing to answer call lights, or failing to revise the care plan after an earlier fall.
A Note on the Data
The nursing home statistics in this article draw from the HHS Office of Inspector General’s data snapshot, CDC public health data on older adult falls, and a 2023 peer-reviewed systematic review and meta-analysis examining falls among older adults in nursing homes. These sources describe population-level patterns and do not determine what happened in any individual case.
We Are Here To Help
If your loved one suffered a serious fall in an Arizona nursing home, Solomon & Relihan can help you understand what happened and what steps to take next. We investigate nursing home neglect claims, secure records, and work with qualified experts to determine whether a fall may have been preventable and whether the facility met its obligations.