Our country’s long-term care facilities have long been plagued by poor quality of care. However, in recent decades, there has been a substantial push by policy makers and patient advocates to curtail nursing home abuse and neglect.
While the quality of medical care seems to be improving, at least a little, some very common injuries still occur quite frequently in nursing homes that are preventable. Falls in nursing homes are one of these problems.
According to the Centers for Disease Control and Prevention, more than 1,800 deaths each year are attributed to falls in nursing homes, and nearly 75 percent of all nursing home residents experience falls annually.
Falls are not just serious because they can cause pain and suffering. The impact and long-term damage can be devastating, leading to fractures, head injuries, brain injuries, immobility and increased risks for other life-threatening conditions.
With an estimated 3 million seniors expected to reside in nursing homes by 2030, according to the National Center on Elder Abuse, this problem could easily affect the lives of a huge number of Americans, including their families.
What Causes So Many Nursing Home Falls?
Most falls in nursing homes are preventable. Causes include environmental hazards, medical errors and poor care decisions.
An environmental factor is something about the nursing home’s physical layout. These are not elements of direct medical or nursing care. Instead, they are elements of the environment in which the senior lives.
On the other hand, care factors include things that staff and administrators do wrong (or fail to do) that lead to falls and injuries. Here are 10 of the most common causes of falls in nursing homes:
Leaving food trays in hallways
Obviously, if trip hazards are left lying around hallways, residents are at a higher risk of falling. Nevertheless, facilities do it all the time.
Poor cleaning schedules
Leaving urine or other fluids on the floors and failing to perform timely cleaning can create a slip hazard. Safer and more conscientious facilities try to do the bulk of the cleaning and mopping late at night when there is less foot traffic, and they make sure janitorial crews regularly inspect for signs of these hazards.
Any movable devices or carts left in hallways where residents may lose footing and attempt to stabilize themselves can present a huge problem.
Designing a floor plan that puts residents too far from a nursing station can cause falls, too. While not the staff’s fault, some corporations and owners choose poorly designed older buildings that place nurses far away from patients. Then, sadly, the most at-risk patients are commonly placed furthest from their caregivers. This reduces the reaction time for responding to falls.
Failure to use assistive devices
Some residents who are known to be fall risks are issued gait belts to help them maintain stability when attempting to walk. Others may be given walkers or wheelchairs to assist them in maintaining mobility. When these devices are not readily available or being shared among multiple residents, many seniors will try to go without them in order to socialize and not be limited or confined to their rooms.
Failure to use alarms
Chair and bed alarms are designed to alert staff when an at-risk resident gets out of bed or up from a wheelchair. The goal is to alert staff so they can assist the resident rather than allowing the resident to fall. In many cases, these devices have dead batteries that have not been changed in years. All too often, the medical records will say that a chair alarm was in place. However, this means nothing if it was not properly tested and in working condition.
Poor incontinence care
As with the other causes, this one really involves training staff to properly consider the end result or consequence of certain care decisions. A resident who is incontinent is unable to control his or her bladder and bowels. Even seniors confined to a bed have pride, and if given the opportunity to be assisted to a restroom to use the toilet, most will choose this over soiling themselves in a diaper or on a sterile pad. But if no one is regularly checking on the resident, he or she will likely try to get up and use the restroom alone. This once again can result in falls.
Inappropriate or improperly administered medications can lead some residents to be confused or disoriented. Residents with dementia may require medications to calm them and help them refrain from wandering. If not given the medication, they may wander to stairways, into other units of a facility or even into other residents’ rooms. If a resident is also a fall risk, this can create a serious safety issue.
Staff often forget to raise bed rails to residents who are at risk for falling out of bed. This is somewhat underscored by the fact that upwards of 35 percent of all nursing home fall victims are individuals who are bed bound or otherwise unable to walk. This means that either the residents are trying to walk unassisted or are simply falling out of chairs and beds due to a failure to keep protective devices in place.
Moving a person from bed to bed or from bed to chair can be dangerous. When nurses and aides have to transfer a patient from one surface to another, there are specific protocols and procedures for moving the person. The situation, environment, urgency, size of the resident, size of the staff members and medical conditions of the resident all come into play when choosing the appropriate transfer technique.
What Types Of Injuries Do Falls Cause?
Beyond the obvious hip fractures, head injuries and arm injuries, countless other injuries can occur during a fall. These can include traumatic brain injuries, punctures, internal bleeding, long-term immobility and death.
Once a person is unable to freely walk or move about, the person becomes more susceptible to other illnesses like infection, bed sores, sepsis and pneumonia. For this reason, falls often precipitate other deteriorations in health.
Preventing Nursing Home Falls
Common sense is the best prevention measure. Buy rubber-based hospital socks and stockings, communicate frequently with primary caregivers to ensure they know the resident and consider checking any bed or chair alarms to see if they work. These are just a few easy ways to prevent falls.
What About Physical Restraints?
Restraints are a hotly debated topic. Some states have banned their use, but other states have simply made them voluntary. Facilities are often very reluctant to use restraints – and rightly so. They greatly reduce a resident’s freedom and autonomy and can also be quite humiliating for a senior.
Also, many staff may forget what time the restraint was placed and leave a person very limited in his or her mobility and range of motion for hours at a time.
For years, nursing homes grew accustomed to using restraints lazily as a way to avoid worrying about falls and keeping residents under control. Fortunately, the law does not allow this anymore. So, while in some highly necessary circumstances they can help, restraints should only be used if recommended by a physician after consultation with the resident and any caregivers or guardians.
What If I Know Someone Who Is Injured In A Fall?
If you know a senior who has suffered a painful fall, you or the resident’s family should first discuss the matter with the facility administrator and possibly the director of nursing. Find out what happened and what the facility will do to prevent future accidents. After all, not every fall is the result of abuse or neglect.
If, however, you suspect you are not being given the whole story, or the fall was more serious than you think is tolerable, you should contact your state’s elder abuse hotline.
Next, you should contact an experienced nursing home abuse and neglect attorney at Davis, Saperstein & Salomon, P.C. We can explain your rights and help you to better understand your options. We serve clients in New York and New Jersey, and we would be happy to help you today.