Falls are among the most common and most serious health events affecting nursing home residents. Because residents are older, frailer, often living with multiple chronic conditions and cognitive impairment, a single slip or trip can lead to fractures, hospitalizations, loss of independence, or death. Nursing homes are on the front line: prevention requires consistent policies, training, environmental design, individualized care plans, and timely response when a resident is at risk. In this blog, we discuss how falls happen in long-term care, what evidence-based steps facilities should take to prevent injuries, key statistics families should know, and what to do if you suspect a nursing home facility is failing to protect a loved one.
Why Falls are a Leading Nursing Home Problem (and Why Prevention Matters)
Older adults fall more often than younger people. National data from the CDC shows more than one in four adults aged 65+ fall each year, and falls are the leading cause of injury among older adults. In nursing homes, the risk and frequency are even higher: pooled studies estimate incidence rates in long-term care settings in the range of about 40–50% of residents experiencing at least one fall over study periods, with many residents falling multiple times. Falls in nursing homes frequently cause serious injuries, hip fractures, head trauma, and other fractures, that lead to hospitalization, functional decline, or transition to higher levels of care.
Because of this concentrated risk, prevention in long-term care is not just a “nice to have.” It’s essential to preserving residents’ health, reducing avoidable hospital transfers, and meeting federal and state standards for safe care. CMS and professional guidelines require facilities to implement individualized fall-prevention plans and monitor outcomes.
Common Risk Factors in Nursing Home Residents
Multiple interacting factors increase fall risk in long-term care residents. Important contributors include:
- Advanced age and frailty (reduced strength and balance).
- Cognitive impairment or dementia (affecting judgment, gait, and awareness).
- Medications that cause dizziness, sedation, or orthostatic hypotension (sedatives, antipsychotics, some antihypertensives).
- Mobility limitations and use of assistive devices (unstable walkers, inappropriate footwear).
- Urinary urgency or incontinence (rushed efforts to reach the bathroom).
- Environmental hazards (slippery floors, poor lighting, cluttered walkways).
- Recent hospitalization or acute illness that weakens a resident.
Multiple systematic reviews identify these as consistent, modifiable, or partially modifiable risk factors, so targeted prevention by long-term care facilities can reduce falls.
What Effective Fall Prevention Looks Like in a Nursing Home
High-quality fall prevention in long-term care is multifactorial: it combines assessment, environment, training, clinical care, and monitoring. Key components include:
- Individual risk assessment and care plans. Every resident should have a documented fall-risk assessment (on admission and after any fall) and an individualized prevention plan.
- Exercise and mobility programs. Supervised strength and balance training adapted for frail residents reduces fall risk and improves mobility when maintained over time. Evidence supports active exercise programs in aged-care settings.
- Medication review and optimization. Regular review of sedatives, hypnotics, and other fall-risk drugs with deprescribing where safe, ideally led by a clinician or pharmacist. Evidence on medication review alone is mixed, but it is an important part of a multifactorial approach.
- Environmental modifications and equipment. Adequate lighting, non-slip flooring, grab bars, appropriately adjusted bed heights, clear pathways, reachable call buttons, and properly fitted mobility aids reduce hazards.
- Timed toileting and continence care. Scheduling assistance for toileting cuts down on risky, unsupervised hurries to the bathroom.
- Staff training and adequate staffing levels. Regular training on safe transfer techniques, recognition of behavioral cues in dementia, and prompt response to alarms. Adequate staffing density ensures supervision and timely assistance.
- Post-fall evaluation and data tracking. Every fall should trigger a prompt clinical evaluation, adjustment of the care plan, and tracking to identify patterns (time of day, location, activity) that suggest system fixes.
Multifactorial interventions that include several of these elements are supported by high-quality reviews as the most promising approach in care settings, particularly when exercise and tailored interventions are included.
How Nursing Homes Should Measure Success
Facilities should track both process measures and outcomes:
- Process measures: proportion of residents with completed fall-risk assessments, percentage with individualized plans, number of staff hours devoted to mobility programs, medication-review rates.
- Outcome measures: fall rate per 1,000 resident-days, number of injurious falls, fall-related hospital transfers, hip-fracture incidence, and mortality related to falls. These measures should be reported, trended, and acted upon at facility quality meetings. CMS and accrediting bodies expect ongoing monitoring and quality improvement.
Warning Signs of Inadequate Fall Prevention
- Frequent unexplained falls or repeated “near-misses” without documented assessment or change in care plan.
- Staff shortages, long response times to call bells, or unattended residents who need help with transfers or toileting.
- Missing or inconsistent documentation of fall-risk screening, care plans, or post-fall evaluations.
- Environmental hazards left unaddressed (cluttered corridors, wet floors, poorly adjusted beds).
- Repeated use of restraints or sedating medications without clear clinical justification, as these approaches can increase risk.
If you see these signs, ask for immediate clarification from supervisory staff and the facility’s medical director and document times and conversations.
Practical Steps Families Can Take Now
- Request and review your loved one’s fall-risk assessment and individualized prevention plan.
- Ask about exercise or mobility programs and how often staff assist with supervised mobility.
- Verify medication review frequency and which clinician or pharmacist performs it.
- Visit at different times (including evenings/weekends) if possible to observe staffing and supervision.
- Insist on prompt evaluation and documentation after any fall; ask for the plan to prevent recurrence.
- Keep a written log of falls, conversations with staff, and any delays in care. This record can be crucial if there is a pattern of neglect.
Frequently Asked Questions about Falls in Nursing Homes
Q: How common are falls in nursing homes?
A: Falls are very common in nursing homes. Systematic reviews report that roughly 40–50% of residents experience at least one fall in study periods, and many fall repeatedly. National data also show that older adults fall frequently overall, and institutionalized populations bear a heavier burden.
Q: Do hip protectors prevent fractures?
A: Clinical trials in nursing homes have produced mixed results and generally have not shown a reliable protective effect for hip fractures with currently available hip-protector designs. They may be used in some residents but should not replace comprehensive prevention.
Q: Can nursing homes reduce falls even when residents have dementia?
A: Yes. Evidence shows that tailored exercise and multifactorial programs can reduce falls even in residents with cognitive impairment, though programs must be adapted and consistently delivered.
Q: What if the facility won’t fix hazards or ignores repeat falls?
A: Start by escalating internally. Speak with the charge nurse, the director of nursing, and the medical director. Document requests and responses. If the facility continues to ignore clear risks or a resident suffers preventable injury, consult an attorney experienced in nursing-home neglect to explore legal options.
Contact the Award-Winning Chicago Nursing Home Neglect Lawyers at John J. Malm & Associates
If your loved one has fallen in a nursing home and you believe the fall or its consequences could have been prevented through reasonable care, you don’t have to accept that outcome silently. Nursing homes have a duty to assess risks, implement individualized prevention plans, maintain a safe environment, and respond promptly when problems arise. When those duties are breached and a resident is injured, families need experienced advocates who understand both the medical evidence and the legal standards that protect residents.
Contact John J. Malm & Associates for a free consultation. Our Chicago nursing home abuse attorneys will review the facts, gather the medical and facility records, and explain whether neglect may have contributed to the fall. Let us stand with your family to protect your loved one’s rights and pursue fair compensation and safer care for other residents.