Falls and Drops

Drops

Residents in nursing home often have limited mobility and ability to care for themselves.  Many of these residents rely completely on nursing home staff to take care of their Activities of Daily Living (ADLs), such as bathing, dressing and grooming.  Nursing home staff also help residents transfer from place to place, including to and from beds and wheelchairs.  Nursing home residents must be completely assessed by the nursing home staff upon entry to the nursing home to determine the level of assistance they require for ADLs and transfers.  Some of the categories tested are:

  • Bed mobility
  • Transfers (to/from bed, to/from wheelchair)
  • Ambulation
  • Dressing
  • Eating
  • Toileting and personal hygiene

A look back assessment is performed to determine how much help the resident needs with ADLs.  ADL Self Performance measures what the nursing home resident actually did and not what he or she might be capable of doing.  ADL Support Provided: Measures the most support provided by staff.  The assessment will rate the resident using one of the following levels of assistance:

  • Independent
  • Set up help only
  • One person
  • Two + person physical assist
  • Activity does not occur

Based on the resident assessments, Care Plans and other similar documents are created which dictate how many staff members are required to help the resident perform each type of activity or transfer and how the transfer should be performed, whether manually or by use of a device, such as a Hoyer Lift.  If insufficient staff, usually Certified Nurse Aides (CNAs), is used, then the resident may be dropped or injured.  This is frequently at issue in cases of understaffing by the nursing home.

Falls

Nursing Home residents can also injure themselves if they fall out of a wheelchair or bed or while ambulating on their own if appropriate safety precautions are not taken.  The nursing home must complete a Fall Risk Assessment upon a resident’s entry to the nursing home to determine how high of a fall risk they are.  There are many different Fall Risk Assessment tools and forms used by nursing homes, each a little different.  Generally, these forms give points for each factor that constitutes a fall risk and any score over a certain number is a high risk and fall risk precautions must be undertaken by the facility.  Here are some of the common risk factors for falls used by nursing homes:

  • Recent Fall History (in the past 3 months)
  • Ambulation/Continence (Ambulatory & Incontinent)
  • Mental Status (Disoriented, Intermittent Confusion)
  • Vision
  • Balance (Standing, Walking, Coordination)
  • Requires use of assistive devices (Cane, Wheelchair, Walker)
  • Blood Pressure (Systolic)
  • Medications (Diuretics: somnolence, volume depletion, electrolyte disturbance, urgency to rush to bathroom, Psychoactives: Benzodiazepines (Ativan, Halcion), Phenothiazines, Antidepressants, and antipsychotics (Mellaril, Haldol), Narcotics, Anticonvulsant stabilizers, Cardiovascular medications, Corticosteroids, or any medication that adversely affects muscle function, coordination, and physical stability)
  • Predisposing Conditions or Diseases (Gastrointestinal: Bleeding, Diarrhea, Defecation Syncope, Postprandial Syncope, Genitourinary: Micturition syncope, Incontinence, Nocturia (going to the bathroom at night), Cardiovascular: Myocardial infarction, Arrhythmia, Orthostatic Hypotension, Musculoskeletal disorders: Arthritis, Inflammatory Joint Disease, Osteoarthritis Proximal Myopathy, Deconditioning, Neurologic: Parkinsonian, Dementia, Stroke, Transient Ischemic Attack, Delirium, Myelopathy, Vertebrobasilar Insufficiency, Carotic Sinus Supersensitivity, Cerebellar Disorder, Peripheral Neuropathy, Diabetes, B12 Deficiency, Multiple Myeloma, Vasculitis, Chronic dehydration)

If the resident is a high risk for falls, the nursing home must make a Care Plan to put in place fall risk precautions to prevent the fall or injury from a fall.  The Care Plan must be tailored to the specific resident because each person is different and each circumstance is different.  Examples of fall risk precautions that can be put in place, depending on the circumstances are:

  • Familiarize the resident with the environment
  • Have the resident demonstrate call light use
  • Maintain call light within reach
  • Keep the resident’s personal possessions within safe reach
  • Have sturdy handrails in bathrooms, room, and hallway
  • Place the bed in low position
  • Keep bed brakes locked
  • Keep wheelchair wheel locks in “locked” position when stationary
  • Use of non-slip, well-fitting footwear
  • Use night lights
  • Keep floor surfaces clean and dry
  • Keep resident areas uncluttered
  • Use of a toileting schedule
  • Physical therapy
  • Bed or chair alarms
  • Hip protectors
  • Fall pads

Falls are the leading cause of injuries among the elderly population.  Direct injuries can include broken bones such as a broken hip or femur, lacerations, head trauma or brain injuries. This level of trauma to a senior can have secondary injuries such as pneumonia and are often associated with increased confusion and hastening decline.  These types of injuries can lead to a permanent decreased quality of life because many elderly people do not fully recover from such injuries.  For example, many elderly people may not be appropriate surgical candidates and cannot have the surgery they require to fix broken hips or femurs, resulting in a permanent bedridden status.  This also can cause depression and other consequences.   Most of these injuries are preventable if appropriate safety measures are taken.  Unfortunately, many nursing homes are severely understaffed in order to make more profit for the nursing home corporation.  Less staff means less help with activities such as transfers or help getting to the bathroom.  If you or a loved one has suffered an injury as a result of a nursing home drop or fall, call Wagner Hughes, LLC for a free consultation at (404) 900-6979.