Can a Nursing Home Be Held Liable for Preventable Falls?

When a nursing home tells you your mother fell, that sentence is doing a lot of work.

It leaves out who was supposed to be in the room, what your mother’s care plan said about walking to the bathroom alone, and whether anyone had looked at her fall risk since she started a new blood pressure pill. Federal regulators sort every nursing home accident into one of two categories, avoidable or unavoidable. Whichever category a fall lands in decides whether the facility is responsible for the broken hip that followed.

Most families never learn about that distinction, but nursing home liability for falls starts there. Here is how the two categories are separated, what a facility owes a resident before a fall happens, what you have to prove, and what to do in the days after.

Common Causes of Preventable Falls in Long-Term Care

Falls are the leading cause of injury death for adults 65 and older. Roughly half of nursing home residents fall in a given year according to federal patient safety researchers, and the reasons repeat from one facility to the next:

• Wet floors, loose rugs, and dim hallways: the elderly slip and fall injuries that everybody pictures first
• Beds left at a height set for the staff’s convenience rather than the resident’s feet
• Call lights, walkers and glasses placed just out of reach
• Sedatives, sleep aids and blood pressure medications that cause dizziness, especially in the first weeks on a new dose
• Residents who need help to the bathroom and wait too long for it

Most preventable falls in nursing homes happen when residents try to walk to the bathroom on their own. A resident who has pressed the call light twice and still needs to go will eventually try it alone, while the aide who didn’t come was probably covering twenty other rooms.

The aide isn’t the problem. The staffing chart is.

The Importance of Individualized Fall Risk Assessments

A nursing home is not allowed to be surprised by a resident’s fall risk. Federal rules require the facility to measure that risk on a schedule.

Every resident gets a full assessment within 14 days of admission, and then again within 14 days after a significant change in condition, and at least once a year, with a shorter review every three months. A baseline care plan has to exist within 48 hours of arrival, and a full care plan with measurable goals follows within seven days of the assessment.

A fall risk assessment for elderly residents is part of that package, and it is supposed to change when the resident changes. New medication, a hospital stay, a stretch of confusion at night. Each one of these situations restarts the clock.

The care plan is where liability can usually be detected. When the plan says two-person assist for transfers and your father fell during a one-person transfer, that’s a bad look. The facility wrote down what the resident needed and then didn’t provide it. Facilities defend these cases by arguing the fall was unforeseeable.

The care plan is the document that proves otherwise.

Legal Elements Required to Prove Facility Negligence

Nursing home negligence claims turn on the same four elements as any injury case, and the first one is easier here than almost anywhere else.

Federal law includes a duty of care. Under the Nursing Home Reform Act, a facility must keep the resident environment as free of accident hazards as possible and give each resident adequate supervision and assistance devices to prevent accidents. Regulators rule an accident avoidable when:

• The facility failed to spot the hazard or the resident’s risk
• Failed to act on it
• Never checked whether what it did was working

Most states add their own resident safety standards on top of the federal rules.

Breach is the failure itself. The new assessment nobody updated, the care plan nobody followed, or the hallway that stayed dark for a month after someone reported it are all examples of a breach.

Causation is where the defense digs in and tries to fight back. They will argue that your mother would have fallen no matter what anyone did, so the evidence must tie the specific breach to the specific fall.

Damages are the medical bills, the rehabilitation, the pain, and the independence that rarely comes all the way back after a hip fracture at 84.

Steps to Take After a Nursing Home Fall Injury

Proving nursing home neglect gets harder every day the paperwork ages. Therefore, the first week matters more than the first year.

Steps to take:

1. Get an outside medical evaluation, not just the facility’s nurse’s. Hip fractures and head injuries often get missed
2. Photograph the resident’s room, including the floor, the bed height, the call light, and what your relative had on their feet
3. Ask in writing for the incident report, the current care plan, and the most recent assessment. Federal rules give residents and their representatives the right to see records within 24 hours and receive copies within two working days
4. Write down the names of everyone on the floor that shift and what they told you, as well as the day they told you
5. Report the fall to your state’s long-term care ombudsman, who can launch an independent investigation

Records get amended, and sometimes that is legitimate. Only sometimes. Request a copy of the records now so you have the version that existed the day the fall happened. That’s the one nobody had a reason to amend yet.

Know the Difference Between Avoidable and Unavoidable

A fall the care plan predicted is not bad luck. It is a plan that was written and not followed. Federal rules put the burden of following that plan on the facility, not the resident.

My Nursing Home Abuse Guide helps families see that difference and act on it before the records go cold. If you believe a fall could have been prevented, talk with a nursing home abuse attorney in your state about what happened and what your family can do next.

Your loved one was owed supervision. Ask whether they got it.