Unfortunately, freedom from nursing home falls is not guaranteed once the senior is admitted.
Nursing home falls occur, both with good care and with bad care from the staff. When they do occur, the results can be devastating. Many seniors suffer from osteoporosis (brittle bone disease) or have thinning of their bones which make them more susceptible to fracture. Hip fractures in particular have a high mortality rate for senior citizens. Even when injury from falls do not occur, falling once helps breed a fear of falling again which has the unfortunate effect of making the senior more susceptible to having another fall – a terrible self-fulfilling prophecy indeed. Some falls are simply unavoidable, but if they can be avoided, federal regulations place the responsibility on staff to prevent nursing home falls. However, many falls can be prevented.
As a family member, there are some things that you can do to help staff prevent nursing home falls and keep your loved one safe from injury from falls:
- Full disclosure of fall history and fall risks: It is crucial that the nursing home staff be given all of the information about the senior’s fall history on admission, including the number of falls, the likely causes of the fall, and any known risk factors for falling. The information that they receive will help the nursing home staff put together a care plan which will address fall risks. The more information that they have regarding nursing home fall risks, the more informed their care plan decisions will be and the less likely injury from falls will occur. Any understatement as to the frequency of the falls or the fall risks, even when done in the name of sparing the feelings of the senior, can result in a poor fall prevention plan.
- Go to the care plan conferences: The care plan is sometimes referred to as the road map for the care that the senior will receive in the nursing home. The care plan is put together at an inter-disciplinary meeting known as the care plan conference. The senior has a right to attend, as do family members selected by the senior. Care plans are reviewed at least quarterly, and more often if there is a change in condition. The senior and designated family members should be notified of all care plan conferences. Unfortunately, care plan conferences are often held in the middle of the day when it is hard for family members to attend. It is important to go so that you can share with the care planners your observations and concerns regarding your loved one and to learn what exactly the staff is planning to do to prevent nursing home falls.
- Alert staff members to fall hazards: One standard part of the nursing home fall prevention program is to keep the floors free of clutter and slipping or tripping hazards. The main item this includes is loose items on the floor. The placement of equipment along handrails can cause problems for seniors who are dependent on them. If you see something on the floor or something else that could cause a problem, you should let the staff know about it immediately. This is not just for the benefit of your loved one, but also the staff and other residents of the nursing home. If messy floors are a recurrent problem (for example, there are frequently spilled liquids on the dining rooms floor), you should contact the administrator, or in the case of large nursing home chains, the corporate office. If the problem is one that happens over and over again, the nursing home management needs to know AND take action.
- Participate in strength and range of motion programs: One of the best lines of defense against nursing home falls is to maintain the strength and range of motion that the senior has, and if possible, to try to improve it. Some nursing homes offer exercise classes or have physical therapy which is available with a doctor’s order. Taking advantage of these opportunities to improve strength and range of motion will help improve balance and hopefully prevent nursing home falls.
- Insist on safety belt usage when appropriate: When a senior requires assistance with walking, the staff should be using a gait belt, sometimes referred to as a safety belt. A gait belt is a basically strap which goes around the mid-section of the senior while he or she is walking and allows the staff member to hold onto the senior by grasping the strap at the back of the senior. This allows the staff member to either stop or control a fall when the patient begins to lose their balance. Uncontrolled nursing home falls pose the greatest risk of serious injury to the senior, and gait belts have been shown to be an effective means of preventing uncontrolled falls. Holding onto the senior’s clothing is not a proper substitute for using a gait belt because it is hard to get a strong grasp on the clothing and because of the risk that the clothing will tear while the patient is falling. Even when the clothing does not tear, clothing does not permit the staff member to control the fall as effectively as a gait belt. Too frequently busy and rushed staff members will opt to assist a senior without using the gait belt when it is needed and is included in the care plan. This is a serious safety issue that should be raised with the nursing supervisor.
There are some things which seem like they would be good fall prevention measures but actually are not.
The one that people often think of first is using a restraint – after all, if they cannot get up unsupervised, they cannot fall. However, restraints have their own safety risks associated with them, and they also contribute to loss of strength and loss of range of motion due to inactivity. Good nursing practice and federal regulations actually discourage the use of restraints where there are other means available to limit fall risks.
Injuries from falls are major health risks for all seniors but especially for those residing in nursing homes. Some falls are truly unavoidable. Developing and implementing a proper care can reduce the risk of serious injury from nursing home falls. Taking some of the steps outlined above is a great way to start your fall prevention plan and can help your loved one avoid unnecessary and preventable injury from falls. The responsibility for preventing falls ultimately belongs to the nursing home staff, but these things can help make them more effective at doing their jobs.