Five ways to prevent nursing home falls

Under federal law, nursing homes are required to provide adequate supervision and assistive devices to prevent falls. How much supervision and what kind of devices will depend on a person-centered assessment of that resident. On this week’s episode, we discuss five ways to prevent nursing home falls.

Schenk: Hi out there. Welcome back to the podcast. My name is Rob. I’m going to be your host for this particular episode. We’re going to be talking about five, count them, five ways to prevent falls in nursing homes.

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Short episode today – want to talk about five concrete ways to prevent falls in nursing homes, falls being in my anecdotal research one of the most common injuries or common mechanisms for injuries in nursing homes. I would say one out of every four of our cases have a fall in them or is a component of one in four of our cases. So the information out here that I’m trying to provide to you I think is critical, although it’s not all-inclusive. It’s just five ways to prevent falls.

As you listen to this episode, think about these as applied to your loved one in the nursing home, and if something jumps out at you, bring it to the attention of the nursing home.

Preventing falls in nursing homes starts with the assessment

So let’s start with the first one. Preventing falls in nursing homes start with a comprehensive assessment. Nursing homes are required at various intervals to conduct a comprehensive assessment of every resident and a comprehensive assessment means evaluating a resident’s risk of fall. So taking into account the resident’s age, cognitive impairments, their physical abilities, their medications, these types of things, it is a comprehensive view. And based on that assessment, you should have an understanding of where that resident’s risk of fall sits with regard to the general public or not, whether they’re a high risk or a small risk for falls. But I would say that that is critical threshold prevention method, like that, in fact the federal regulations require it. So there are some things that might not necessarily be required by federal regulations or we can argue back and forth whether or not it’s a standard procedure. The comprehensive assessment as it pertains to assessing the resident for the risk of fall is a non-negotiable. The nursing home must do that.

As we’ve talked about in previous episodes, if you request medical records, look to see if there’s an assessment in there, because there should be, and how do they rate your loved one in terms of whether or not they could be likely to fall, because it has to be done. So assessing a resident for fall is the first step or the first way that we can prevent falls.

Care plans are essential for preventing falls

The second way, the second I would say essential, threshold, non-negotiable way that we prevent falls is we create a care plan based on that comprehensive assessment. We’ve talked about care plans in other episodes. The care plan functions as the blueprint for care. It provides objectives, goals and interventions that go towards the problems that a resident may have.

By way of example, the care plan might say something along the lines of, “Resident is at risk of fall. We are going to keep resident from falling for the next 120 days. Here is the list of interventions that are going to prevent that resident from falling.” It is important that you know what is in that care plan and that you take part in the care plan planning process, but again that you specifically know what’s in the care plan. Get a copy of it and look at what interventions there are if your loved one is at risk for falling because if you – what is the old saying? If you fail to plan, you plan to fail? Or if you plan to fail – no, you never plan to fail. If you fail to plan, you plan to fail. There it is.

So that’s why the assessment and the care plan are the top two critical ways to prevent falls because a) they’re required by the regulations but b) that sets up what specific things you’re going to do for that particular resident, for your loved one specifically, because no two residents are the same. That’s going to establish the plan of care. It’s going to establish the method of treatment for your loved one to prevent falls.

Appropriate rails and lighting can prevent nursing home falls

The number three way that we prevent falls in nursing homes is to provide appropriate rails, guide rails and lighting in the nursing home itself. So we’ve talked in other episodes about what we would call “physical plan requirements,” meaning how the nursing home should be laid out and how it should be constructed to keep residents safe from falls. That includes providing guide rails around showers, bathtubs, in corridors as well as making sure that there is adequate lighting where it needs to be correctly lit, because having something too bright can be just as much of a hazard as having something too dim. It should be an adequate amount of lighting so the resident has less trouble walking or ambulating through that space in the nursing home.

So an asterisk here is that it is counterintuitive in terms of safety with regard to bedrails. I often have clients who are angry and call me when a resident has fallen out of bed that they should have had bedrails. In fact, bedrails often are more dangerous for other reasons. In other words, the danger of bedrails, injury from bedrails is greater than the safety they provide for a resident falling out of bed and injuring themselves that way. We’ve talked about bedrail injuries in other episodes, but essentially bedrails present a danger of asphyxiation and basically crushing the resident between the mattress and the rail itself. It functions as what you would call a restraint, a physical restraint on that resident.

So there needs to be a thorough assessment of the risk to the resident and asphyxiation, other dangers of bedrails that outweigh the risk of the resident falling and hurting themselves. So the issue here is that bedrails may not be best for your loved one and may not be the best way to prevent falls from the bed. So there are other ways around that in terms of falling from bed. You can put the bed in the middle of a setting. There are fall mats that you can put around the bed, that type of thing that are way better, way safer than bedrails.

But again, the third way of preventing falls is having appropriate railings, guide rails in bathrooms, on toilets or by toilets, in hallways as well as adequate lighting. That is the number three way to prevent falls.

Regular rounding for incontinent care can prevent falls

Number four way is having a regular rounding routine for continence care. Often what we see in fall cases is that if the resident is incontinent or is having issues with continence care, they’ll signal with the call light, not get any help, and then get out of bed to go use the bathroom because they don’t want to go on themselves. They didn’t get the help they need. So making sure that there’s some type of toileting program that the nursing home is on top of providing regular rounding for continence care is critical, because again, like I said, most the time, residents do not want to go on themselves and if they’re not using absorbent products, they need to go to the bathroom. And they oftentimes will get up and attempt to do it themselves when they do not have the physical ability to do so. So making sure there’s regular rounding on a schedule is important for preventing falls.

Sensor alarms and adequate supervision

The fifth and final way that we’re going to talk about today is having appropriate sensor alarms and providing adequate supervision. With regard to adequate supervision, that’s actually required under federal regulations. So the nursing home is going to tell you that they can’t provide one-on-one care. They can’t have someone that has eyeballs on your loved one 24 hours a day. That’s beside the point. Federal regulations require that if your loved one is assessed as needing more supervision, the nursing home must provide it or let you know that they cannot provide the care that is required for your loved one. So in some situations, based on that assessment, based on how high they are of a fall risk or an elopement risk, your loved one may need a sitter, someone to just sit there and watch your loved one to make sure they don’t get up and walk around depending on the other interventions. But adequate supervision is non-negotiable. They must assess your loved one for how much supervision they need and then provide it if it is in fact a lot.

Now with regard to sensor alarms, in the regulations, sensor alarms kind of are a good and bad. If there is an alarm, a sensor alarm, meaning an alarm that goes off if your loved one moves, gets up and starts walking, if that alarm makes noise, then there is an argument to be made that that is an illegal restraint if the consequence of that noise is your loved one is too scared to move because the alarm goes off and they don’t want to move. Hope that makes sense, because anything – anything that restricts your loved one’s ability to move is possibly an improper restraint. That includes noise. That includes noise. So if it does have that effect, then a sensor alarm that makes noise that is audible to your loved one may not be appropriate.

Sensor alarms that are silent to the resident but maybe go off at the nursing station, that’s altogether different. That is not a restraint. So your loved one, based on how much of a risk they are of getting up and falling, sensor alarms that go off at the nursing station or maybe a tablet or whatever the case may be that the staff member might have, that is an excellent way to help reduce the likelihood of fall because, “Oh, Ms. Johnson got up. The sensor is blinking. I’m going to go run in there and see if she’s okay.” This is something that, in my experience, is inexpensive. It’s easy to implement and can really be crucial in helping reduce the likelihood of falls. The issues that we see though is if the alarm is to go off at the nursing station, what happens when there’s nobody at the nursing station? That’s the issue.

Closer to the nursing station 

A couple of other things I would mention is that moving your loved one, if they are prone to get up and kind of walk around, moving them to the closest room to the nursing station might be beneficial. So that’s an added sixth thing I would recommend just off the top of my head.

But five things that I would say are crucial to preventing falls – assessments, care plans, appropriate rail, guide rails and lighting, regular rounding and then alarms and/or adequate supervision. These are the things that most often prevent falls in my opinion. They’re not the only interventions to prevent falls, but they’re pretty crucial.

I hope that you found this episode informative. If you are enjoying the content of these episodes, then please by all means like and subscribe wherever you get your podcasts from. Check us out over on YouTube. New episodes are out every other Monday, so it’s twice a month – excuse me – twice a month. Check us out then. And with that, we’ll see you next time.