In 2003, the Centers for Disease Control and Prevention estimated that there would be three million adults living in nursing home and long-term care facilities by the year 2030. Today, we know that the aging global population has increased demand for assistive care, both in healthcare institutions and private home settings. The U.S. Bureau of Census reports that currently, over 5% of Americans aged 65 and older, reside in congregate care, while 4.2% are in nursing homes, for critical care needs. The number of adults aged 95 and older living in nursing homes, is over 50%.
As increased demand for assistive living and nursing homes reaches a critical point, and the largest global population segment (The Baby Boomers) matures into middle and late stages of retirement and needs, the healthcare system will remain under pressure to provide care, and space for aging seniors. This increased strain on care facilities can sometimes result in overcrowding, understaffing and poor maintenance that can lead to nursing home fall injuries and negligence, even at highly rated institutions.
According to one report from the (CDC), between 50% and 70% of elderly patients suffer from nursing home falls every year, which is twice the rate of injury that seniors living at home incur. How can families identify the difference between accidental fall injuries and those caused by negligence or lack of appropriate care and supervision?
How Falls Happen in Medically Supervised Environments
When you think about long-term care facilities, the precautions that medical staff take to ensure the safety of residents (particularly those unable to ambulate effectively) seem reasonable. Wheelchairs are often used for transportation, and other assistive devices including walkers and railings are available, anticipating the needs of seniors who have trouble walking on their own. Beds are equipped with safety railings, and in some cases, the use of soft restraints is required to ensure that residents do not accidentally fall out of bed.
With all the equipment and technology used to care for medical patients, and round-the-clock trained supervision, it is difficult to understand why a nursing home can be such a dangerous place for senior residents. So how do they occur?
According to the Centers for Medicare & Medicaid Services (CMS) a fall is legally defined as “failure to maintain an appropriate lying, sitting, or standing position, resulting in an individual’s abrupt undesired relocation to a lower level.” The CMS also defines a fall injury as “an episode in which a resident lost his/her balance and would not have fallen, were it not for staff interventions.” The definition is important because it helps delineate between accidents that happen, and those that might have been prevented in the absence of negligent care.
Before any resident is admitted to a nursing home, the clinical care team is required by law to conduct an Assessing Fall Risk report. This assessment, a Minimum Data Set (MDS) evaluation, must be completed within 14 days of admitting a new patient to a nursing home, however many institutions have a 24-hour mandatory assessment period. The report outlines specific triggers, emotional or physiological, that may place the patient at a heightened risk of fall injury. Once the triggers and conditions are understood by the medical care team, a care plan is developed for the individual, including the use of assistive devices, to help prevent injuries. Staff should be aware of the fall risk of each patient in a nursing home, to supervise and intervene accordingly.
Falls in nursing home environments happen when:
- Seniors are adjusting to new medications that may make them feel drowsy and impact balance and visual acuity for depth perception.
- Seniors have emotional episodes that result in an attempt at fast movement, without using normal assistive devices.
- Patients can fall out of chairs, beds, or lose their grip on a cane or ‘walker’ and fall suddenly.
- The resident has a mental health issue or cognitive degeneration, which prevents them from remembering their physical limitations.
- Patients can fall during normal activities, such as bathing, or using the washroom.
- The resident is dropped by a healthcare worker, or allowed to slip while moving or assisting them in a regular activity.
Cameras help nurses survey patients that are moving around in allowed areas, and that provides them with a cue to assist, or guide a resident back to a wheelchair, or bed. Unfortunately, if a facility has many residents and insufficient staffing, the ability to intervene before a fall accident occurs is significantly reduced. Long-term care facilities can be legally and civilly liable for injuries and even wrongful death suits, should a resident in their care (identified as a fall risk in the MDS) become injured due to lack of supervision and assistance.
For more information about abuse or negligent care in nursing homes, see more here or at the Nursing Home Abuse Guide, an educational organization that provides resources for caregivers and family members.
Andera Colon is a freelance writer and blogger from Chicago, IL who loves to write about varied topics including health, automobile, technology, and more. Currently, she is focusing on Law related topics. When she is not writing, she enjoys traveling with her friends and taking long walks on the beach.
