Many Falls in Facilities Do Not “Just Happen”

Many Falls in Facilities Do Not “Just Happen”

While falls are the top cause of emergency room visits for the elderly, many falls in nursing homes are preventable, as a personal injury lawyer Trenton, NJ trusts can explain.  Understanding how falls happen in these facilities is key to for a good advocate to a loved one.  Preventing a fall is of paramount importance, as falls frequently lead to hip fractures, skull fractures and brain bleeds.  Falls lead to immobility – either because the resident stops walking for fear of falling again, or simply can’t walk due to the injury.  Immobility can lead to decline, bed sores and death.

Overwhelmingly, most nursing home residents are at some risk for falls.  When a new resident is admitted to a nursing home there is a comprehensive assessment including one to determine the risk for falls.  This level of risk is the foundation for what interventions are required. The higher the risk, the more interventions required. Without an accurate initial assessment, the resident is at grave risk because the wrong interventions will be in place.

If a resident does get an appropriate initial risk assessment, then the right tools to prevent falls are identified.  Interventions may include things such as bed or wheelchair alarms, a wheelchair lap tray, a highbacked wheelchair, a self-releasing seat belt, lowering the bed, a floor mat, or a toileting schedule.

However, the key to any intervention is the staffing levels.  You can have the best interventions in place but if there aren’t enough staff in the building to supervise the residents, all residents are at grave risk.

For example, many residents with dementia or Alzheimer’s forget to use their call bell to ask for help before going to the bathroom.  One easy intervention for these folks is an alarm that sounds when they begin to get up. These residents move slowly, and this is a good intervention to notify the staff that the resident is getting out of bed so they can get to the resident hopefully before they are even sitting all the way up.  That said, the alarm won’t prevent the fall – it is the staff’s ability to respond to the alarm that is the key. Without the right number of staff, all the alarms in the world won’t stop a catastrophe.

A facility should obviously set staffing levels on “census.”  Census is how many residents are in the building. But more importantly, nursing homes should staff to “acuity.”  Acuity is how much care each resident requires. Acuity is more important than just numbers. A basic acuity analysis should account for assistance with activities of daily living like eating, bathing, dressing and grooming.  These are time consuming activities which may require one on one help. The acuity analysis will also account for residents that have conditions that require more nursing care, like bed sores. Using acuity analysis to set staffing levels is a tailored approach required by law.    

Those initial assessments will give the facility a clear picture of acuity, both for the individual resident and can give a picture of the entire facility.  From there, the facility should set appropriate staffing levels regardless of what interventions are necessary. This is the key to keeping residents supervised and safe.

When looking to place a resident, or if you have a loved one in a nursing home, understanding the staffing levels is important.  One nurse aide to eleven residents (1:11) on the day shift may be overwhelming and impossible for the aide if the residents need a modest amount of care.  Asking questions about staffing will be important to being the best advocate you can be for your loved one.



Thanks to our friends and contributors from Davis & Brusca, LLC for their insight into slip and fall cases.

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