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Falls: When are they negligence or abuse?

With a loved one in a nursing home, every day can be a challenge. You know that their health is declining and that they need more support to do the things they would have been able to do on their own in the past.

That's why you weren't surprised the first time you heard that they'd fallen. You thought they had just forgotten to call for help and decided to get up on their own. Of course, nurses can't be everywhere all the time, so falls happen when they're least expected.

What you found out later was that your loved one had indeed called for help, but after waiting for 20 minutes, no one had come for them. So, they shifted their weight over to the wheelchair and rolled over to the window to open it for some fresh air. When they stood to get up, they forgot to put on the brake, and they fell as they attempted to stand.

When is a fall a nursing home's fault?

In this case, the call for assistance went unnoticed, and your loved one felt they had no choice but to take steps to do what they wanted to do on their own. Not responding to a patient's call for help is a serious problem. Nursing home staff members are always supposed to be monitoring their call lights. If a patient calls, a nurse or aid responds shortly. Not responding simply isn't an option, for reasons like above.

Generally speaking, it shouldn't take more than four or five minutes for a response to a call light, even if it's to stop in and make sure the patient is okay. A call light could indicate that a patient has fallen and was able to reach the button to ask for help, or it could be a call to go to the restroom. There is never a time when it's acceptable to make a patient wait for a half hour, hour or longer, because some situations are time-sensitive and simply cannot be delayed. Delaying responses can result in serious injuries and even death in worst-case scenarios.

What should be done when a nursing home resident suffers a fall?

When a nursing home resident suffers a fall, it is very important that the first response team reacts in the appropriate way. All staff in nursing homes should be trained so that they can safely help injured residents and prevent further injuries.

  • Nursing home staff should assess the situation and the severity of the incident. This means that the vital signs and cranial nerve should be checked. It should be confirmed that the injured resident can move and feel their lower limbs. Additionally, their level of consciousness should be checked. It is very important that the nursing home caretaker checks whether there has been any type of injury to the head as a result of the accident.
  • After an assessment has been made, the nursing home should get in contact with the appropriate people. This will usually include a doctor and the family members of the resident. This will help in making sure that all safety precautions have been put in place and that a fall can be prevented in the future.
  • Finally, the nursing home resident should be monitored to ensure that they recover from the incident and to make sure that their condition has not deteriorated.

Fall prevention methods

There are many methods that nursing homes can employ to help keep residents from falling. Providing handrails throughout the corridors, keeping the flooring level and providing mobility devices like walkers can all go a long way in keeping residents safe.

Nursing homes can also prevent falls by ensuring that residents have everything they need within reach or a reasonable distance. A senior who is trying to reach a nightstand that is too far from the bed might fall while reaching for it. Making sure that the resident has a way to make it it to the toilet can also help to prevent falls since he or she might not have to take risks to make it there.

Causes of falls in seniors

In some cases, residents might need to be evaluated for fall risks. Medications, cognitive decline and other issues might point to a person being at risk of falling. Residents who have a known fall risk may require personal assistance when they need to move around.

Floor conditions can also be a factor. For example, if a nurse spills a patient's water on the ground and does not mark the spill before running off to get something to clean it up with, then someone may walk across it or slip on the wet area. Blocking off the area or leaving a sign are some of the best ways to prevent falls based on slick areas.

Sometimes, a premises is dangerous because of the negligence of the nursing home's team in monitoring the flooring. For example, if there is a piece of carpet that is sticking up or a resident that has spilled a drink onto the linoleum, both could pose a threat to the less-mobile elders in the facility

The risks of falls

There are many risks of falls that these residents face. Broken bones, head injuries and spinal cord injuries are three very serious injuries that can occur after a fall. The arms, legs and hips might also suffer from breaks and fractures in a fall. 10 to 25 percent of falls among the elderly who are in institutionalized care result in lacerations, fractures or a need for emergency care.

One risk factor is osteoporosis. In may people who have it, the risk of suffering hip fractures is so high that it can happen during simple activities that involve bearing weight. Based on that, nursing home staff should learn which of their patients have osteoporosis, and make sure that those patients avoid weight-bearing activities.

Staff should also understand that women are, as a group, more at risk than men are. This is because women lose bone density faster as they age, sbstantially due to the decrease in estrogen levels that happens when menopause begins.

Heredity also plays a part. People who are small, slender, Caucasian or Asian, have a particularly high risk of osteoporosis and thus of hip fractures. Poor nutrition, and eating disorders like bulimia and anorexia nervosa also add to a person's risk.

"Never events"

Injuries from slip-and-falls are considered to be preventable "never events." A never event is defined as one of 29 "adverse medical event[s] that can result in death or significant disability" by the National Quality Forum.

The Journal of the American Medical Association (JAMA) found that many nursing homes fail to do all they can to prevent patients from falling. The Association concluded -- based on 100,000 of these types of injuries studied over a five-year period -- that these injuries rack up health care costs substantially.

What you can do

Of course, as loving relatives, your concerns are for the patients and not the facilities' bottom lines. It's important to ask about staffing levels when looking into various nursing homes. Inadequately staffed facilities are likely to have more patient injuries due to a lack of supervision.

Life after a fall may not be the same for a nursing home resident. A simple fall can make the person feel unsure about their ability to get around. In the case of a hip fracture, full mobility might not be regained. The mobility issues can lead to depression and other serious issues. If the nursing home was at fault for the fall, the senior or their family should pursue options for compensation.

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