Nursing Home Falls: When a Fall Is Neglect

Falls are covered by the Quality of Care part of the federal regulations, found at 42 CFR 483.25(d). The rule says a home has to keep the environment around residents as free from accident hazards as possible. Each resident must also get enough supervision and the right assistance devices so accidents do not happen.

Care has to meet professional standards, honor what the resident wants, and match the resident's care plan. That plan is the written document the home creates for each person, laying out what they need and how staff will provide it. Residents who struggle with movement are owed the services, equipment, and hands-on help that let them stay as independent as they can. This rule has stayed the same since the start of 2017.

Families can use the rule itself to weigh whether a fall might count as neglect. These questions track what the home has to do:

• Did staff know the resident was at risk of falling, and did the care plan reflect that risk?
• Did the resident get the walker, assistance, or supervision the plan required?
• Were there dangers in the room or hallway the home could have taken care of?
• Did the family learn about the injury promptly?

A home has to notify the resident, their physician, and a relative at once when there is an injury or a decline. Skipping that step is its own separate violation.

Facilities sometimes use bed rails to stop a resident from rolling out of bed, though federal rules put limits on them. The home has to try other options first before installing one. Staff must also look at whether the resident could get trapped by the rail.

On top of that, the home has to lay out the risks and benefits for the resident or their representative and obtain consent. The bed needs to suit the resident's size and weight. Rails have to go in and be maintained exactly as the manufacturer directs.

If you're thinking about legal action, a good first step is to check whether the home has already been cited for failing to prevent accidents. If it would help to talk it over, you can call to reach a law firm that advertises on this site. For help that isn't an emergency, you can call the Eldercare Locator. Inspection records can reveal whether inspectors have already caught the home coming up short. When inspectors record something like this, it is called a citation, meaning a written notice that a federal rule was broken.

In the current CMS records, which cover standard inspections and complaint visits over roughly the last three inspection cycles, 6,927 citations under the accident and supervision rule found residents harmed or in immediate danger. Inspectors have written it up 21,343 times at 10,076 homes, with 6,927 of those citations involving residents who were hurt or at immediate risk.

Elopement is when a resident walks out of the home or away from a safe area without staff noticing. It goes hand in hand with wandering, and the Alzheimer's Association reports that six out of every ten people with dementia will wander at least one time. Anyone with dementia faces this risk at any stage, and wandering can put a life in danger.

Red flags include asking to "go home" while already at home, being restless, and pacing. When someone's confusion gets worse later in the day, wandering tends to happen from early evening onward. Taking care of basics like toileting, food, and water brings the risk down. Door alarms and pressure mats can also let staff know when someone is moving or opening a door.

Many people who wander turn up within 1.5 miles of where they disappeared. When a person with dementia has not been located within 15 minutes, the Alzheimer's Association recommends calling 911 to report a missing person. It also recommends letting police know the individual has dementia.

It can fall under the same duty to give adequate supervision so accidents are prevented. Homes also have to help every resident maintain a healthy weight and take in enough fluids. If a doctor or another health care provider prescribes a special diet for someone with a nutrition problem, the facility has to provide it.

A home that disregards a prescribed diet, or leaves someone who needs eating assistance by themselves, can be cited. The food and fluids rule has been cited 5,099 times, with 50 of those at the immediate danger level.

The record for every home on this site is drawn from the federal Care Compare files and refreshed each month. Those records span 14,690 nursing homes. Across them, 9,248 citations reached the immediate jeopardy level. That is the gravest level there is, and it means residents faced imminent risk of serious harm. You can search for any home by entering its name, city, or ZIP. It is also possible to compare two or three homes side by side.