Falls are one of the most common causes of serious injury in nursing homes, assisted living facilities, memory care facilities, skilled nursing facilities, and residential care facilities for the elderly. Many residents are older, frail, cognitively impaired, medicated, weak, recovering from surgery, or dependent on staff for transfers and walking.

Not every fall is the result of neglect. Some falls happen even when a facility provides reasonable care.

But many falls are preventable.

A nursing home fall may be considered neglect when the facility knew, or should have known, that a resident was at risk of falling and failed to take reasonable steps to protect them. These cases often involve failures in fall-risk assessment, care planning, supervision, toileting assistance, bed safety, mobility support, staff communication, and post-fall response.

The Mason Firm represents residents and families in serious nursing home abuse, elder neglect, assisted living negligence, memory care negligence, and wrongful death cases throughout California.

Past results do not guarantee future outcomes. Every case is different.

Why Nursing Home Falls Are So Serious

A fall that might cause a bruise in a younger person can be devastating for an elderly resident. Nursing home residents may have osteoporosis, balance problems, weakness, dementia, medication side effects, blood thinner use, or other medical risks that make a fall especially dangerous.

A nursing home fall can cause:

• hip fractures;
• pelvic fractures;
• arm, wrist, ankle, or shoulder fractures;
• head injuries;
• brain bleeds;
• traumatic brain injuries;
• spinal injuries;
• facial injuries;
• wounds and skin tears;
• loss of mobility;
• hospitalization;
• surgery;
• loss of independence;
• fear of walking;
• rapid physical decline;
• and death.

After a serious fall, some residents never return to their prior level of function. A hip fracture, brain injury, or hospitalization can lead to complications, immobility, infection, pressure sores, malnutrition, and further decline.

That is why facilities must take fall prevention seriously.

What Is Elder Neglect?

California law defines elder neglect to include the negligent failure of a person or facility with care or custody of an elder or dependent adult to exercise the degree of care that a reasonable person in a similar position would exercise.

In the context of a fall, neglect may involve a failure to provide reasonable care, supervision, monitoring, assistance, or safety precautions for a resident with known risks.

A fall case is not simply about the moment the resident hit the ground. The investigation should ask what the facility knew before the fall and what it did, or failed to do, to prevent it.

When Can a Fall Be Evidence of Neglect?

A nursing home fall may suggest neglect when there were warning signs before the fall or when the facility failed to respond appropriately after prior incidents.

Common examples include:

• the resident had a documented fall risk;
• the resident had dementia or confusion;
• the resident had a history of prior falls;
• the resident needed help transferring;
• the resident needed help getting to the bathroom;
• staff failed to answer call lights;
• staff left the resident unattended;
• the care plan required assistance that was not provided;
• bed alarms or chair alarms were ordered but not used;
• the resident was placed in an unsafe bed or chair;
• staff failed to use required mobility devices;
• the resident was on medication that increased fall risk;
• the facility failed to update the care plan after earlier falls;
• the facility failed to notify a physician or family;
• or the facility gave inconsistent explanations about what happened.

The stronger the evidence that the facility knew the resident was at risk, the more important it becomes to examine whether reasonable precautions were actually followed.

Fall-Risk Assessments

A nursing home or care facility should evaluate whether a resident is at risk for falling. That assessment should consider the resident’s medical condition, mobility, cognition, medication, prior falls, toileting needs, balance, vision, strength, and need for assistance.

A fall-risk assessment may identify risks such as:

• dementia;
• confusion;
• weakness;
• unsteady gait;
• recent hospitalization;
• prior falls;
• dizziness;
• poor balance;
• use of blood thinners;
• sedating medication;
• need for toileting assistance;
• use of a walker or wheelchair;
• poor safety awareness;
• and inability to call for help.

The assessment is only the starting point. A facility must then create and follow an appropriate care plan.

Care Plans and Fall Precautions

If a resident is identified as a fall risk, the facility should implement reasonable fall precautions. The exact precautions depend on the resident’s condition and needs.

Fall precautions may include:

• assistance with transfers;
• supervised walking;
• toileting schedules;
• keeping the call light within reach;
• responding promptly to call lights;
• lowering the bed;
• floor mats when appropriate;
• bed or chair alarms when appropriate;
• non-slip socks or proper footwear;
• walker or wheelchair assistance;
• medication review;
• physical therapy evaluation;
• increased observation;
• room placement near the nurses’ station;
• staff communication during shift changes;
• and family notification of changes in condition.

A facility may be negligent if it creates a care plan but does not follow it. A care plan that exists only on paper does not protect a resident.

Falls From Bed

Falls from bed can be especially concerning when the resident has dementia, confusion, weakness, poor mobility, or a known history of trying to get out of bed without help.

A fall from bed may raise questions such as:

• Was the resident known to be confused or impulsive?
• Was the resident trying to get to the bathroom?
• Was the bed too high?
• Was the call light within reach?
• Was the resident supposed to have supervision?
• Were bed alarms or floor mats required?
• Was the resident placed in a safe room location?
• Were staff aware that the resident tried to get out of bed alone?
• Were medications causing confusion or dizziness?
• Had the resident fallen before?
• Was the care plan updated after prior incidents?

A fatal fall from bed should never be dismissed as simply “one of those things” without reviewing the resident’s condition, risk factors, care plan, supervision, and facility response.

Dementia, Confusion, and Fall Risk

Residents with dementia, Alzheimer’s disease, memory loss, or confusion may not remember to call for help. They may try to stand without assistance, wander, climb out of bed, remove safety devices, or forget that they are weak or unsteady.

That does not mean falls are unavoidable. It means the facility must account for the resident’s cognitive impairment.

In dementia-related fall cases, important questions include:

• Did the facility know the resident had dementia?
• Did staff know the resident lacked safety awareness?
• Was the resident impulsive or restless?
• Did the resident try to get up without help?
• Were fall precautions designed for someone with cognitive impairment?
• Did staff check on the resident often enough?
• Was the resident supervised during high-risk times?
• Did the facility rely on the resident to ask for help when the resident could not reliably do so?

A facility cannot simply rely on a confused resident to follow instructions that the resident cannot understand or remember.

Toileting-Related Falls

Many nursing home falls happen when residents try to get to the bathroom. Toileting is a common trigger because residents may feel urgency, embarrassment, confusion, or fear of soiling themselves.

Facilities should consider toileting needs when developing fall precautions.

Neglect may involve:

• failure to provide scheduled toileting;
• failure to answer call lights;
• failure to assist the resident to the bathroom;
• failure to use safe transfer techniques;
• leaving a resident unattended on or near the toilet;
• failing to provide bedside commodes when appropriate;
• and failing to recognize that nighttime toileting increases fall risk.

If a resident repeatedly tries to get up to use the bathroom, the facility should respond with a practical plan rather than waiting for another fall.

Falls During Transfers

Transfers are another common source of injury. A resident may need help moving from bed to wheelchair, wheelchair to toilet, chair to bed, or standing to walking.

Transfer-related falls may involve:

• one-person assist when two-person assist was required;
• failure to use a gait belt;
• failure to use a mechanical lift when required;
• improper lift technique;
• rushing;
• understaffing;
• leaving the resident unsupported;
• failure to lock wheelchair brakes;
• failure to follow the care plan;
• and inadequate staff training.

If the resident required assistance, the facility should be able to explain what level of assistance was required, who provided it, and whether staff followed the plan.

Repeated Falls Are a Red Flag

One fall may occur despite reasonable care. Repeated falls are different.

After a resident falls, the facility should reassess the resident, investigate what happened, update the care plan, notify appropriate providers, and implement new precautions if needed.

Repeated falls may suggest:

• the original care plan was inadequate;
• staff were not following the plan;
• the facility failed to learn from prior incidents;
• medication side effects were ignored;
• supervision was inadequate;
• toileting needs were not addressed;
• or the facility was understaffed.

A facility should not simply document each fall and move on. The question is what changed after each fall to prevent the next one.

Unwitnessed Falls

Many serious nursing home falls are unwitnessed. Staff may say the resident was “found on the floor.” That explanation raises additional questions.

Unwitnessed falls may indicate:

• inadequate supervision;
• failure to conduct required checks;
• failure to use alarms;
• failure to respond to call lights;
• unsafe room placement;
• poor staffing;
• or failure to follow the care plan.

An unwitnessed fall does not automatically prove neglect, but it should prompt careful review of monitoring records, room checks, alarms, staffing, call-light response times, and the resident’s known risks.

Facility Explanations That Deserve Scrutiny

Families are often given short explanations after a fall. Some may be accurate. Others may be incomplete.

Common explanations include:

• “She was found on the floor.”
• “He tried to get up by himself.”
• “She forgot to call for help.”
• “He is just a fall risk.”
• “Falls happen at this age.”
• “Nobody saw what happened.”
• “She was fine earlier.”
• “It was unavoidable.”

These explanations should not end the inquiry. A resident being a known fall risk is exactly why a facility must use reasonable fall precautions. A resident with dementia forgetting to call for help is exactly why the facility should not rely only on the resident’s memory or judgment.

Evidence That Matters in a Nursing Home Fall Case

Fall cases often depend on facility records, witness accounts, medical records, and the family’s observations.

Important evidence may include:

• fall-risk assessments;
• care plans;
• nursing notes;
• incident reports;
• witness statements;
• photographs of the room or injury;
• hospital records;
• ambulance records;
• imaging reports;
• medication records;
• therapy notes;
• call-light logs;
• alarm records;
• room-check records;
• staffing records;
• caregiver assignment sheets;
• physician notifications;
• family notifications;
• prior fall records;
• facility policies;
• and complaint history.

Families should also preserve photographs, text messages, emails, voicemails, notes from conversations, and any written explanations from the facility.

What Families Should Do After a Nursing Home Fall

If a loved one suffers a serious fall in a nursing home or care facility, consider taking these steps:

1. Get medical attention. Head injuries, hip fractures, internal injuries, and brain bleeds may not be obvious immediately.
2. Ask what happened. Ask who witnessed the fall, where it happened, when it happened, and what the resident was doing.
3. Ask what precautions were in place before the fall. Was the resident on a fall-risk plan? Did the care plan require assistance, alarms, supervision, or toileting support?
4. Ask what changed after the fall. The facility should reassess the resident and update precautions when needed.
5. Take photographs. Photograph injuries, the bed, the room, footwear, wheelchair, bathroom, floor, call-light location, and anything else that may matter.
6. Write down a timeline. Include prior falls, changes in condition, medication changes, family complaints, and facility explanations.
7. Request records. Relevant records may include incident reports, care plans, fall-risk assessments, nursing notes, and hospital records.
8. Speak with an attorney promptly.

Early review can help preserve evidence and evaluate whether the fall was preventable.

When a Fall Causes Death

Falls can be fatal, especially for elderly residents with dementia, frailty, blood thinner use, head trauma, or serious medical conditions.

A fatal fall case may involve:

• a fall from bed;
• a fall during transfer;
• a fall while toileting;
• an unwitnessed fall;
• a fall after prior warnings;
• a fall after repeated prior falls;
• delayed medical evaluation;
• failure to send the resident to the hospital;
• or failure to notify family or physicians.

When a fall causes death, families may have wrongful death and survival claims. The investigation should examine not only the immediate injury, but also what the facility knew before the fall and whether reasonable precautions were in place.

Contact The Mason Firm

The Mason Firm represents residents and families in serious nursing home abuse, elder neglect, assisted living negligence, memory care negligence, fall injury, and wrongful death cases throughout California.

The firm has handled elder neglect claims, including a confidential elder neglect settlement involving the death of a 78-year-old resident with dementia who fell from bed, suffered a head injury, and later died. Past results do not guarantee future outcomes. Every case is different.

If your loved one suffered a serious fall in a nursing home, assisted living facility, memory care facility, or residential care facility, contact The Mason Firm for a free case review.

Call 858-444-5256 or contact us online to speak with a San Diego nursing home abuse lawyer.