Falls & Restraints
Preventing Falls in Nursing Homes
As I discussed in my why falls happen article, nursing homes know from all the studies that residents have a much higher risk of falling and a much higher rate of injury. Therefore, a nursing home should assume all residents at admission are a fall risk, evaluate the risk, and create fall prevention program. This is what is known in legal terms as the “standard of care” and is one of the essential elements of proving a nursing home negligence case to a jury. It simply means what the nursing home should have been doing. In fact, the federal law that regulates nursing homes [OBRA 1987] requires periodic assessments meant to identify residents at high risk for falling.
How Nursing Homes Evaluate Fall Risk
Often the nursing staff screens incoming residents for fall risks and many tools exist for working through the assessment. Because most nursing homes take Medicare and Medicaid patients, they are required to use what is known as the MDS (minimum data set). This process is a comprehensive assessment of each resident’s functional capabilities and helps nursing home staff identify health problems. They cover most of the common risk factors for falls. See my article: Nursing Home Falls - How they happen) for more information.
Once someone has been identified as a fall risk, either at admission or after a fall has occurred (a prior fall is usually a good indicator of fall risk!), the nursing home should perform an in-depth, comprehensive assessment. There are two main sources of policies on how nurses should evaluate fall risk: the MDS resident assessment protocol and the American Geriatrics Society’s clinical guidelines for falls. Both of these are obviously authoritative sources for your nursing home attorney to find standards of care in your case.
A thorough fall assessment should include all of the following:
- history of fall circumstances
- medications - some medications can disorient, cause vertigo, etc.
- acute & chronic medical problems
- mobility levels
- vision test
- walking test
- legs joint function exam
- neurological examination
- cardiovascular exam - because blood pressure problems can make people faint
Preventing Nursing Home Falls
Restraints
Up until recent times, it was common for nursing homes to use restraints such as harnesses, belts, and bedrails to prevent falls by physically restraining a resident. Before the 1987 OBRA legislation, it was very common to see them used. The federal law now requires that only a doctor may prescribe their use. And they should never be used or ordered when staffing levels are low or as “punishment.”
Fall Alert Systems
Many nursing homes are now using alert systems now that they are forbidden by law from using restraints. Typically these are electronic devices which notify staff when the resident tries to get out of bed or walk unassisted. There are all kinds of devices out there such as ankle bracelets that go off when a leg gets vertical (getting out of bed), tether cords attached to a wall that break away when the resident gets up, pressure sensitive pads on the bed that sense when someone gets up, and infra-red beams that detect when someone walks through them. These are but a few.
But What About Non-Preventable Falls?
Some falls are not preventable and not every fall is negligence. So if a home cannot prevent the fall, can it help break the fall and/or limit the injuries? There are trial going on right now over in Europe where companies are testing protective floor pads and protective garments like football players wear to protect their hips from hits.
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GEORGIA RESOURCES
- Georgia Council on Aging
- Georgia Council of Community Ombudsmen
- Georgia Office of Regulatory Services: Long-Term Care
- Georgia's Long Term-Care Ombudsmen Program
[...] when they assessed the patient as a fall risk and made him wear an alarm - an acceptable method of preventing falls in a nursing home. But that is about the extent of what they did right. Speculating, the staff not responding to [...]