Slips and Falls in Nursing Homes: Who’s Responsible?

When thinking about a slip and fall injury, you might envision an able-bodied adult slipping on a wet store floor, falling on ice-covered pavement or tripping down poorly maintained stairs. Yet among all age demographics, the elderly population experiences a high percentage of slip and fall injuries, including those in a nursing home or other care setting.

Unfortunately, slip and fall cases in a nursing home aren’t always straightforward. Facilities have an obligation to patients and visitors to keep a safe, clutter-free space but they also have a duty to provide patients with treatment and devices suited to their condition.

Added to these factors, medications and irreversible conditions may also increase a resident’s risk of experiencing a slip and fall. Within this gray area, a facility looking to cover up negligence or insufficient care may place part of the responsibility on the resident.

Falls Among the Elderly

Nursing homes care for some of society’s most vulnerable individuals and, regardless of the source, a slip and fall can be devastating. Many residents live with osteoporosis and a slip and fall injury could result in a fractured hip, wrist or arm, or severe back and neck injuries. In certain cases, complications from a hip fracture don’t just reduce a patient’s mobility – they can be fatal.

Seniors may also experience head trauma or a traumatic brain injury, soft tissue damage or internal bleeding. Delayed wound healing and skin changes draw out the recovery process, resulting in additional complications.

If your loved one experiences a slip and fall injury in a nursing home, facilities accepting Medicare and Medicaid must abide by Standard of Care protocols, including providing an environment free of trip hazards and appropriate care and mobility devices in relation to a resident’s physical condition. Keeping these points in mind, here’s what to know about these accidents in nursing homes.

How Frequent Are Slip and Falls?

The Centers for Disease Control and Prevention (CDC) has reported that the typical nursing home with 100 beds sees up to 200 reported falls annually. It’s assumed that facilities experience additional unreported cases.

Each year, as many as 1,800 nursing home residents die from a slip or fall related injury, while others live with a permanently debilitating condition as a result. Among common causes the CDC has identified are:

Assessing a Resident’s Health and Risk

Nursing home intake procedures involve assessing each resident for an individualized care plan. These assessments factor in their physical condition and health, in relation to their safety, mobility and risk of slip and fall injuries.

These assessments examine each patient’s strength and balance issues, mobility limitations and visual impairments and must factor in medications with side effects related to balance and drowsiness. Other issues, including dementia and Alzheimer’s and the care needed, are integral to a resident’s individualized care plan.

In considering these factors, a facility examines and establishes each patient’s fall risk. From here, the patient must be:

• Supplied with a walker or similarly adequate mobility aid
• Given a bed, chair and toilet height in relation to their abilities
• Provided with cushioned surfaces, rails and grab bars for stabilization throughout their daily activities
• Never left alone outside of their bed
• Provided with assistance during transfers – for instance, from a bed to a wheelchair or to the bathroom to bathe
• Equipped with chairs and bed alarms that help notify staff and prevent residents from falling

However, several factors may be glossed over during this process, preventing the patient from receiving the assistance they need:

• The home doesn’t thoroughly assess the resident during the intake stage
• The facility doesn’t provide appropriate or safe equipment
• The home offers a plan but, due to understaffing or organization, care workers fail to adhere to all recommendations or don’t consistently implement them on a day-to-day basis
• Staff fail to offer proper assistance to patients getting out of bed, including in transfers, in bathing or providing the appropriate degree of restraint
• A resident’s needs change due to age, health or injury, but the facility does not review its care plan or provide them with the mobility equipment needed
• The patient’s muscle and ambulatory issues are not addressed through physical or occupational therapy
• Patients experiencing bone loss issues are not given medications to address bone density

With these factors in mind, certain patients have higher slip and fall risks than others, including those:

The Facility’s Design

Although the intake assessment helps with evaluating a resident’s slip and fall risks, a nursing home has a duty to all patients and any staff and visitors to maintain a hazard-free environment. For residents and staff members, the following factors increase the risk of slip and fall injuries on the facility’s premises:

• Weather-related issues
• Layout issues involving floor texture, level and composition
• Lighting
• Leaving debris and objects in the middle of a hallway
• Not establishing a schedule for residents in terms of bathing and toileting, which increases the risk they’ll attempt these tasks themselves
• Ignoring or not providing bed alarms
• Not equipping beds with rails, especially for patients with a habit of wandering
• Not adding wedge cushions or padding to a wheelchair or bed, increasing risk of slipping out
• Having slippery floors
• Leaving out trip hazards, including electrical cables and medical equipment
• Not providing ramps or handrails, especially on stairs and walkways
• Improperly cleaning the facility, leaving puddles of water or fluid in areas where residents may walk
• Having staff members without the physical strength attempt to transfer a resident by themselves
• Not providing proper training to employees
• Not being watchful of all residents, especially as they get out of a shower or finish toileting
• Over-medicating residents to make them more compliant, without providing sufficient assistance for mobility

Should a patient fall, it’s the nursing home’s responsibility to record the incident on the Minimum Data Set (MDS). This data is then reported to the federal government.

What Is a Nursing Home’s Liability?

Due to the factors detailed above, liability when a slip and fall injury occurs in a nursing home is not always cut and dried. Responsibility can be placed on the home and its staff for issues related to the intake procedure, patient care and future modifications, monitoring residents, equipment, its hiring and training practices, and its approach to maintenance.

Certain injuries, particularly related to a resident’s evolving health, may not be avoidable and these instances create a gray area where the home pushes the blame onto the resident, instead of addressing its processes and staffing. Common instances include:

• A resident with a history of refusing to use a call button for help or attempting to do things themselves
• The progression of dementia and Alzheimer’s
• Pre-existing conditions not discussed during the intake process
• Mental health issues
• Medication side effects affecting a patient’s central nervous system or alertness

Did your loved one slip and fall in a nursing home, only for the facility to claim their health or behavior was behind the incident? Don’t accept these life-threatening injuries as an inevitable part of aging. To hold the facility accountable for varying degrees of negligence, reach out to Trantolo & Trantolo’s nursing home attorneys today with your claim.