Falls and Fractures

Falls and fractures are among the most common injuries to occur in the nursing home setting. We often handle cases involving falls which result in fractured hips that require surgery, and falls that result in closed head injuries, such as a subdural hematoma or brain bleed, which can be deadly. Falls are one of the leading causes of accidental death in the United States. The majority of falls involve older adults. Almost all nursing home residents are at an increased risk for falls. If a resident is at risk for falls, the nursing home has a duty to implement a plan of care aimed at reducing the risk.

The key issues regarding liability in a fall case are (1) whether the resident was properly assessed for being at risk of falls; and (2) whether appropriate preventive measures were taken to reduce those risks. One fall does not necessarily imply a lack of care or attention, depending upon whether there was notice to the nursing home that the resident was at an increased risk for falling, and whether appropriate preventive measures were taken by the nursing home.

Risk Factors for Falls

The risk factors for falls include:

  1. Age;
  2. Mental status;
  3. Means of elimination;
  4. History of falling within the past 6 months;
  5. Visual impairment;
  6. Confinement to chair or bed;
  7. Low blood pressure;
  8. Gait and balance; and
  9. Medications.

Causes of Falls

The most common causes of falls in the nursing home setting include:

  1. Failure to properly assess the resident’s risks of falling;
  2. Inadequate supervision of the resident (often due to lack of adequate staff);
  3. Hazardous conditions within the nursing home (e.g., slippery or cluttered floors, inadequate lighting, inaccessibility of call lights, improper use of wheelchairs, including locks on wheels, and walkers and canes);
  4. Improper height of beds and use of bed rails; and
  5. Failure to consider the effect of medications which increase fall risks.


Often, the issue of using restraints comes up in fall cases. This is a very controversial issue, and there is, among medical professionals and others, an anti-restraint attitude. Although restraints are still used, one must examine the pros and cons of using restraints and of which types of restraints to use. Their purported usefulness in preventing falls and controlling agitated residents must be weighed against the possibility of restraints causing physical and psychological injuries. A resident may not be restrained because he or she is difficult, or requires considerable attention. Except in an emergency, use of restraints is only appropriate with the requisite documentation and orders from a treating physician. This applies to both physical and chemical (medication use) restraints.

Impact of Falls on the Elderly

Even minor falls can lead to periods of bed rest or reduced activity. Falls that result in greater injuries usually lead to hospitalization. Hip fractures among the elderly can be particularly devastating. Twenty-seven percent of elderly persons who suffer a hip fracture die within one year following the injury. See L.J. Melton & B.L. Riggs, Risk Factors for Injuries After a Fall, One Clin. Geriatric Med, 525-39 (1985). That is why you often hear elderly people refer to a hip fracture as a “death sentence.” Even when the elderly survive a hip fracture, they are usually left with decreased mobility and often require assistive devices to walk thereafter. Falls can cause a loss of confidence and/or fear of future falls, which can also lead to decreased mobility. This lack of mobility can, in turn, lead to other medical complications, such as the development of pressure sores.

If you or someone you love has suffered a fall-related injury while residing in a nursing home, the nursing home neglect lawyers at Suthers & Harper would like to help. For a FREE consultation, please contact us online through our confidential evaluation form or call us toll free at 1.800.320.2384.

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