Falls

Falls are a high-volume, high-risk, high-cost challenge for continuing care and aging services organizations. The Centers for Disease Control and Prevention (CDC) estimates that between 50% and 75% of nursing home residents fall every year, and older adults are more likely to sustain injuries after a fall than the rest of the population (CDC "Falls in Nursing Homes").

In addition to the serious injuries and costs associated with falls, continuing and long-term care organizations risk financial consequences if they do not have measures in place in an effort to prevent resident falls. Injuries from falls can result in lawsuits against facilities. Additionally, the Centers for Medicare and Medicaid Services (CMS), as well as state agencies, may impose monetary penalties against organizations that have not established effective measures to manage falls and have one or more residents who are seriously injured or harmed from a fall. Although falls management programs are in place in many facilities, risk managers must ensure that these programs are followed and are effective in managing falls and injuries related to falls.

Risk managers should implement comprehensive falls management programs in all types of aging services settings—ranging from skilled nursing care to independent living to adult day services—although the scope of the program will vary with each setting. This article provides guidance on the following:

Several tools for a falls management program are provided. See Resource List for a list of tools available.

Falls are common, particularly for older adults, both in the community and in healthcare settings. CDC estimates that one in three U.S. adults age 65 or older falls each year (CDC "Important Facts About Falls").

Older adults are more susceptible to falls because many risk factors for falls worsen with age. These include impaired mobility, vision, balance, gait, muscle strength, or cognition; use of multiple medications; and chronic conditions such as arthritis and orthostasis (Tinetti). And once an older adult falls, the individual may develop a fear or falling and become less willing to perform some activities, such as bathing, dressing, and walking (Resnick et al.) Unfortunately, reduced activity may actually increase that person's risk of falling. Environmental hazards such as clutter and poor lighting can also contribute to falls.

Within nursing homes, between 50% and 75% of residents fall each year—twice the rate among older adults living in the community. A typical nursing home with 100 beds reports 100 to 200 falls annually. Many more falls may go unreported, and many residents...