How to Prevent Falls at Home and in the Nursing Home
Injuries from accidental falls suffered by elderly individuals are a growing problem in Ohio and throughout the country.
The cost of fall-related hospital treatment hit $645,000,000.00 in 2009 in the State of Ohio. About 63% of those falls involved hip fractures and 26% of those falls involved traumatic brain injuries. If you are caring for someone who is at risk for falls you must be aware of the fact that any fall for an elderly person can result in not only life-threatening but life-ending injuries.
63% of the falls that occurred in 2009 resulted in hip fractures. That's 63% of all of the falls for all of the people in Ohio according to the Ohio Hospital Association. This is not limited to elderly people. Anyone who suffers a fall is at risk for suffering a fracture. Elderly people are usually at increased risk of injury as their bones are usually more prone to break than someone who is younger. Elderly people who have co-morbidities or other health problems can be at even greater risk. Elderly people with osteoporosis or other problems that make their bones more brittle can be at greater risk for a fracture. Elderly people can also be at greater risk for a fall in the first place.
26% of all the falls that occurred in Ohio in 2009 resulted in a traumatic brain injury. Obviously, a traumatic brain injury would have grave consequences for any person. For an elderly person to suffer a traumatic brain injury would be clearly severe.
Both fractures and brain injuries, carry significant risks for anyone who suffers them. If a fracture must be surgically repaired then the individual must undergo surgery. Surgery can be extremely traumatic for an elderly person. The surgery itself is traumatic and carries with it a certain amount of risk. People hospitalized because of surgery are at an increased risk for infection. The decrease in mobility that a person who has had hip surgery endures, can put a person at increased risk for bed sores, pneumonia, and a host of other complications.
Often, a healthy person, suffers a fall, suffers a fracture, has to go to the hospital for surgery and recovery, is subsequently discharged to a nursing home for a short-term stay of rehabilitation, and during that short-term stay suffers consequences. Often these individuals suffer bed sores. Sometimes these individuals suffer additional falls. The Dickson Firm handled a case where an individual suffered a fall at a nursing home resulting in a traumatic pelvic fracture. That resident was transferred to the hospital where it was determined that surgery was simply too risky and created too great a risk that the resident would not survive so the resident was returned to the nursing home in traction, with a broken pelvis. In this case, the traction was used to hold the person's leg in a certain position in the hopes that that resident's pain would be alleviated and potentially the fracture would begin to heal. The nursing home then allowed the resident to fall out of bed, in traction, and suffer an additional fracture, which ultimately caused that resident's death.
The risk of falling increases significantly as people get older. Falls are the leading cause of injury-related emergency department visits, hospitalizations and death for older Ohioans. If you are admitting someone you love into a nursing home, you must make certain that that nursing home takes fall prevention seriously. Fall prevention is literally a matter of life and death. You should find out what interventions the nursing home uses to prevent falls.
Some nursing homes have eliminated the use of all alarms and sensors as part of their fall prevention program. In the opinion of the attorneys of The Dickson Firm, this is a grave mistake. We realize that some nursing homes are endeavoring to create more of a home-like environment. We realize that many nursing homes are trying hard to look less like hospitals and more like a person's home. These efforts are commendable. The goal of making a nursing home seem more home-like, can be achieved with paint and wallpaper and furnishings and an emphasis on interior design. However, the look of a nursing home must never be more important than the safety of the residents. There is simply no way for the nurses and the aides of a nursing home to properly monitor all of their residents without the use of alarms and sensors. Nursing homes are required by law to provide their residents with adequate supervision to prevent accidents. If a nurse and an aide are responsible for keeping an eye on 20 or 30 residents there is no possible way they can physically watch each of them, particularly at night when the residents are in their rooms in their beds, without the benefit of alarms and sensors.
The use of alarms and sensors helps the nursing home staff provide their residents with adequate supervision. If a resident starts to get up, the alarm or sensor goes off, and alerts the staff to the fact that the resident is starting to get up so that they can respond to that resident, address their needs, and redirect them so that they are safe. It is simply unreasonable to expect an aide to keep an eye on 25 residents in their rooms asleep during the night shift without the benefit of alarms or sensors.
Over the last decade fatal falls have increased 163% for Ohioans 65 years or older. About 964 people in this age group died from falls and 105,000 reported an injury that required a doctor visit or restricted their activity in 2010 according to the State of Ohio Health Department.
Women are more vulnerable to serious injuries as they grow older according to the Hospital Association. In 2010 nearly twice as many women ages 65 to 75 were hospitalized for falls than were men. The ratio more than tripled for women who are 85 and older compared with men.
The use of medication can increase the risk of falls. Drug interactions can cause dizziness, impaired balance or coordination. When someone is recuperating in a nursing home after surgery, they may be on a number of medications to alleviate pain. These same medications may make the resident sleepy or dizzy or disoriented or cause them to lose their balance. Further, the nursing home is obviously an unfamiliar surrounding for a nursing home resident who has not been there before. Nursing home residents may be confused. They often want to go home. They often try to get up and leave the nursing home when they're not supposed to.
However, all of these concerns can be addressed with proper care. If you admit someone to a nursing home it is imperative that you find out about their fall prevention program. Please note that anyone who is recovering from hip surgery in a nursing home is at risk for an additional fall. An additional fall, shortly after a hip surgery, can result in an additional fracture and force that resident to undergo a second risky and complicated surgery. Residents can also be at risk for a dislocation. Residents who are recovering from hip surgery are at increased risk for suffering a hip dislocation where the hip is dislocated from the socket. It can be more difficult to recover from a hip dislocation then it can be to recover from a fracture. In some elderly individuals, a hip dislocation can be permanent. If an elderly individual is older, particularly if they are thin, it may be that there is simply not enough muscle and cartilage to heal once the hip has been dislocated. Therefore, these residents must get significant attention so that they do not suffer a dislocation or a fall.
Elderly individuals who have impaired vision, lack of strength in their legs and lower back, and general physical weakness, are all at increased risk for falls. One way to help a person avoid falls both at home and in a nursing home is to help them stay fit. Movement is almost always a good idea unless the person's doctor advises against it. Physical activity leads to greater flexibility and greater strength and greater balance which should help avoid falls. Proper nutrition can help a person avoid falls short term and long term. Short term, a person who is undernourished, weak or faint, can be at increased risk for falls. Long term, a person who is weak, underdeveloped, or has poor balance can be at increased risk for falls.
A toileting program can be used to prevent falls. If a nursing home can determine why a person is trying to get up and can anticipate their needs, that nursing home can help prevent future falls by anticipating why the resident is trying to get up so they can prevent them from getting up. Nursing Homes should always look into why a resident is trying to get up as part of fall prevention. Do they have to go to the bathroom? Are they hungry? Are they bored? Are they in pain? Are they confused? All of these needs can be - and must be addressed by the nursing home.
Once a person suffers a fall, they may be afraid to get up in the future or to engage in physical activity or to attend social events, all of which can have negative effects for the elderly person. This can lead to decreased physical activity and/or isolation which can have negative physical, mental and emotional consequences.
In your home, make sure you remove hazards such as loose rugs, electrical cords, obstacles in the walkway, wobbly furniture, slippery floors, and any other hazards that may cause a fall. Nursing homes are obligated to provide their residents with a safe environment and to eliminate fall hazards that can cause someone to trip and fall down. Make sure that the area where the elderly person is has adequate lighting both inside and out. Use nightlights in bedrooms, bathrooms and hallways. Make sure that entrances are accessible, particularly in inclement weather. Consider if additional handrails are needed both inside and outside the house. Consider if a stair lift is needed to help the person go from one floor to another. Keep walkways free of seasonal dangers such as slippery leaves, ice and snow.
Encourage your elderly loved one to get an eye exam annually to check for age-related diseases and to make sure their eyeglass prescription or contact prescription is up to date.
Have their doctor or a pharmacist review their medications to ensure there is no potentially dangerous interaction and/or to make sure that the medications are not causing unusual dizziness, drowsiness or disorientation. Monitor your loved one just as the nursing home is obligated to monitor their residents, to make sure that they are not off balance or overly drowsy.
Take care of your loved one's feet, get them checked regularly, make sure that their fingernails and toenails are kept cut, make sure they don't have corns or bunions, make sure they wear shoes with non-skid soles, and make sure laces and straps are secured.
When an elderly person gets up in the morning they should sit on the side of the bed for a few minutes to orient themselves and ensure that their feet are planted firmly on the ground before standing. There are a number of assistance devices that are available. Nursing homes are obligated to provide their residents with the necessary assistance devices to prevent falls. These devices can include walkers, canes, and even poles that can be installed next to the bed to assist the elderly person in hoisting themselves up or lowering themselves down. Lift chairs are available to help an elderly person get up out of a chair and sit down in a chair. Grab bars are also available for assisting elderly people in getting on and off the toilet and/or in and out of the tub. Bars are also available to assist them to position themselves in bed. Walk in showers and tubs are also available.
Make sure that your elderly loved one is not rushed. Make sure they have plenty of time to perform their activities, falls are often caused by rushing.
If you plan to admit your loved one to a nursing home, it is imperative that you find out about the nursing home's fall prevention program. Every new resident to a nursing home is at risk for falls unless they are returning to the nursing home and are fully familiar with it. Any new admit to a nursing home is coming into unfamiliar surroundings, and is obviously unable to care for themselves which is why they are being admitted to the nursing home.
One of the most tragic scenarios is when a family who cares for an elderly resident at home, admits their loved one to a nursing home for short-term respite care while they take a vacation or attend a family event, and that resident suffers an injury during that brief admission. It is imperative, before you admit your loved one to a nursing home, that you check that nursing home out thoroughly. Find out what their fall prevention program is. Find out if they have anything in writing explaining that program so that you can review that material. Find out the reputation for that nursing home.
Read our article about selecting a nursing home for further tips on what you can do to help you pick a proper nursing home for your loved one.
Often the staff at the nursing home either tells the family that the fall was unavoidable or does not tell the family the whole story of the fall. If someone you love is in a nursing home and suffers a fall, even if they are not injured, you must look into the cause of that fall thoroughly with the nursing home. Make sure you meet with the staff immediately. Find out why your loved one fell. Were they supposed to have an alarm or sensor in place? Was that alarm or sensor in place? Find out if they were alone when they fell.
Were they left unattended? If so why? Meet with the Director of Nursing. Find out the names of every nurse and aide involved and write down their names. Talk with them if you can. Often falls occur because residents are left unattended without the benefit of an alarm or sensor which puts them at risk for falling.
If a nursing home resident cannot walk safely on their own, they must not be left unattended without an alarm or sensor. Otherwise, they are able to get up and walk on their own which is not safe. If someone you care about, has suffered a fall in a nursing home, and the nursing home is not willing to answer your questions about the fall, you should take immediate steps to move that resident to a different nursing home. Nursing homes are required by law to immediately notify the resident's physician and the resident's family any time there is a significant change in their condition, including any kind of life-threatening complication, and any time there is an accident.
If someone you love is in a nursing home and they have suffered a fall, make sure you ask the nursing home whether they have ever fallen before. Often nursing homes do not contact family members as they are supposed to to report falls. If your loved one is able to communicate with you effectively, find out if they have had other falls. If someone you love is in a nursing home and they have suffered a fall and you were not contacted, take immediate steps to move that resident to a different nursing home.
If someone you love has been abused or neglected in a nursing home, including suffering a fall, call the attorneys at The Dickson Firm and ask for Blake Dickson. We would be happy to talk with you.