According to the Centers for Disease Control and Prevention, falls are the leading cause of injury among older adults in the United States, and many occur in long-term care facilities where residents already face elevated risks.
Facilities routinely perform fall-risk assessments to identify residents who may be vulnerable—but these evaluations do not always prevent injuries. In many cases, fall-risk assessments fail because staff do not properly follow care plans, reassess residents after health changes, or implement the safety measures recommended by the assessment.
At Beausay & Nichols Law Firm, our attorneys represent families in complex medical malpractice and catastrophic injury cases, including nursing home negligence. With over 40 years of combined trial experience, we’ve seen how preventable falls can lead to devastating injuries such as brain trauma, hip fractures, and loss of independence. When facilities fail to evaluate or monitor residents properly, the consequences can be life-altering.
Understanding why fall-risk assessments often fail elderly residents can help families recognize warning signs and protect their loved ones. In this blog, we’ll explain how fall-risk assessments are supposed to work, why they sometimes fail to protect vulnerable residents, and what warning signs families should watch for when visiting loved ones in nursing homes.
What Are Fall-Risk Assessments in Nursing Homes?
Fall-risk assessments are designed to identify residents who are more likely to fall so facilities can take preventive action.
Healthcare providers typically evaluate factors such as:
- Mobility and balance
- Medication side effects
- Cognitive impairment
- Prior fall history
- Vision or neurological conditions
Many nursing homes use structured tools, such as the Morse Fall Scale, or similar clinical screening methods, to categorize residents by risk level. These tools are meant to guide care plans and safety interventions.
The Biggest Reason Why Fall-Risk Assessments Often Fail Elderly Residents: Assessments Are Not Updated Often Enough
Fall-risk evaluations should not be a one-time event—they must be ongoing and triggered by specific events. Yet some facilities fail to reassess residents after major health changes, leaving outdated care plans in place. The Agency for Healthcare Research and Quality notes that fall-prevention programs require ongoing reassessment and monitoring to remain effective.
When reassessments do not happen, a resident may be treated as low risk even after their condition worsens.
1. After any significant change in condition
Federal nursing home regulations require facilities to reassess residents when there is a “significant change” in physical or mental status, such as illness, medication changes, injury, or functional decline. This reassessment must occur within 14 days of the change.
Examples of changes that should trigger a new fall-risk assessment include:
- New medications (especially sedatives or blood pressure drugs)
- Hospitalization or return from the hospital
- Infections or acute illness
- Declining mobility or weakness
- Cognitive changes such as confusion or delirium
- A previous fall
2. After every fall
Clinical fall-prevention guidance recommends reassessing risk immediately after each fall, as prior falls are among the strongest predictors of future falls.
Facilities should review:
- What caused the fall
- Whether the care plan was followed
- Whether new safety measures are needed
3. At regular scheduled intervals
Nursing homes must also perform comprehensive resident assessments at least every 12 months, with quarterly updates to track changes in health and functioning.
Because fall risk is closely tied to mobility, medications, and cognitive status, these periodic assessments typically include a review of fall risk.
Staffing Shortages Can Undermine Fall Prevention
Even when assessments correctly identify fall risks, facilities must have adequate staff to carry out safety measures.
Unfortunately, many nursing homes struggle with staffing shortages. Residents who need assistance getting out of bed, walking to the bathroom, or transferring to a chair may attempt to move independently if help is delayed.
Without sufficient staffing levels, even a well-designed fall-risk assessment cannot prevent accidents.
Care Plans Are Sometimes Ignored
Fall-risk assessments typically generate specific care instructions. These may include:
- Assistance with walking or transfers
- Bed alarms or chair alarms
- Non-slip footwear
- Scheduled bathroom assistance
- Physical therapy or mobility support
But if staff fail to follow the care plan—or if communication between shifts breaks down—the recommended safety measures may never be put into practice.
The Centers for Medicare & Medicaid Services (CMS) requires nursing homes to provide care plans that prevent avoidable accidents and injuries whenever possible. When these care plans are ignored, fall risks remain unaddressed.
Environmental Hazards Are Often Overlooked
A resident’s environment can also contribute to falls. Common hazards include:
- Poor lighting
- Cluttered walkways
- Loose flooring or rugs
- Improper bed height
- Missing grab bars
Facilities must address these hazards as part of a comprehensive fall-prevention strategy.
When Preventable Falls Happen, Families Deserve Answers
Fall-risk assessments are meant to protect vulnerable residents, not simply check a box in a medical chart. When facilities fail to reassess residents after health changes, ignore care plans, or overlook environmental hazards, the systems designed to prevent injuries can break down.
For families, a serious fall can raise difficult questions: Was the resident properly evaluated? Were safety measures followed? Could the injury have been prevented?
At Beausay & Nichols Law Firm, we help families throughout Ohio investigate situations where nursing home care may have fallen short. Our attorneys focus on complex medical malpractice and catastrophic injury cases, and we understand how to examine medical records, care plans, and facility practices to determine whether negligence played a role.
If your loved one suffered a serious fall in a nursing home and something about the situation doesn’t feel right, speaking with an attorney may help you understand what happened. Contact Beausay & Nichols Law Firm today for a free case evaluation.
