Nursing Home Falls in Rhode Island
A practical guide to fall risks, supervision, prevention, post-fall assessment, repeated falls, care-plan changes, major injuries, and when a fall may raise concerns about nursing home care.
Why do nursing home residents fall?
Nursing home residents often have multiple fall risks at the same time. Common contributing factors include:
- Muscle weakness or poor balance.
- Dementia or impaired judgment.
- Recent hospitalization or illness.
- Medication side effects.
- Low blood pressure or dizziness.
- Urgent toileting needs.
- Unsafe footwear.
- Poor vision.
- Environmental hazards.
- Improperly fitted wheelchairs, walkers or other equipment.
- Transfers attempted without needed help.
What should a nursing home do to reduce fall risk?
CMS requires nursing homes to keep the resident environment as free from avoidable accident hazards as possible and to provide adequate supervision and assistive devices to help prevent accidents. CMS guidance under F689 emphasizes identifying risks, evaluating them, implementing interventions, monitoring whether they work, and changing the plan when needed. citeturn140155search24
Fall prevention may include:
- Fall-risk assessments.
- Appropriate footwear.
- Safe bed and chair positioning.
- Toileting schedules.
- Grab bars and assistive devices.
- Physical or occupational therapy.
- Medication review.
- Clear pathways and adequate lighting.
- Supervision during transfers.
- Two-person assistance when clinically required.
Supervision and assistive devices
A resident who needs assistance should not be expected to wait indefinitely or attempt an unsafe transfer alone. Staff should understand the resident's current transfer status and use required equipment or assistance.
Examples of preventable situations may include:
- A resident known to need two-person assistance being transferred by one person.
- A call light repeatedly going unanswered until the resident tries to toilet alone.
- A wheelchair with unsafe brakes or footrests.
- A resident with repeated falls receiving no reassessment.
- Failure to use a prescribed walker or transfer device.
What should happen after a nursing home fall?
After a fall, the resident should be assessed for injury and for possible changes in condition. Depending on the circumstances, the response may include neurological monitoring, physician notification, imaging, hospital transfer, pain assessment, and review of medications or vital signs.
What families should ask after a fall
- When and where did the fall occur?
- Was anyone present?
- What was the resident trying to do?
- Was the resident supposed to have assistance?
- What injuries were found?
- Was a physician or practitioner notified?
- Was the family notified promptly?
- Was the resident sent for imaging or hospital evaluation?
- Was the fall-risk assessment updated?
- What changes were made to the care plan?
Repeated falls deserve closer review
A single fall may occur despite appropriate precautions. Repeated falls are different because they create opportunities for the facility to reassess and modify interventions.
Families should ask whether earlier falls led to:
- A new fall-risk assessment.
- Medication review.
- Therapy evaluation.
- Changes in transfer assistance.
- Environmental modifications.
- More frequent toileting assistance.
- Additional supervision.
If the same fall pattern continues without meaningful reassessment, the concern may be less about the individual fall and more about whether the facility responded appropriately to known risk.
Falls with major injury
CMS tracks the percentage of long-stay residents who experience one or more falls with major injury as a quality measure. CMS identifies falls with major injury as an important resident-safety outcome because they can result in new physical limitations, disability and other serious consequences. citeturn140155search0turn140155search6
Major injuries can include fractures, joint dislocations, closed head injuries with altered consciousness, and other serious injuries defined in CMS reporting guidance.
Hip fractures and head injuries
Falls can be especially serious when they result in hip fractures or head injuries. Residents taking anticoagulants or with osteoporosis may be at elevated risk for complications.
After a serious fall, families should preserve hospital records, imaging results, transfer documentation, and the nursing home's fall and care-plan records.
Questions families should ask about fall prevention
- What is the resident's current fall-risk status?
- What assistance is required for transfers?
- Does the resident require one-person or two-person assistance?
- What devices should staff use?
- How often is fall risk reassessed?
- What changed after the last fall?
- Are medications contributing to dizziness or sedation?
- Does the resident need more frequent toileting assistance?
- Are staff consistently following the care plan?
When might a fall indicate inadequate care?
A fall may deserve closer investigation when:
- The resident was left without required supervision.
- The facility ignored known fall risks.
- Required transfer assistance was not provided.
- A needed assistive device was unavailable or defective.
- Staff failed to respond to repeated call lights.
- The resident had several earlier falls without meaningful care-plan changes.
- Staff accounts of the incident are inconsistent.
- The resident's injury was not assessed promptly.
These factors do not automatically establish neglect, but they may justify requesting records and asking the facility for a detailed explanation.
For broader safety patterns, see our Warning Signs of Nursing Home Neglect guide and Rhode Island Nursing Home Abuse & Neglect Resource Center.
Staffing and falls
Falls can sometimes be related to staffing if residents are unable to obtain timely assistance with transfers, toileting or mobility. Staffing numbers alone do not prove causation, but they can be relevant context.
See our Rhode Island Nursing Home Staffing Comparison guide for ways to evaluate staffing levels and our Rhode Island Nursing Home Complaint guide if a serious concern remains unresolved.