What Family Should Know About Prevention, Warning Signs & Their Rights

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Sep 21, 2026

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Falls in Nursing Homes: What Families Should Know About Prevention, Warning Signs and Their Rights

For many families, moving a parent into a nursing home comes with a quiet sense of relief. Someone will be there around the clock. Meals, medications and help with bathing are taken care of. The worry about a fall in an empty house at night finally eases.

Then the phone rings. Mom was found on the floor beside her bed. Dad slipped in the bathroom and has a broken hip. The staff say these things happen. Sometimes they do. But falls in care facilities are also one of the clearest windows into whether a resident is being properly supervised, and families who understand the rules are much better placed to protect the person they love.

How often falls happen in nursing homes

Falls are a serious risk for every older adult. The Centers for Disease Control and Prevention reports that about one in four Americans aged 65 and older falls each year, and falls are the leading cause of injury and injury-related death in that age group.1

In nursing homes the numbers are higher still. The Agency for Healthcare Research and Quality estimates that between half and three quarters of nursing home residents fall each year, roughly twice the rate of older adults living in the community.2 Residents are frailer, often have dementia, take more medications that affect balance, and may need help simply getting to the bathroom. That is exactly why facilities are expected to plan for fall risk rather than react to it.

What nursing homes are required to do

Nursing homes that accept Medicare or Medicaid must meet federal standards set out in the Nursing Home Reform Act and its regulations. One of those rules requires each facility to keep the resident environment as free of accident hazards as possible, and to make sure every resident receives adequate supervision and assistance devices to prevent accidents.3

In practice, that means a resident's fall risk should be assessed on admission and whenever their condition changes, and the findings should be written into a personalized care plan. Depending on the person, that plan might include help with every transfer, a bed set low to the floor, a bed or chair alarm, scheduled toileting, non-slip footwear, a review of sedating medications, or physical therapy to build strength. Families have the right to see that care plan and to take part in the meetings where it is reviewed.

When a fall may point to neglect

Not every fall is someone's fault. A resident who is steady on their feet can still trip, and no facility can promise that falls will never happen. The question is whether the facility did what it reasonably should have done for that particular resident.

Warning signs that deserve a closer look include repeated falls without any change to the care plan, a fall after a resident was left unattended despite being assessed as needing help, wet floors, poor lighting or cluttered hallways, call bells that go unanswered for long periods, and staffing that seems too thin to manage the residents on the unit. Falls rarely happen in isolation, either. Unexplained bruises, new pressure sores, weight loss, dehydration, or a sudden change in mood or alertness can all be signs that a resident is not getting the attention they need.

Understanding where the line sits between an accident and negligence can be difficult for families, especially while a parent is in pain or recovering in hospital. Law firms that handle nursing home negligence cases explain how the law treats falls, bedsores, medication errors and understaffing, which can help families decide whether a situation calls for questions or for formal action.

What to do after a fall

First, make sure your loved one is being assessed and treated. A fall that looks minor can hide a fracture or a head injury, particularly in residents on blood thinners. Ask whether a doctor has examined them and whether imaging was done.

Next, ask for information in writing. Request the facility's account of what happened, when your parent was last checked, and what changes will be made to the care plan. Write down the names of staff you speak with and the date of each conversation. Take photographs of any injuries and of the room if you notice hazards. You are also entitled to request copies of your parent's medical records.

If you are not satisfied with the facility's response, there are outside places to turn. In Pennsylvania, complaints about nursing homes can be made to the Department of Health, which licenses and inspects facilities, and the Long-Term Care Ombudsman Program, run through the Department of Aging, advocates for residents free of charge.4 Nationally, the Care Compare tool on Medicare.gov lets families see a facility's inspection results, staffing levels and quality ratings.5

Know the deadlines

Families often wait, hoping things will improve or not wanting to upset staff who care for their parent every day. That instinct is understandable, but legal claims have time limits. In Pennsylvania, most personal injury claims, including those arising from nursing home negligence, must generally be filed within two years.6 Gathering records and speaking with an attorney early keeps options open, even if the family ultimately decides not to pursue a claim.

Choosing and monitoring a facility

The best protection is attention. Before choosing a nursing home, look at its inspection history and ask how it manages fall risk, how many aides are on each shift, and how quickly call bells are answered. After a move, visit at different times of day, including evenings and weekends, when staffing is often thinnest. Get to know the nurses and aides by name. Attend care plan meetings and ask what has changed since the last one.

Most nursing home staff work hard in difficult conditions, and most want the same thing families do. But residents who have someone watching out for them tend to receive better care. A family that asks questions, keeps records and knows its rights gives a parent the best chance of staying safe, steady and well looked after.

References

  1. Centers for Disease Control and Prevention. Older Adult Fall Prevention: Facts About Falls. Atlanta: CDC.

  2. Agency for Healthcare Research and Quality. The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities. Rockville, MD: AHRQ.

  3. 42 C.F.R. § 483.25(d), Requirements for Long Term Care Facilities: Accidents.

  4. Pennsylvania Department of Aging, Long-Term Care Ombudsman Program; Pennsylvania Department of Health, Division of Nursing Care Facilities.

  5. Centers for Medicare & Medicaid Services. Care Compare, Medicare.gov.

  6. 42 Pa. C.S. § 5524 (Pennsylvania two-year limitation period for personal injury actions).

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Retirement, an interstate move, a new medical diagnosis, death of a spouse, changing care needs, or concern about future incapacity can all be useful times for a legal review.Can an elder law attorney help when a parent develops dementia?An attorney can help families understand legal issues involving existing powers of attorney, estate planning, financial authority, guardianship, conservatorship, and related planning. The available options depend significantly on the individual's capacity and existing documents.Does Medicare pay for long-term assisted living or nursing care?Medicare and Medicaid have different purposes and eligibility rules. Families should not assume Medicare will cover ongoing custodial long-term care. Medicaid may help eligible individuals with certain long-term care expenses, subject to applicable rules.What if my parent already has a will?A will is important, but it generally does not answer every question that can arise during incapacity. Families should also consider whether appropriate financial and health care decision-making documents are current.A Practical Checklist for Treasure Valley FamiliesYou do not have to solve every aging issue at once.Start by gathering:Current estate planning documentsPowers of attorneyHealth care directivesInsurance informationRetirement account informationProperty recordsMajor account statementsLong-term care insurance policiesImportant contact informationA list of medications and health care providers when appropriateThen identify what has changed.Has someone moved? Has health declined? Has a spouse died? Has an appointed agent become unavailable? Is additional care becoming necessary?Those answers can help determine what deserves attention first.Connect With Donna Schuyler Law PLLC Through Seniors Blue BookAging brings changes, but families do not have to wait until every decision becomes urgent.Thoughtful senior legal planning in Idaho can help older adults maintain greater control over their choices while giving caregivers and loved ones clearer direction when help is needed.Donna Schuyler Law PLLC serves Boise and Treasure Valley families with elder law, estate planning, guardianship, conservatorship, probate, and related aging-focused legal matters.To learn more, visit Seniorsbluebook.com or call 208-344-1947.Seniors Blue Book connects seniors, caregivers, families, and professionals with local housing, care, health, and senior-resource providers throughout Boise and the Treasure Valley.