Sept. 22 2025 | Resident Falls
Resident falls can be devastating to the residents, their family, and facility staff. One out of every five falls results in serious injury such as broken bones or head injury. Each year, three million older people are treated in emergency departments for injuries related to falling, and falls are the number one cause of traumatic brain injuries.
Resident falls remain the most frequent liability claim in both assisted living (53%) and skilled nursing facilities (37.6%). It’s no wonder, given the fact that residents residing in these care settings typically experience lower mobility, balance concerns, hearing loss, and cognitive impairment.
According to the 2024 CNA Aging Services Professional Liability Claims Report, assisted livings continue having a higher portion of falls claims when compared to skilled nursing facilities, however payouts remain high in both sectors. Closed claims for falls averaged just over $267,000 for assisted livings and $228,000 for skilled nursing facilities.
The report attributes resident falls as the primary claim not only due to resident health decline but also staffing shortages and staff not adequately trained in fall prevention measures.
Residents with dementia experienced an increased percentage of falls when compared to the 2021 dataset (from 62.2% to 70.4%). This increase resulted in fall claims involving residents with dementia sitting at about $246,500 when compared to almost $232,000 in 2021.
Residents with dementia experience an altered awareness of their surroundings along with a more pronounced impairment in balance that contributes to increased number of falls in this population. To add, residents with dementia have difficulty recalling circumstances of the fall and related injuries, making it difficult for staff to plan for prevention measures.
Claims involving resident falls can create challenges for the facility’s defensibility. Likewise, falls can lead to reputational downfall and in some cases severe financial harm to the facility, let alone the negative outcomes to the residents.
The CNA report includes recommendations for facility leadership and staff to minimize falls. Those risk management recommendations include:
FALL RISK ASSESSMENT/EVALUATION AND INTERVENTION
Perform and document fall risk assessments/evaluations upon admission, quarterly, post-fall, and with a change in condition. Review fall risk at daily meetings including reviews of any incidents, the resident’s record, care/service plan, and effectiveness of any interventions already in place. Track fall trends, include CMS measures (for skilled nursing), and hold regular quality assurance/performance improvement meetings where fall-related performance improvement plans are addressed.
CARE/SERVICE PLANNING
Address and document fall risk in each resident’s care/service plan. Include resident-specific interventions, and train staff to implement those interventions. Consider interdisciplinary interventions when developing fall prevention plans.
DOCUMENTATION
Document resident and family teaching. If the resident chooses not to follow recommendations, be sure to document that choice in the resident’s record with notation that the resident and family were advised of the potential consequences of that decision. Reinforce best practices with clinical documentation through ongoing education, training, and peer-review auditing.
COMMUNICATION
Create a work environment that includes team huddles when a resident’s clinical condition warrants further evaluation. Communicate with providers and families when there is a fall. Avoid delays in care and transfers to higher levels of care when clinical change in condition indicates the need.
EXPECTATIONS MANAGEMENT
Educate staff on communication strategies aimed at eliciting, acknowledging, and managing realistic resident and family expectations, including fall management.
TRAINING AND EDUCATION
Implement competency-based training on safe resident handling upon hire, following incidents, and at least annually thereafter, including safe use of mechanical lifts.
INCIDENT REPORTING AND INVESTIGATION
Ensure incident reports are completed timely and thoroughly, contain objective information, and are reviewed by leadership for adequacy and compliance with the facility’s policies and procedures. Promptly investigate and conduct a root cause analysis, and based upon findings, construct action plans.
Incident data should be tracked, trended, analyzed, and monitored to determine outcomes of interventions.
For additional resources and strategies related to falls, access the CNA Carefully Speaking publication entitled, “Resident Falls: A Collaborative Strategy for Risk Mitigation.”
WHCA will continue with this series on liability claims and payouts; next month’s article will focus on resident abuse claims.