It probably comes as no surprise that falls are the number one cause of injury for seniors, the leading cause of hospital admissions for nursing home residents, and the top issue prompting facility lawsuits. The average facility fall-related cost is $17,000.00. Half of all residents fall annually and 1 in 3 of those who fall will fall two or more times in a year. Reducing falls begins with strong assessment skills that identify the most critical individual risk factors which require intervention. Are you evaluating these top risk factors contributing to your resident’s falls? [1]

483.25(d) Accidents, F 689 Free of Accident Hazards/Supervision/Devices states the facility must ensure that the resident environment remains as free of accident hazards as is possible”; and that “each resident receives adequate supervision and assistance devices to prevent accidents”. [2] The intent of this requirement is to ensure that the facility provides an environment that is free from accident hazards over which the facility has control, and provides supervision and assistive devices to each resident to prevent avoidable accidents. Facility responsibilities include these key areas:

      • Identifying hazard(s) and risk(s);
      • Evaluating and analyzing hazard(s) and risk(s);
      • Implementing interventions to reduce hazard(s) and risk(s); and
      • Monitoring for effectiveness and modifying interventions when necessary.


The Most Common Causes of Nursing Home Falls

Many factors potentially contribute to falling. The goal of the evidence-based fall prevention program is to mitigate risk factors to prevent as many falls as possible. Some of the most common individual risk factors include: [3]


Intrinsic Factors Extrinsic Factors
•       Lower body weakness & poor grip strength

•       Gait and balance deficits

•       Cognitive impairment

•       Visual deficits

•       Vitamin D deficiency

•       Medications

•       Foot pain or poor footwear

•       Wheelchair fit

•       History of falls

•       Chronic conditions


•       Use of assistive devices

•       Poor wheelchair fit

•       Environmental hazards

•       Lighting

•       Clutter

•       Uneven/wet floors

•       Unstable furniture

•       Furniture placement

•       Call light

•       Inaccessible personal items

•       Hard to manage clothing



Most falls are caused by a combination of risk factors with the more risk factors a person has, the greater their chances of falling. Effective falls prevention programs have systems in place to identify and objectively measure an individual’s risks through an assessment process with protocols to reduce relevant fall risk factors through targeted interventions. This means that every fall prevention care plan will not look the same.


Take a Step Toward Improving Fall Prevention & Management in 2022

It takes an interdisciplinary team to implement a fall management program. It takes ongoing educational opportunities to provide the interdisciplinary team with the new ideas and diverse alternatives that will help them implement a successful fall management program.


Make plans to join us February 2, 2022 for the first webinar in the Wining the Fall Prevention Battle webinar series: Assessing Fall Risk Using Evidence Based Practice. In this session, we will review the components of an effective fall risk assessment and assist the facility in ensuring they are identifying the intrinsic and extrinsic risk factors that most commonly contribute to falls.  Examples of tools will be explored to guide the facility staff in analyzing common risk factors as a first step in the goal of implementing the most effective interventions to prevent falls.  Learn more and register


Amie Martin OTR/L, CHC, RAC-CT, MJ

Learn more about the rest of the Proactive team.