Fall Prevention in Skilled Nursing Facilities

The rate of falls at skilled nursing facilities and rehab hospitals is quite high, and most administrators struggle to implement a successful method that can be tracked and monitored with the goal of reducing them.
A single fall with major injury can cascade into a survey citation, a state investigation, and lost census.
Environmental controls and therapeutic intervention are among the ways of helping to ensure fall prevention at skilled nursing facilities.
Fall prevention in hospitals and other healthcare facilities is not successful, in part, because of a lack of intervention adjustments following assessment and because the appropriate rehab equipment is not used.
A 90-day fall prevention reset is recommended to keep fall rates consistently down at your skilled nursing facility or hospital.

One of the most pervasive and persistent problems at skilled nursing facilities is falls. Approximately half, and up to 75% at some facilities of the 1.6 million residents in U.S. skilled nursing facilities fall every year. Facilities average about 1.5 to 2 falls per bed annually, and about one-third of residents who fall will do so two or more times within the year. Facilities average approximately 1.7 falls per bed per year, with a range of 0.6 to 3.6.

Many skilled nursing facilities and rehab hospitals have a fall prevention program on paper, but very few of these healthcare facilities actually know how to successfully implement and monitor policies that actually help to prevent falls among patients or residents.

The High Risk and Severe Consequences of Falls at Skilled Nursing Facilities

Frequent Re-Falls

About one-third of residents who fall will do so again within a year.

Serious Injuries

Approximately 10 percent to 20 percent of all falls result in major trauma, including hip fractures, traumatic brain injuries, and severe lacerations.

Fatality Rates

Falls are the leading cause of injury-related death among older adults, with thousands of U.S. deaths each year linked to fall complications.

Psychological Impact

Even falls without physical injury can cause a severe “fear of falling,” leading residents to voluntarily restrict their movement, which rapidly accelerates muscle weakness and loss of independence.

Components of an Effective Fall Prevention Program at a Skilled Nursing Facility

An effective fall prevention program at a skilled nursing facility must be multi-faceted and patient-centered. Also, it requires comprehensive risk screening, continuous staff education, targeted environmental modifications, and tailored care plans.

Risk Assessment and Care Planning

Standardized Screenings

Conduct a comprehensive fall risk assessment upon admission, or after any change in medical condition, and periodically using validated tools like the Fall Risk Assessment Tool, FRAT.

Multidisciplinary Evaluation

Be sure to include the participation of nurses, as well as physical and occupational therapists, and doctors as you craft a patient care plan.

Medication Reviews

Regularly audit a patient’s medical regimen, especially sedatives, antihypertensives, and diuretics, to minimize side effects such as dizziness or orthostatic hypertension.

Environmental Controls and Equipment Modifications

Keep all patient and resident rooms and corridors free of tripping hazards, such as throw rugs or unnecessary cords.
Ensure that all necessary items like call lights, water, glasses, and phones are consistently within the resident’s reach.
Frequently evaluate, maintain, and adjust wheelchairs, walkers, and canes. Be sure residents are regularly wearing sturdy, non-slip footwear.
Maintain bright, glare-free lighting. Use motion-sensor nightlights in hallways and bathrooms and illuminated light switches that are easy to locate in the dark.
Install continuous, secure handrails on both sides of corridors. Equip all resident bathrooms with ADA-compliant grab bars near toilets and in shower stalls.

It is worth noting that environmental controls have the lowest cost-to-impact ratio of any fall prevention investment.

Therapeutic Intervention

While environmental controls keep frail patients from falling, physical therapy prevents them from becoming frail in the first place.

Strength Training

Strength training can significantly help prevent falls in skilled nursing facilities, as long as it is combined with balance exercises and customized to the resident’s specific level of frailty. Programs that incorporate progressive resistance training improve lower limb strength, gait, and stability.

The most effective fall-prevention routines blend strength training with balance and functional exercises.

Research tells us that exercise interventions should run for a sustained duration, such as six to 12 months, with the strongest evidence supporting three sessions weekly to bring about measurable reductions in fall risk.

Balance Training

Balance training is extremely effective in fall prevention programs at skilled nursing facilities. It works best when combined with strength and functional training that is customized to each resident’s physical capabilities and frailty levels.

One of the main advantages of balance training is improving the body’s natural reflexes. For example, this enables residents to safely adjust their posture or put out an arm to brace themselves if they lose their footing.

What’s more, participating in controlled, supervised movement helps residents to reduce their fear of falling, which can cause seniors to become sedentary and gradually lose their physical abilities.

Gait Training

Gait training is an effective strategy for a fall prevention program at rehab hospitals and skilled nursing facilities. By focusing on strength, stability, and proper walking mechanics, this helps residents maintain functional independence rather than resorting to unnecessary movement restrictions.

Gait training enhances balance and helps the brain and body communicate more effectively, allowing residents to navigate uneven surfaces and transition from sitting to standing safely.

As part of gait training, it is helpful to use assistive devices. This trains residents on how to safely and efficiently use walkers, canes, and gait belts to provide stability during daily movements.

Sit-to-Stand Training

A successful fall prevention program in healthcare facilities is aided by incorporating sit-to-stand training as a therapeutic intervention. By directly targeting the leg strength and core stability required to safely rise from a bed or chair, this training reduces the functional decline that typically leads to falls.

Sit-to-stand training helps to prevent falls in skilled nursing facilities because it promotes task-specific muscle building. Rising from a seated position requires lower-body strength. Repeated sit-to-stand exercises improve the muscle power needed to transition safely.

This form of exercise also brings about better balance and posture. The movement trains the body to shift weight correctly over the base of support, which improves overall stability when a patient or resident begins to walk.

Sit-to-stand exercises also help with fall prevention during physical therapy as it offers the patient increased autonomy. For example, safely transferring between surfaces, such as bed to chair or to different physical therapy equipment, is a critical component of independence and directly limits risky, unassisted movements.

The S2S Standing Frame™ by Therapeutic Industries is a pioneering piece of equipment that transforms into several therapy devices to allow multiple therapies without transferring a patient from one apparatus to another.

Post-Fall Analysis

Root-Cause Meetings

Conduct a multidisciplinary meeting right after a fall to identify the specific cause and determine if the fall was preventable.

Actionable Adjustments

Update the resident’s care plan in real-time to address the particular contributing factors that led to the incident.

Facility Tracking and Quality Improvement

Metrics Monitoring

Track facility-specific Key Performance Indicators, or KPIs, such as the fall rate (number of falls per 1,000 resident days.

Leadership Review

Regularly review collected data to identify high-risk times, locations, or situations across your skilled nursing facility and adjust organizational policies accordingly.

Reasons Why Fall Prevention Programs Fail

The reasons fall prevention programs at skilled nursing facilities fail are chronic understaffing, alarm fatigue, inadequate risk assessment, and poor interdisciplinary communication. Systemic issues like these lead to delayed responses to call lights, inconsistent care plan implementation, and environmental hazards like clutter or wet floors.

Common Breakdowns in Fall Prevention at Skilled Nursing Facilities

Communication Gaps and Inaccurate Assessments

After a patient is labeled a “fall risk,” general interventions such as low beds or mats are typically applied universally. But if a resident’s medical condition changes, these plans are not always updated to address new medications or cognitive decline.

A holistic, team-based approach can only be successful if nursing staff, physical therapists, and attending physicians communicate effectively. A communication gap exists, however, if a resident’s balance or physical therapy improvements go unnoted by floor nurses, which leads to unnecessary continual restrictions.

Staffing Constraints and Workload

Understaffing restricts the time caregivers can spend helping residents, which could prompt patients to attempt unassisted transfers.

When there aren’t enough nurses on staff, call light wait times can increase. Residents who need service, like going to the bathroom, will typically try to get up themselves, and that is a leading cause of falls.

Overreliance on Alarms and Interventions

In many cases, bed and chair alarms are used as “sitters,”; however, excessive alarms create background noise that can lead to staff desensitization. For example, staff may ignore them or respond too late.

What’s more, overly restrictive measures, like using physical restraints or excessive bed alarms, can heighten a resident’s anxiety, agitation, and overall fall risk.