Falls in Nursing Homes — the Scale of the Problem

Falls are the leading cause of injury in nursing home residents, and one of the most preventable. The Centers for Disease Control and Prevention estimates that nursing home residents experience 1–3 falls per bed per year — a rate far higher than the general elderly population. In Texas, falls are among the most common triggers for both CMS citations and nursing home negligence lawsuits.

Not every fall is evidence of neglect. Some residents have such severe balance, cognitive, or neurological impairment that falls may occur despite optimal care. But when a resident falls because the facility failed to implement appropriate fall prevention measures — or ignored known risks — that fall is evidence of negligence and the facility is liable for resulting harm.

🚨 Falls can be fatal

Hip fractures caused by falls are a leading cause of death in elderly nursing home residents. Head injuries from falls can cause subdural haematomas that are fatal if not promptly diagnosed. If your loved one has fallen and sustained a significant injury, seek immediate medical evaluation and report to DFPS at 1-800-458-9858.

Why Falls Happen in Nursing Homes

  • Inadequate supervision — high-fall-risk residents left unattended or without bed alarms, chair alarms, or floor mats
  • Understaffing — when staff cannot respond to call lights quickly, residents attempt to get up unassisted
  • Medication side effects — sedatives, antihypertensives, and diuretics are common fall-risk medications; failure to monitor and adjust is negligent
  • Environmental hazards — wet floors, poor lighting, cluttered hallways, improperly adjusted beds or wheelchairs
  • Failure to use assistive equipment — not providing walkers, canes, or non-slip footwear to residents who need them
  • Inadequate fall risk assessment — failing to reassess risk after a health change, hospitalisation, or medication change

What the Nursing Home Must Do

Federal regulations (42 CFR §483.25) require facilities to ensure each resident receives adequate supervision and assistance to prevent accidents. For fall prevention specifically, the standard of care requires:

  • Conduct a fall risk assessment on admission and after any significant change in condition
  • Implement an individualised fall prevention care plan for all at-risk residents
  • Use bed and chair alarms for residents with impulsive or unsteady mobility
  • Provide non-slip footwear and appropriate assistive devices
  • Review and adjust medications that increase fall risk
  • Ensure the environment is free from hazards — adequate lighting, clear pathways, properly adjusted equipment
  • Respond promptly to call lights — most falls occur when residents attempt to get up without waiting for assistance
  • After every fall, conduct a root cause analysis and update the care plan to prevent recurrence

When Is a Fall Evidence of Neglect?

A fall may be evidence of nursing home negligence when:

  • No fall risk assessment was conducted or documented on admission
  • The resident had a documented fall history and no adequate prevention plan was in place
  • The resident had previously fallen at the facility and the care plan was not updated to prevent recurrence
  • Environmental hazards contributed to the fall — wet floors, poor lighting, inappropriate footwear
  • The resident was taking high-fall-risk medications without documented monitoring or adjustment
  • The resident called for help and no one responded before they attempted to get up independently
  • Staffing records show the unit was understaffed on the day of the fall

Warning Signs of Fall Risk Neglect

  • A history of falls at the facility with no apparent care plan changes
  • Call lights taking more than 5–10 minutes to be answered
  • Resident wearing socks without non-slip soles
  • Resident reporting that they have to get up alone because "no one comes"
  • Bed or chair alarms not in use for a resident with unsteady gait
  • Staff unable to name the resident's fall risk level or prevention plan when asked

Did a nursing home fall cause serious injury in Texas?

Hip fractures, head injuries, and fall-related deaths are among the most common and strongest nursing home negligence cases in Texas. A free attorney consultation can tell you whether the facility's failure caused your loved one's injury.

When a nursing home fall results from negligence, the facility may be liable for:

  • Medical expenses — hospitalisation, surgery, rehabilitation
  • Pain and suffering damages
  • Wrongful death damages if the fall was fatal
  • Punitive damages in cases of gross negligence — for example, a facility that repeatedly failed to implement fall prevention despite prior falls and regulatory warnings

Texas nursing home negligence claims must be filed within 2 years of the date of injury. Consult an attorney promptly — medical records, incident reports, and staffing logs are critical evidence and may be more difficult to obtain over time.

Frequently Asked Questions

Yes — in fact, a known fall risk creates a heightened duty of care. The facility must implement a care plan specifically designed for that resident's risk level. A fall that results from failure to implement appropriate precautions for a known high-risk resident is strong evidence of negligence.
A resident's refusal of certain interventions may be relevant, but does not automatically eliminate the facility's liability. The facility must document the refusal, explore alternative preventive measures, and continue to monitor the resident's safety. A cognitively impaired resident who "refuses" safety measures may lack the capacity to make that decision — the facility retains a duty to protect them.
CMS health inspection reports list fall-related citations, which are publicly available on Medicare's Care Compare. Our Texas directory also shows citation and penalty history. An attorney can obtain the facility's complete internal fall incident reports through legal discovery — a pattern of falls with inadequate corrective action is powerful evidence of systemic negligence.