Why Nursing Home Falls Are a Life and Death Matter

Taking a fall is something that can happen to any of us. A slick floor, an uneven surface, a missed step—and suddenly, you’re on the ground.

Many falls are brushed off as embarrassing but harmless. But even a seemingly “routine” fall can cause serious injuries, including traumatic brain injuries and broken bones. For older adults, the risks are far higher. And nursing home falls—where residents fall at roughly twice the rate of seniors living independently—a fall can be a life-and-death event.

Falls are the leading cause of fatal injury among adults age 65 and older, with the majority of fatal falls involving people over 75. A single fall also doubles a person’s risk of falling again. In nursing homes, those repeat falls are not just common. They are a warning sign of inadequate care and a leading basis for nursing home negligence claims.

Anatomy of a (Nursing Home) Fall

Falls are not a “normal” part of aging. Most falls can be prevented. In fact, the CDC considers falls preventable injuries.

In healthcare parlance, a death or serious injury from a patient fall is considered a “never event”—one that medically should not occur when proper safety protocols are in place.

Yet nearly 1 in 10 adverse events experienced by Medicare nursing home residents are falls that result in significant injury.

Falls affect seniors more frequently—and more profoundly—than they do younger people. In addition to age-related physical changes such as weaker muscles, poorer balance, reduced vision and hearing, and slower reflexes, older adults are more likely to suffer from chronic health conditions (e.g. diabetes, heart disease, and arthritis) and medication side effects that are known risk factors for falls.

Falls are a serious injury risk for all older adults. Each year, there are approximately 3 million emergency department visits and 1 million hospitalizations due to older people falling. About one-third of falls cause an injury that requires medical treatment or activity restrictions. And falling once doubles the chances of falling again.

Falling is itself a risk factor for falls, in other words. Even if an initial fall does not cause injury, a senior who falls may become afraid of falling, and this fear may cause them to cut down on everyday activities, leading them to feel depressed and become less active and weaker—further fall risk factors.

Over half of nursing home residents fall every year, which is about double the incidence reported among community-dwelling older adults. Residents who survive falls often sustain hip fractures and head injuries that result in permanent disability and reduced quality of life. But while the first fall at a nursing home may not be injurious or deadly, the next one might be.

• Around 2,000 nursing home residents die from fall-related injuries each year. The average is around 2.5 falls per resident, per year. Even these numbers may understate the scope of the problem, however, because many nursing home falls go unreported.
• According to a 2025 review from the Department of Health & Human Services, nursing homes failed to report 43 percent of falls with major injury and hospitalization among Medicare-enrolled residents, as legally required by federal regulations.

Why would a nursing home fail to report a fall, at the risk of penalties, denial of payments, and loss of funding? It could be an attempt to conceal poor care—and a sign of negligence.

Repeated falls are one of the most common reasons for nursing home malpractice claims, and the average cost of these claims is increasing.

A recent claims report from CNA Insurance found that more than 59% of fall-related closed claim allegations in the skilled nursing (i.e., nursing home) assisted living setting involved a resident with a prior history of falls. Claims in which there was a history of a previous fall are more costly than those with no prior history of falls, the report also found.

Risk Factors for Nursing Home Falls

Nursing home falls, and efforts to prevent them, have been extensively studied for decades.

Health professionals typically divide fall-related risk factors into two broad categories:

• Individual resident factors, such as physical limitations, cognitive impairment, chronic medical conditions, and the side effects of certain medications.
• External, facility-related factors, which reflect how a nursing home identifies, manages, and responds to fall risks; what’s sometimes referred to as the facility’s culture of safety.

Facility-related risk factors are especially important in nursing homes because residents live in a controlled environment and rely on staff for supervision and assistance. These external factors can include cluttered hallways or rooms, inadequate lighting, insufficient staffing levels, limited staff training on fall prevention, an improper mix of nursing skills, and a lack of resources to support safe mobility and physical activity.

Failures in these areas often surface in nursing home lawsuits. In the CNA Insurance survey, 51% of settled claims alleged improper care, 44% involved a failure to monitor, and 5% cited an unsafe environment.

Importantly, these claims indicate not just a single negligent incident, but a systemic breakdown in assessment, supervision, and response.

How a facility approaches safety on a day-to-day basis matters. A fall by itself is not always proof of negligence. But research consistently shows that nursing homes with stronger safety cultures have lower rates of adverse events, including falls.

Experts also emphasize the importance of resident-specific fall risk assessments, and not just relying solely on facility-wide policies.

Residents with a history of prior falls are known to be at higher risk and may require closer monitoring or additional precautions.

But even without a documented fall history, certain conditions—such as dementia, balance disorders, or the use of specific medications—can signal the need for targeted fall prevention strategies.

Recommended interventions may include:

• Staff education on fall risk reduction
• Exercise programs shown to improve balance and strength
• Efforts to reduce environmental hazards, such as decluttering walkways
• Ensuring appropriate bed and chair heights using assistive technology

Effective fall prevention programs should be tailored to each resident and account for factors like fall history, medications, cognitive status, mobility, environmental risks, and the use of safety technologies such as bed alarms or low-bed positioning.

Individualized fall prevention programs are designed to address what safety experts describe as a dangerous assumption in long-term care: that falls are inevitable and not necessarily preventable.

How to Tell If a Nursing Home Resident Has Fallen

Not every nursing home fall is witnessed or promptly reported—or reported at all. Families might only find out something is wrong by noticing changes in a loved one’s condition and not through a formal incident report.

Warning signs of a possible fall include:

• Unexplained bruises, cuts, swelling, or fractures
• Head injuries or new complaints of pain
• Sudden difficulty standing, walking, or moving from a bed to a chair or wheelchair
• Increased use of a wheelchair or mobility aids
• Confusion, agitation, withdrawal, or fear of movement
• Torn clothing or bloodstains on bedding

Communication red flags may include:

• Vague or inconsistent explanations from staff
• Delays in notifying family members
• Missing or incomplete incident reports

When warning signs go unanswered or explanations don’t add up, families should raise concerns with nursing home staff—and, if necessary, speak with an injury attorney to understand their options.

Graham Law’s Nursing Home Negligence Attorneys

Families are right to ask questions after signs of injury appear, whether there is a clear, documented explanation or not.

An injury report can be an important piece of evidence in a nursing home negligence claim, but it may not tell the full story. Addressing concerns early, both with the nursing home and with a nursing home injury lawyer at Graham Law, can increase accountability and, in the most serious cases, make the difference between life and death.