Focus: Falling at the care home

Focus: Falling at the care home

Senior woman to use walking frame in a sunny parkWhilst many care homes are fully staffed, with amazing and caring employees, unfortunately, some fall short of the expected mark.  Care homes in financial difficulties may be under-resourced and understaffed, leaving their residents at risk of harm, injury and placing other residents at risk.

Elderly, vulnerable or frail residents in a care home are generally at high risk of falling.

Falls can, of course, occur for a wide variety of reasons including: poor mental cognition, cognitive impairment, poor eyesight, weak muscles, poor mobility, cardiac irregularities causing dizziness, high or low blood pressure (causing dizziness or fainting spells), imbalance perhaps due to arthritis or a stroke, as well as certain medications which may increase the risk of falling.

However, with proper care and supervision, residents who are known to be prone to falling, or who are at a greater risk of falling, should not be left unsupervised or allowed to mobilise on their own.  It’s all about risk assessment and prevention.

Medical conditions such as Parkinson’s disease or a stroke, are known to put individuals at greater risk due to poor balance, muscle weakness, sensory loss and involuntary movements (resulting from medication).

If coming out of hospital, the care home should be notified of any perceived or known risk of falling, so that the care home can take preventative measures immediately to assess and minimise the risk of injury.

Alternatively, when an individual enters a care home environment for the first time, the care home should carry out a Falls Risk Assessment in any event as a matter of standard good practice, to assess multiple factors, such as:

  • the frequency and number of falls, say, in the last 3 to 12 months;
  • what medication is being taken (e.g. sedatives, anti-depressants, diuretics, anti-hypertensives, hypnotics);
  • whether there are any psychological factors (such as anxiety, depression, lack of co-operation, insight or judgment into their mobility);
  • the level of their cognitive status;
  • whether they have dizziness/postural hyper-tension or other factors/recent changes in their functional status and/or medications which might affect their mobility (or anticipated mobility).
  • their vision;
  • whether they need assistance with transfers;
  • whether their behaviours exhibit signs of agitation, confusion or disorientation;
  • whether they are compliant or non-compliant with instructions;
  • whether their footwear is safe and appropriate;
  • whether they are able to use mobility aids safely;
  • their environment should be assessed and whether they have difficulties orientating around their environment e.g. getting between the bed and the bathroom;
  • nutritional needs – whether or not they are underweight or have a low appetite; for example, low sugar levels may cause dizziness and imbalance;
  • continence needs – whether or not they have any known urgency needs, as that may prompt them to get up quickly and more prone to falling.

All these factors should then form part of your relative’s Care Plan.

The Care Plan is a daily tool that should be frequently reviewed and reassessed to ensure that the care home staff are fully cognisant of your relative’s needs and their risk of falling.

Falls, especially with elderly and vulnerable residents can lead to significant long term injuries which may be difficult to treat or cure, and can in turn lead to further medical complications.

Often, physical injuries from falls will result in soft tissue injuries and extensive bruising, head injuries or fractured wrists, arms or hips.

Psychologically, a nasty fall can be a real shock to the system. Falling can cause a marked loss of confidence, making the individual more nervous and cautious, and generally anxious about being left alone for fear of falling again. They may become more reticent to go out (even if accompanied). A loss of confidence can dramatically affect their independence.

The risk of falling is based on the Falls Risk Assessment Tool (FRAT) which is used by healthcare professionals to identify patients at risk aged 65 and over.

Prevention is clearly better than cure.  If you know or suspect that your relative is at a high risk of falling, then you will need to ensure that any Falls Risk Assessment and Care Plan is actively monitored, reviewed and strictly implemented to reduce the risk of your relative falling.

In some instances, bed rails may need to be fitted to the side of the bed, or a crash mat placed around the bed, to protect an individual from injury.

We often hear of residents in care homes being neglected, and being left to wander around unsupervised or mobilise independently, when they should have a carer with them to assist with their mobility needs.

Our top tips:

  • If a proper risk assessment has not been carried out or is not being implemented, ask the care home manager why?
  • If you see that your relative is repeatedly falling, then you must question why and how the care home have allowed such neglect to occur. Has there been negligence?
  • Ask to see the existing Falls Risk Assessment(s) and insist that the care home revisit this immediately (if they have not done so) and implement better protective measures.
  • Raise any concerns you have with the care home manager. Don’t wait for an inevitable accident to happen, as it could be too late.

Daily Telegraph “More older people dying from injuries caused by falls

Was the title of an article in the Daily Telegraph on 2nd May 2019. Research shows that more than 5,000 older people died due to a fall in 2017.

We believe that such tragedies in a care home environment should be entirely avoidable with adequate monitoring, risk assessment, supervision and care.

Look at your relative’s care needs and assess whether the care home have adequate staffing and preventative measures in place to prevent your relative from falling.

The care home should keep a detailed entry of every time an individual has fallen.  However, as we know from experience, a lot of care home notes can be sketchy, inaccurate, incomplete or misleading. Some staff may try to protect their job by underplaying the fall and making light of it, or perhaps not mentioning it to the family at all!

Unfortunately, many falls tend to go unsupervised, which means there are no witnesses to the fall, and no staff around that should have been in close attendance monitoring and supervising your relative.  Had there been, arguably the fall could have been prevented.

It is important that the care home records accurately record the nature and frequency of falls. Each time your relative falls, check the care home records to see, if and how, it has been recorded in their daily records, and to ensure that the circumstances and injuries are consistent with the facts. Good record keeping is essential, and may equally prove a decisive factor in determining whether your relative meets the criteria for NHS Continuing Healthcare Funding at a Full Assessment.

For further information, read our blogs: June’s feature on flawed CHC assessments and the importance of good record keeping.

Set out below is a description of the different levels of need, under the ‘Mobility’ Domain in Decision Support Tool (DST), ranging from ‘no’ needs to ‘severe’ needs for an individual who is completely immobile.  However, if the care home records are incomplete, then that could seriously jeopardise your relative’s chances of getting fully-funded NHS Continuing Healthcare Funding (ie FREE care) for all their healthcare needs.

5. Mobility

Description  

Level of need

 

Independently mobile  

No needs

 

Able to weight bear but needs some assistance and/or requires mobility equipment for daily living. Low

 

Not able to consistently weight bear.

OR

Completely unable to weight bear but is able to assist or cooperate with transfers and/or repositioning.

OR

In one position (bed or chair) for the majority of time but is able to cooperate and assist carers or care workers.

OR

At moderate risk of falls (as evidenced in a falls history or risk assessment)

Moderate

 

Completely unable to weight bear and is unable to assist or cooperate with transfers and/or repositioning.

OR

Due to risk of physical harm or loss of muscle tone or pain on movement needs careful positioning and is unable to cooperate.

OR

At a high risk of falls (as evidenced in a falls history and risk assessment).

OR

Involuntary spasms or contractures placing the individual or others at risk.

 

High

 

Completely immobile and/or clinical condition such that, in either case, on movement or transfer there is a high risk of serious physical harm and where the positioning is critical. Severe

 

Conclusion:

If your relative has fallen at a care home and you believe that the care home have been neglectful, then we recommend that you take the matter up immediately with the care home manager and insist on a full investigation. Accidents can happen, but they can have life-changing consequences. Families are too often cautious about making waves whilst their relative is still receiving care. But we take the view that any fall is one fall too many.

We would like to hear from you if your relative has fallen in a care home and you suspect fault. Tell us what followed and what the outcome of your complaint was.

6 Comments

  1. Hi Julie
    My father died as a result of his 25th fall in under 8 months in 2017. I blame health professionals, Social Services and NHS for this as his healthcare needs were never properly assessed. My mother was similarly neglected in 2016 when she spent 100 days in hospital. After my father’s sad demise I researched and fought for a proper assessment for my mother against the neglect, indifference and incompetence of health professionals. We finally got CHC for my mother in a great nursing home and she enjoyed her last two years without one single stay in hospital despite having the same prevailing health circumstances and required necessary interventions. Costs were £28k per year NHS CHC in the nursing home but a hospital bed is minimum £400 per day so minimum £40k cost to NHS in 2016. The “Health Professionals” therefore wasted circa £12k of taxpayers money in neglecting to properly assess my mother’s care in late 2015/early 2016. Won’t talk about the costs relating to my father but his involved “Health Professionals” I hold responsible for his death.
    You must log everything about your step mum and put in writing your demands for reassessment for her. Demand to be there when it happens and prior to this demand to see her Falls Risk Assessment and mobility assessment. It sounds as though your step mum needs constantly assisted mobility and you should demand this until a reassessment is completed. Good luck!

    • Dianne Taylor 3 months ago

      Hello Richard,I hope you can help me?
      My local hospital is treating my mother following 2 consecutive falls at home last week. They have carried out various “ medical” tests but when I enquire about what is happening, all they have told me in a week is that “ They are looking into safeguarding!!!
      I expect them to threaten me when I tell them I want her to spend her final days at home.
      She is 96, has later stage Alzheimer’s and other issues. I have POA for both health and finance but they don,t seem to be listening at all.
      My adage is, she can fall anywhere ( home or nursing home) but it is her wish to remain at home and as her daughter I am just carrying out her wishes. How do I make them listen to me?
      Thank you Dianne Taylor

      • Catherine Clarke 2 months ago

        In my experience ‘safe guarding’ is set in place against the carer/realtive to protect the patient. Safe guarding is not designed against professionals. My husband was safe guarded against me due to docotors mistaken belief I was out to harm him. This resulted in the NHS completely ignoring my concerns re my husbands welfare/ treatment. Safe guarding as far as I am concerned contributed towards my husbands death. What is sauce for the goose is sauce for the gander – and the law needs to change re safe guarding. Additionally when ever I spoke about POA, my husband was always deemed to have mental capacity – even though he was often delusional. In other words, when it suited professionals my husband had capacity – they were not able to see how vulnerable he actually was. Record what is said meticulously.

  2. Dianne Taylor 3 months ago

    My mother is 96 living at home with help from carer 4 x per day.
    Recently diagnosed with a condition called C V.I.Blood not pumping from the heart to the veins in the legs causing Chronic pain & blood to “ pool” in her ankles. Not curable at her age, so prescribed VERY strong pain relief. She has now had 2 falls within as many days with bumps on the head and a very black eye socket, yet, the GP did not see fit despite being asked by me why this is not a primary health need and would not fast track. She was returned to hospital this morning and I have been told by the hospital that they are concerned for here safety and are to regard this as a “ safeguarding issue”.
    Are the hospital really going to hold the GP/ Nurses accountable? I don,t think they will despite what they might think. NHS all stick together no matter HOW wrong they are just to protect budgets!!

  3. Julie 3 months ago

    My step mum who has dementia and is almost blind, has had over 20 falls in the nursing home since January. A couple of falls have resulted in paramedics being called and one trip to A&E, many are not witnessed by staff as they do not have sufficient staff to monitor her closely and she is a wanderer! We don’t always get told about them at the time they happen, it’s just mentioned when I notice bruises on her arms hands and head! CHC say it’s not their issue…. and are so far behind with the assessments here,it’s well over 15 months since the last one. I’ve called numerous times to ask but keep getting fobbed off!

    • Michael Clarke 3 weeks ago

      Julie I am in a similar situation with my dad. Have you made any progress with your case?
      Michael

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