Falls are a significant safety concern within long-term care facilities. Approximately 50% to 75% of individuals residing in nursing homes experience a fall each year, a rate more than double that of older adults living in the community. These incidents frequently lead to severe consequences; about one in ten falls results in a serious injury, and falls contribute to roughly 1,800 deaths annually among residents. Understanding the specific locations where these incidents occur is fundamental to implementing targeted preventative measures.
The Primary Locations of Falls: Resident Rooms
The majority of falls in nursing homes take place within the resident’s room; some data suggests up to 81% of falls that cause injury happen here. This high frequency is primarily due to unsupervised transfers. Getting in and out of bed or rising from a chair are high-risk moments when a resident attempts mobility without assistance.
The bed area is a central hazard, especially when beds are set too high, complicating safe entry and exit. Residents may fall while reaching for personal items or navigating the space around the bed while affected by muscle weakness or medication side effects. These movements are often spurred by a wish to maintain independence when staffing coverage is lower, such as at night.
The bathroom and toilet area within the room presents a second, highly specific hazard zone. This small, confined space requires complex maneuvers, especially for residents using mobility aids. Falls here are frequently linked to environmental factors such as wet, slippery floors and the difficulty of quickly transferring onto or off the toilet.
The need for prompt toileting assistance is a major trigger for unsafe, rushed movements that result in a fall. Poor lighting, particularly at night, challenges residents with impaired vision or cognitive decline. Navigating the distance between the bed and the bathroom in low visibility substantially adds to the fall risk.
Risk Factors in Transitional Spaces and Common Areas
While resident rooms account for the most falls, transitional spaces and common areas also present distinct hazards. Falls in hallways and corridors are often attributed to environmental factors, estimated to be a contributing cause in 16% to 27% of all nursing home falls. These areas are characterized by high traffic, which increases the likelihood of encountering misplaced objects or temporary obstructions.
Common issues in hallways include clutter, such as maintenance equipment or temporary medical carts, which obstruct pathways and create tripping hazards. Changes in flooring materials or the presence of unsecured rugs can destabilize a resident’s gait. Inadequate lighting, or lighting that creates confusing shadows, makes it difficult for residents to perceive environmental risks and navigate safely.
Dining rooms and activity spaces are other locations where falls frequently occur, often due to the density of furniture and the potential for spills. Residents maneuvering wheelchairs, walkers, or canes around tables and chairs are at risk of collision or entanglement. Spilled food or beverages create slippery surfaces that staff may not clean immediately, leading to slips.
These public areas involve dynamic movement and social interaction, which can distract residents from focusing on their balance and environment. Falls here are often related to temporary environmental hazards and the navigation of a complex, shared space, rather than the intrinsic risks of transferring in a private room.
Location-Specific Mitigation Strategies
Targeting prevention efforts to the specific location of the fall is an effective strategy for risk reduction. In the resident’s room, intervention focuses heavily on the bed and transfer areas. Maintaining the bed at its lowest possible setting, or utilizing specialized low-profile beds, reduces the distance and potential impact should a fall occur during exit.
For residents at high risk, bed exit alarms can immediately alert staff when a person attempts to get out of bed unassisted, enabling a prompt response. Additionally, ensuring that the wheels of all furniture, especially the bed, are locked when stationary eliminates the risk of equipment rolling away during a transfer.
Within the bathroom, interventions focus on stabilizing the environment and managing urgency. Installing grab bars around the toilet and shower provides necessary support for transfers and maneuvering in the tight space. Using non-slip mats and promptly addressing wet floors are essential environmental controls to mitigate slip hazards.
For transitional spaces, facility-wide protocols are implemented to manage the environment. This includes rigorous adherence to policies that keep hallways and corridors free of clutter, especially during high-traffic times like shift changes or mealtimes. Improving lighting throughout the facility, particularly in dimly lit corridors and stairwells, ensures residents can clearly see their path and any potential obstacles.