Falls in Hospitals and Nursing Homes: A Family Caregiver’s Prevention Checklist

The call comes at 2 a.m. Your mother got up to use the bathroom in an unfamiliar hospital room, reached for a bed rail that was not where she expected it, and ended up on the floor. She is bruised and shaken. You are left wondering how it happened and whether anyone could have stopped it.

Falls are common, and they are not just a problem at home. The CDC reports that 1 in 4 older adults falls every year. The Agency for Healthcare Research and Quality estimates 700,000 to 1 million hospital falls a year in the United States. It also says close to one-third of them can be prevented.

Care settings add their own risks, and family members are often the first to notice when something is off. Unfamiliar rooms, new medications, bed alarms, and busy shifts all play a part. This guide gives families a checklist to use on the first day, long before anything goes wrong.

Why Patients and Residents Fall

Most falls in care settings have multiple causes. A person who was steady at home can become unsteady within hours of arriving at a hospital or moving into a new room at a care home. The environment changes, the routine changes, and the body is often under stress.

Here are the most common contributors and what families can watch for:

Medication deserves special attention. Pain relievers, sleep aids, and blood pressure drugs can all cause dizziness. Do not change anything on your own. Ask the care team to review the medication list with the patient’s physician.

Families most often miss delirium. A parent who is suddenly confused, agitated, or unusually sleepy may be showing a medical change, not just a bad night. Tell a nurse right away and describe what looks different from normal.

The most predictable cause of all is the bathroom. Many falls happen when a patient tries to walk there alone because they did not want to bother anyone. Older adults often wait too long, then rush. Plan ahead by agreeing on a toileting schedule with the nurse.

Footwear and furniture matter too. Socks without grips, loose slippers, and beds raised too high all make a bad step more likely. So do IV poles and tubing that run across the path to the door. None of this is dramatic, which is exactly why people overlook it.

The Hospital Stay: 8 Questions to Ask on Admission

Hospitals follow fall-prevention routines, but routines work best when families speak up early. On day one, ask the nurse these questions:

1. Was a fall-risk assessment done, and what was the result?
2. Is a bed or chair alarm in use, and is it switched on?
3. Are non-slip socks provided?
4. How often are rounds made, including overnight?
5. Who helps with toileting at night, and how do we call them?
6. Is the call button within easy reach, and has the patient practiced using it?
7. Do any new medications raise the risk of dizziness or confusion?
8. Does the patient need a walker or cane, and where will it be kept?

Write the answers down on paper. Ask again at every shift change, since a note in the chart does not always reach the next nurse. Night shifts deserve extra attention because staffing is thinnest then, and patients are most likely to wake up disoriented. A short list taped inside the room, in plain words, helps anyone who walks in.

Bring the small things that keep a person steady. Glasses, hearing aids, and sturdy closed-back shoes or grip socks all help. Ask whether the bed can stay in its lowest position and whether the bedside table and water are within reach, so your parent doesn’t have to lean or stand to reach them.

Reviews of falls in Chicago hospitals often point to missed risk assessments or delayed help, both of which are easy to spot early if a family knows to ask. Small gaps in the basics are where most trouble starts.

Keep the tone friendly. Nurses are juggling many patients, and a calm, specific request gets a faster response than a complaint. Facilities and families want the same outcome, which is a safe recovery.

Choosing and Monitoring a Nursing Home

A nursing home is a long-term setting, so prevention must be ongoing. It starts before move-in.

Begin with Medicare Care Compare at medicare.gov/care-compare. It lists star ratings, inspection results, and staffing information for certified nursing homes. Use it to compare facilities, then treat the ratings as a starting point, not the final word. Numbers cannot tell you how a hallway feels at 6 p.m.

Next, ask about staffing. How many residents does each aide handle on the day shift, the evening shift, and overnight? Illinois sets minimum staffing ratios, and a facility that falls short must post a notice saying so. That is worth knowing before you sign anything.

Then visit more than once, and at different hours. A tour at 10 a.m. shows the facility at its best. Stop by around dinner, on a weekend, and in the early evening. Notice who answers call lights, how long it takes, and whether hallways are clear of carts and wheelchairs.

Ask what the facility does to prevent falls in general. Good answers include regular physical therapy or strength programs, medication reviews, and a plan for what happens after any fall. Ask how often staff change, too. High turnover means new faces who may not know your parent’s habits.

Ask to read the care plan. It should list the resident’s fall risk, walking aids, toileting schedule, and any alarms. If your parent’s needs change, ask for an updated plan and request a copy.

Finally, stay present. Residents with regular visitors tend to get noticed sooner when something changes. Even a short visit gives you a chance to look at footwear, lighting, and the path to the bathroom. If your parent uses a walker or cane, make sure it’s within reach of the bed or chair, not across the room where it cannot help.

Signs a Fall Was Not Reported

Sometimes a fall happens, and the family hears nothing. Staff may have missed it, or the resident may not remember it or may not want to say. Watch for these quiet signals:

• Unexplained bruises, especially on the hips, arms, or head
• A new limp or favoring one side
• Sudden fear of standing or walking
• Wincing during transfers
• Changes in mood, appetite, or sleep

Do not jump to conclusions. These signs can have other causes, such as a medication change or a minor bump against a bed frame. Most facilities want families to ask.

Try an open question: “I noticed a bruise on Mom’s arm. Can you help me understand what happened?” That invites a real answer without sounding like an accusation. Ask the nurse on duty first, and write down their name, the date, and what they tell you.

If the answer feels vague, ask whether an incident report exists. Then follow up in writing. A short email creates a record and keeps the tone polite. You can say, “Thank you for talking with me today. I want to confirm what we discussed about Dad’s fall on Tuesday night.” Clear dates and names make later conversations easier for everyone involved.

What to Do After a Fall

If a fall does happen, move one step at a time.

1. Have a nurse or doctor check the person. Do not move someone who may be hurt.
2. Request the incident report and ask what the facility believes caused the fall.
3. Ask whether imaging is needed if there is pain, a new limp, or a blow to the head. The physician decides.
4. Photograph visible injuries and the surrounding area, such as the floor, the bed, and the call button.
5. Ask the care team to update the care plan so the same thing does not happen again.
6. Keep a simple log of dates, names, and conversations.

Residents also have rights. The Illinois Nursing Home Care Act says residents must have basic needs, including toileting, met in a timely manner. It also lets residents and their representatives raise grievances without fear of reprisal. Each facility must keep a written grievance process and tell families where to send complaints, including to the Long-Term Care Ombudsman Program.

Share what you learn with the patient’s physician, since a fall can signal a change in health, medication effects, or balance that needs a closer look.

If the response does not feel adequate, you can contact the ombudsman. A lawyer who handles injury cases can also explain your options.

Printable Caregiver Checklist

Falls in care settings are common, but many are preventable. Families who ask early, visit often, and write things down give every resident a better chance of staying safe. Screenshot this list and keep it on your phone.

1. Ask if a fall-risk assessment was completed.
2. Confirm bed or chair alarms are on.
3. Check for non-slip socks and clear floors.
4. Place the call button within easy reach.
5. Ask who assists with night toileting.
6. Review new medications with the care team.
7. Read the care plan and request updates.
8. Visit at different hours.
9. Note any bruises, limps, or mood changes.
10. Ask for the incident report after any fall.

This article is for general information, not legal or medical advice.

AUTHOR BIO: A contributor at Rosenfeld Injury Lawyers, a Chicago team of attorneys that helps people hurt in slip and fall accidents, wrote this article. The team writes about safety in hospitals, care homes, stores, workplaces, and public spaces, and the practical steps families can take soon after an injury. Learn more about their general approach to Illinois injury cases.