We have blogged many times on this website about falls, particularly falls that occur in the context of nursing homes and assisted living facilities.

Nursing homes and assisted living facilities are similar, but they are also different. It is actually unclear under the law in Ohio whether or not assisted living facilities are subject to different regulations than are nursing homes. If you look at the definition of a nursing home in the relevant Ohio statutes, there is certainly an argument to be made that an assisted living facility is, in fact, a nursing home and therefore subject to the same regulations.

However, the fact remains that people have different expectations in an assisted living facility. One of the biggest differences is that most people in an assisted living facility are expected to have a certain level of independence. They are expected to be able to move around on their own. Most people in an assisted living facility can get up in the middle of the night and go to the bathroom on their own. Most people in an assisted living facility can eat on their own.

Usually, in an assisted living facility, the staff makes sure that the residents take their medications. The staff makes sure that the residents are eating. However, it is usually not expected that each and every resident in an assisted living facility is going to receive constant supervision from the staff.

In a nursing home, the law requires the nursing home to provide each and every resident with adequate supervision to prevent accidents. This is a federal regulation that applies to all nursing homes in the entire country. In the State of Ohio, there is a body of law known as the Nursing Home Residents Bill of Rights. In that law, nursing homes are legally obligated to provide each and every one of their residents with a safe environment.

Therefore, if someone you love is in a nursing home, and they are at risk for falls, it is imperative that you talk with the Director of Nursing and find out what the plan of care is to keep your loved one safe.

If someone you love has been neglected or abused in a nursing home or in an assisted living facility or any other type of facility, please call us at 1-800 OHIO LAW as we would be happy to talk with you here at The Dickson Firm and help you in any way that we can.

Every single person who is admitted to a nursing home is required to be comprehensively assessed. The nursing home must conduct a comprehensive assessment and based on that comprehensive assessment, must formulate a comprehensive care plan with measurable objectives and timetables. If your loved one is a fall risk, then one of the things that that assessment must determine is, in fact, that your loved one is at risk for falls.

Thereafter, the nursing home must develop a comprehensive care plan, that addresses their risk for falls. The nursing home must endeavor to prevent falls and the nursing home must endeavor to prevent injuries from falls.

A fall out of bed is very different from a fall while walking. If your loved one is at risk for falling out of bed, the nursing home should put your loved one in a bed in the lowest position or even put a mattress on the ground and put a mat near the bed. Then, if your loved one falls out of bed, they will not fall far, and they will be on a mat so they will not suffer injury.

Many people call us and tell us that they asked the nursing home to restrain their loved one to prevent their loved one from falling. While physical restraints are sometimes permitted in a hospital setting or other setting where a person is there for a shorter period of time, physical restraints are usually not implemented in a nursing home. The reason for this is that physical restraints are usually not effective and, in fact, can create a greater risk to the residents.

If someone is in bed and they are likely to try to get out of bed and it is not safe for them to get out of bed and walk on their own, then sometimes family members think that the nursing home should put up the bed rails. The problem with that is that if the person tries to get out of bed, they will climb over the bed rails. Now they are falling from an even higher height and much more likely to suffer injury. In addition, sometimes nursing home residents get their head caught in the bed rail, and they actually strangle.

Sometimes people think that the resident should be physically restrained. However, as the resident tries to get out their restraint, they often strangle. Therefore, neither putting the bed rails up nor physically retraining a person is usually implemented in the nursing home. Instead, as indicated above, if a person is at risk for falling out of bed, then the bed is put in the lowest position, and a mat is placed by the bed.

If your loved one is in assisted living, the real question is, is assisted living appropriate?

Placing a loved one in a nursing home or assisted living facility can be a very difficult decision. As people get older, there are a number of hard decisions that their family has to make. Often the family must make the determination that it is no longer safe for the person to drive and so they have to take their keys away, which is very emotional.

Thereafter, they have to make the very difficult decision to put them in a facility, either an assisted living facility or a nursing home.

Obviously a nursing home gives them less freedom. If a person is in an assisted living facility, they can still maintain a modicum of independence. Many assisted living facilities are set up like small apartments.

The assisted living facility provides the residents with food. But the residents have their own space. Often couples are in assisted living together. However, you must be very honest with yourself about whether or not assisted living is appropriate for your loved one. Can your loved one safely walk around the facility or are they at risk for falls? Can your loved one take themselves to the bathroom at night? Does your loved one have dementia? Does your loved one have Alzheimer's disease? Are they confused? Are they prone to walk out of the facility? If they do walk out of the facility, is it safe for them to be
outside on their own? This is a particularly relevant question during the inclement weather that we are experiencing currently.

Many of our cases involving assisted living facilities involve a situation where the assisted living facility did not perform an adequate assessment of the resident and did not determine that they were an appropriate candidate for assisted living.

Tragically, some assisted living facilities make this determination for financial reasons. They want to keep the resident at heir facilities so they can continue to earn the monthly payment for that resident to be at that facility. It is imperative that family members make the determination as to whether or not an assisted living is appropriate for their lived one. While it certainly may provide additional independence for their loved one, if their loved one is not safe, it is not worth it.

The good news is that falls can be prevented.

As you are talking with the staff at the nursing home where your loved one is a resident or even at the assisted living facility, the facility should provide you with a list of interventions that they are implementing to keep your loved one safe. If your loved one is in a nursing home, and they are at risk for falling, there are a number of things the nursing home can do.

Nursing Homes should use alarms with all residents at risk for falls. There are alarms that can be used when your loved one is in bed or when your loved one is in a chair that will alert the staff if your loved one tries to get up and walk unattended. This is only effective if the nursing home is properly staffed. Nursing homes are required to have an adequate number of properly trained people at their nursing home. They must meet the needs of their resident. If the nursing home has sufficient staff, then they should be able to respond when a fall alarm goes off.

Nursing homes can also use motion detectors and other devices to alert them if somebody is
trying to get up.

Many nursing homes tell people that they cannot use alarms because alarms are restraints. This is absolutely 100% not true. Alarms are not restraints.

The argument is that the alarm startles the resident and, therefore, inhibits their movement. This is a false argument promulgated by the nursing home to justify their failure and use alarms to keep their residents safe. There are many different kind of alarms. Some alarms light a light up over the resident's door. Some alarms can trigger a pager that the nurses wear. Some alarms can send a message to the nurses' station. There are even alarms that, when they go off, they play a recording of the resident's family member's voice. So the resident's daughter can record a message encouraging her mom to sit down. When the resident begins to get up, the recording plays, and the resident hears her daughter encouraging her to sit down and wait for help. The notion that alarms are restraints is simply and unequivocally false and no one who is placing a loved one in a nursing home should accept that claim from any nursing home.

Another way that nursing homes can keep residents safe is by anticipating their needs.

Nursing home residents get up for a finite number of reasons.
- They get up because they are bored.
- They get up because they are hungry.
- They get up from a chair because they are tired and they want to go to bed.
- They get up because they are confused.
- They get up because they have to go to the bathroom.
- They get up because they are in pain.

If the nursing home puts together a plan of care intended to meet their needs, they can anticipate the resident's needs and, therefore, prevent the resident from getting up. If a resident gets up every night at 3:00 in the morning to go to the bathroom, the nursing home can simply place that resident on a toileting schedule and take them to the bathroom every night at 2:30 a.m. and thereby anticipate their needs to get up.

Many older residents have to get up and use the bathroom frequently during the night. If urination is extremely frequent, the resident can be considered for a catheter or some type of protective pad or underwear that they wear. The nursing home must check on them frequently. And the nursing home must make sure they are kept clean and dry. If a resident is wearing some kind of clothing that is meant to absorb when they urinate or they have a bowel movement, that cannot be left on their skin. That resident needs to be cleaned up on a regular basis. If your loved one needs help every time they have to
go to the bathroom, they are probably not a great candidate for assisted living. They probably need to be in a nursing home.

If someone you love has been neglected or abused in a nursing home or in an assisted living facility or any other type of facility, please call us at 1-800 OHIO LAW as we would be happy to talk with you here at The Dickson Firm and help you in any way that we can.