Start with the direct answer
A falls-and-fractures case usually concerns a resident who fell in a care facility and was injured: a fall that no one witnessed, a fall from a bed, wheelchair, or toilet, a fall during a transfer, or a fall by a resident who was supposed to be checked on, assisted, or supervised. Fractures are the injuries families ask about most often, especially hip fractures, but the same review applies to head injuries, wrist and arm fractures, pelvic fractures, and injuries found after an unwitnessed fall.
The investigation compares what the facility knew about the resident before the fall with what it actually did. Relevant questions include whether a fall-risk assessment was completed on admission and after changes in condition, whether the care plan named specific interventions, whether those interventions were in place, whether call lights were answered, whether bed or chair alarms were working and responded to, and whether staffing on that shift could deliver the supervision the plan required.
The decisive legal question is rarely whether the resident fell. Lawyers and reviewers generally examine whether the facility's assessment, care planning, supervision, or post-fall response fell below the applicable standard of care and whether that failure caused or worsened the injury. Those questions require a patient-specific review of the records, and the rules, deadlines, and expert requirements vary by state.
State falls and fractures guides
Each published state guide covers that state's deadlines, presuit or expert procedure, and care-oversight system for a possible preventable fall or fracture in a nursing home or other care facility.
What to do first
- For a new injury, severe pain, deformity, head strike, or sudden confusion, call 911 or insist on an emergency evaluation, and write down when the fall happened or when the resident was found.
- Request records from every involved setting: the nursing home or care facility, the hospital, radiology, the surgeon or orthopedist, rehabilitation, and any therapy provider.
- Preserve the family's own materials: photographs of injuries and of the room, the names of staff and witnesses, call logs, portal messages, and any written explanation the facility provided.
- Write a timeline before memories blur, covering the resident's condition before the fall, earlier falls or near-falls, complaints the family made, the fall itself, and everything the facility did afterward. Label estimates as estimates.
- Ask a lawyer licensed in the state where the care occurred to evaluate deadlines, expert requirements, responsible parties, and whether the records support a preventable-fall claim.
Why falls happen in care facilities
Many falls trace back to a risk that was never fully assessed. A resident may arrive with a history of falls, weakness, confusion, dementia, poor balance, low blood pressure on standing, vision problems, or medications that cause dizziness or sedation. If the admission assessment understates that risk, or if no one updates the assessment after a first fall, a new medication, an illness, or a decline in mobility, the care plan built on it will not protect the resident.
Other falls happen because the plan existed on paper but was not followed. Interventions such as assisted toileting rounds, a low bed, a bed or chair alarm, non-skid footwear, a walker within reach, increased checks, or one-to-one supervision only work when staff carry them out on every shift. Understaffing, agency staff unfamiliar with the resident, unanswered call lights, and alarms that are turned off, unplugged, or ignored are recurring themes when families reconstruct a fall.
Medications and environment matter too. Sedatives, sleep aids, some blood-pressure medicines, and other drugs can increase dizziness and fall risk, and a fall that follows a medication change deserves a close look at the medication record. Wet floors, clutter, poor lighting, broken handrails, beds left at a high position, and wheelchairs without footrests or locked brakes create hazards that federal guidance expects facilities to identify and correct.
What happens after the fall is part of the case, not an afterthought. A careful post-fall response usually includes checking for injury and pain, vital signs and neurological checks where indicated, notifying the physician and the family, arranging imaging or transfer when symptoms warrant it, documenting what was found, and reassessing the care plan so the same fall does not happen again. A resident described as uninjured who is later found to have a fracture, or a facility that cannot produce a coherent post-fall record, raises questions that the chart should be able to answer.
The evidence map
- Incident and accident reports: the facility's own account of the fall, including when it was found, who responded, what the resident said, and what was done next; ask whether the version given to the family matches the written report.
- Fall-risk assessments: admission, quarterly, and change-of-condition assessments showing the risk level the facility assigned and when it was last updated.
- The care plan: the specific interventions the facility chose for this resident, such as toileting rounds, alarms, supervision level, assistive devices, and therapy, so actual practice can be compared with the plan.
- MDS assessments: the federally required resident assessment records, which capture mobility, cognition, prior falls, and care needs and can be compared with the facility's other records.
- Staffing records: assignments and schedules for the relevant shifts, which show whether the supervision and assistance in the care plan could realistically be delivered.
- Alarm and call-light information: bed and chair alarm logs, maintenance records, and call-light response information, where the facility keeps them, bearing on whether alarms were in place, working, and answered.
- Post-fall notes and monitoring: nursing notes after the fall, pain and injury checks, vital signs, neurological observations, physician and family notifications, and any change to the care plan.
- Imaging and hospital records: X-ray, CT, and hospital records identifying the fracture or other injury, when it was diagnosed, and what treatment followed, including surgery and rehabilitation records.
- Medication records: the medication-administration record around the fall, especially recent starts, dose changes, sedatives, and as-needed medicines that can affect balance and alertness.
Find legal help in the right area
The relevant lawyer usually needs to evaluate the state where the care occurred, not simply the family's home address. Medical-malpractice and nursing-home rules, presuit requirements, expert qualifications, damages rules, defendants, government notice provisions, and limitation periods vary by state. Senior Justice Help can collect the care setting, city, state, approximate date, injury, and contact information and forward the request for an appropriate attorney review. A connection is not a promise that a lawyer will accept the matter.
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Written by: Senior Justice Help Editorial Team, Family questions and nursing home records research team
Pages are written for families, checked against public agency sources, and reviewed for clarity, sourcing, and overclaiming. The site does not provide medical advice or legal advice.