Anyone who has had a loved one in a nursing home knows that feeling of dread when the phone rings early in the morning or late at night. It's never good news.
"I'm sorry -- your mother fell out of bed again and is on her way to the emergency room," the voice at the other end says.
We were lucky. None of my mother's falls resulted in serious injury. But thousands of nursing-home residents aren't so fortunate.
About 1,800 die every year from injuries related to falls, such as traumatic brain injury and broken bones, according to the Centers for Disease Control. Those who survive are often left with permanent disabilities that further reduce their quality of life.
Since my mother fell and broke her hip at home in 2011, she has been wheelchair-bound -- thanks to balance issues and dementia that have prevented her from learning how to walk again. During her three-month nursing-home stint for rehab, she fell three times. In the two years since that she has been living at home with a full-time aide and sleeping in a bed with guard rails, she hasn't fallen at all.
Falls occur at least twice as often in nursing homes than among elderly people living in the community. Nursing homes with 100 beds typically report 100 to 200 falls a year, but many more falls go unreported, the CDC says. As many as half of the nation's 1.5 million nursing-home residents fall at least once every year -- and many fall more than once.
While nursing-home residents generally are frailer than elderly people living at home, conditions at the facilities also contribute to the problem. Chief among them is medication that affects coordination and causes confusion, such as antipsychotics that nursing homes prescribe to make patients more compliant -- although the Nursing Home Reform Act of 1987 expressly forbids the use of "chemical restraints." More than one in five nursing-home patients receive these drugs.
Nursing homes are required by law to perform a fall-risk assessment on every patient -- checking for gait disorders and other problems that predispose patients to falling -- and implement a fall-prevention plan, says Robert Rooth, a Chicago area lawyer who specializes in nursing-home cases. But the plans often consist of a preprinted form that fails to address each individual's issues and needs.
"Nursing homes don't have enough staff to monitor people properly or get them to the toilet," Rooth says. "On a wing of 20 to 30 residents, you typically have one nurse who sits at a nursing station giving out doctor's orders and two to three CNAs [certified nursing assistants] who are the least trained and the least paid, and they have to do everything.
"If there were enough properly trained staff and they really looked at the reasons people are falling, no one would have to fall because it's not rocket science."
Falls often occur because residents try to get to the bathroom by themselves after they ring for help and no one appears. Motion-detector alarms, beds set at a low height and a protective mat placed by the bed can help minimize falls and injuries.
Nursing-home patients should also be given the option of having guard rails on their bed. When I asked to have them put on my mother's nursing-home bed, I was told that they are illegal, when, in fact, the Nursing Home Reform Act says they can be provided with a doctor's orders.
Between 1985 and 2009, nearly 500 hospital and nursing-home patients died from suffocation or strangulation after becoming caught between the bed rails and the mattress. No preventable death should occur in a nursing home, but that number is dwarfed by the 1,800 deaths every year caused by falls.
Once again, my mother is lucky: She can afford the one-on-one care and medical equipment that has kept her safe since her nursing-home stay. But most elderly people can't -- and the nursing homes entrusted with their care aren't giving them the protection they deserve.