[email protected] | November 5, 2026 | Nursing Home Abuse
The phone call usually goes something like this.
“Your mother had a fall. She’s okay, but we sent her to the hospital to get checked out.”
Then you get to the ER and learn she has a broken hip. Or a brain bleed. Or she was on the floor for who knows how long before anyone found her.
I hear from a lot of Kentucky families in this exact spot. And the first thing most of them ask me is: Is a fall just an accident, or is it neglect?
Here’s the honest answer. The fall itself is only part of the story. What I really want to know is what the nursing home did before the fall, and what it did after.
That’s what this post is about. I’ll walk you through what a nursing home should be doing at each stage, so you can tell whether your loved one got the care they were owed.
How Common Are Nursing Home Falls?
Very. Falls are one of the most common ways nursing home residents get badly hurt.
In 2025, the federal government’s own watchdog, the HHS Office of Inspector General, looked at one year of Medicare data. It found 42,864 falls that caused a major injury and sent a resident to the hospital. Of those residents, 1,911 died in the hospital. (OIG report)
Here’s the part that should bother every family. The same review found nursing homes failed to report 43 percent of those serious falls in the resident assessments they’re required to file.
That matters because those assessments feed the fall ratings you see on Medicare’s Care Compare website. OIG also found that the homes with the lowest reported fall rates had the highest rates of unreported falls. So a good fall score doesn’t always mean what you think it means. (I wrote more about how to read Kentucky nursing home ratings and inspection reports here.)
Kentucky is not doing better than the rest of the country. In CMS data covering April 2024 through March 2025, 3.78% of Kentucky nursing home residents had a fall with major injury, compared to 3.28% nationally. (Becker’s)
OIG also found that most residents who had a serious fall had risk factors the nursing home already knew about. And homes with lower nurse staffing had higher fall rates.
In other words, many of these falls were not a surprise.
Before the Fall: The Nursing Home’s Job Starts on Day One
Federal law requires every nursing home that takes Medicare or Medicaid to keep the resident’s environment “as free of accident hazards as is possible” and to give each resident “adequate supervision and assistance devices to prevent accidents.” That’s 42 C.F.R. § 483.25(d). Inspectors cite it as tag F689.
In plain English: the nursing home has to figure out who is likely to fall, and then actually do something about it.
That starts with a fall risk assessment when your loved one moves in. Staff should look at things like:
- Past falls
- Trouble walking, standing, or balancing
- Dementia or confusion
- Medications that cause dizziness or drowsiness
- Vision problems
- Needing to get to the bathroom often or in a hurry
If the resident is a fall risk, that should show up in the care plan. Depending on the person, the plan might call for:
- Two staff members for every transfer, or a mechanical lift
- A low bed and fall mats
- Help to the bathroom on a set schedule
- Non-skid socks or proper shoes
- A walker or wheelchair kept within reach
- More frequent checks, especially at night
But a care plan doesn’t carry itself out. People do.
That’s where a lot of these cases turn. The plan says two-person assist, but only one aide was on the hall. The plan says toileting every two hours, but nobody came for five. When I see that gap, I start asking about understaffing. And with the federal government rolling back nursing home staffing minimums, I expect to see more of it.
Medications matter too. Sedatives, sleep aids, antipsychotics, and some blood pressure drugs all raise fall risk. If a resident was over-medicated or given the wrong drug, that’s its own problem. I covered that in my post on nursing home medication errors.
Right After the Fall: What Staff Should Do
The first hour after a fall matters a lot. Here’s what good nursing care looks like:
- Don’t rush to pick the resident up. A nurse should check for injury first. Yanking someone with a broken hip back into bed makes it worse.
- Do a head-to-toe assessment. Pain, swelling, bruising, a leg that looks shorter or turned out, any change in how the resident is talking or acting.
- Check for a head injury, especially if the fall wasn’t witnessed. If nobody saw it happen, staff can’t assume the resident didn’t hit their head. Most facilities have a policy for ongoing neurological checks after an unwitnessed fall.
- Pay extra attention to blood thinners. A resident on a blood thinner who hits their head can have a brain bleed that doesn’t show symptoms right away. That resident usually needs a closer look, and often a trip to the ER.
- Call the doctor and call the family. Federal law requires the nursing home to immediately consult the resident’s physician and notify the family or legal representative when an accident causes an injury that might need a doctor’s care. That’s 42 C.F.R. § 483.10(g)(14).
- Write it down. The nurse should chart what happened, what they found, who they called, and when. The facility should also fill out an incident report.
That notification rule gets broken more than you’d think. If you found out about a fall days later, or from the hospital instead of the nursing home, read my post on what to do when a nursing home didn’t notify the family.
A slow response can turn a survivable fall into a fatal one. A hip fracture that sits for a day. A brain bleed nobody checks for. That’s the kind of thing I look for.
In the Days After: The Care Plan Has to Change
The nursing home’s job isn’t over once the resident is back in bed.
Some injuries show up late. A resident with dementia may not be able to say their hip hurts. They may just refuse to stand, stop eating, or get more agitated. A slow brain bleed can look like the resident is just “more confused than usual.” Staff should be watching closely for changes like these in the days after a fall.
And then the big one. After a fall, the nursing home should figure out why it happened and change the plan so it doesn’t happen again.
If a resident fell trying to get to the bathroom alone at 3 a.m., the answer isn’t to write “educated resident to use call light” for someone with advanced dementia. The answer is a real change: scheduled toileting, more checks overnight, a bed closer to the bathroom, a low bed, something.
When I see the same fall happen twice, three times, four times, with the same plan in place every time, that tells me a lot.
Hip fractures in particular are serious business for older adults. For a frail nursing home resident, a broken hip often means surgery, a long recovery, a loss of independence, and sometimes the beginning of the end. (More on that in our broken bones resource.)
Red Flags I Would Pay Attention To
When a family brings me a nursing home fall case, these are the things that make me want to dig deeper:
- Nobody saw it. The resident was found on the floor, and no one can say how long they were there.
- The story keeps changing. One aide says the resident was in bed. The nurse’s note says the bathroom. The incident report says the hallway.
- Repeat falls with no new plan. The care plan reads the same after the third fall as it did before the first.
- Delayed treatment. Hours or days passed before anyone sent the resident out for an X-ray or CT scan.
- Late or no phone call. You learned about the fall from the hospital, or days after it happened.
- The plan called for two people, and only one was there. Or the lift was broken. Or the hall was short-staffed that night.
- A head injury on a blood thinner with no ER visit and spotty neuro checks.
- Sudden new sedating medications in the days or weeks before the fall.
Any one of these is worth a closer look. Two or three together usually tell a story.
Not Every Fall Is Neglect
I want to be straight with you here.
Older people fall. Even in a great nursing home with good staff, some falls happen that nobody could have stopped. The law doesn’t require a nursing home to be perfect.
What the law requires is reasonable care. Did the facility know about the risk? Did it put a real plan in place? Did staff follow it? And when the fall happened, did they respond the right way?
You also have to connect the dots between what went wrong and the injury. That’s called causation, and it’s often where these cases are won or lost.
A fall plus a bad outcome is not automatically a case. A fall plus a broken promise usually is.
What Families Should Do Now
If your loved one fell in a Kentucky nursing home and got hurt, here’s where I’d start:
- Ask for the records. The chart, the care plan, the fall risk assessments, the incident report, and the medication records. You have a right to them.
- Write down what you were told, by whom, and when. Phone calls blur together fast.
- Take photos of any bruises, cuts, or injuries.
- Check the room for cameras. If you or the facility had one in place, that footage can disappear. Here’s what Kentucky law says about putting a camera in a nursing home room.
- Don’t wait. Kentucky’s deadlines for these cases can be short, and evidence goes missing. Here’s how long you have to sue a nursing home in Kentucky.
My firm handles nursing home abuse and neglect cases across Kentucky, from our office in Lexington to Louisville and beyond. We prepare every case like it’s going to trial, because nursing homes and their insurers know which lawyers will actually try a case. You can see some of our case results here.
If you’re wondering whether your loved one’s fall was more than an accident, learn more about our Kentucky nursing home fall cases or just give us a call. We’ll look at what happened and give you a straight answer.
Call (859) 413-3900 or get a free consultation.