Out of the Box: A New Look at Fall Prevention in Skilled Nursing Facilities

Falls are a common issue in the elderly population and a major concern in facilities that serve this population.   Aside from the direct injury falls can incur, residents are also at risk of loss confidence.   Their fear of falling often leads to social isolation and depression.   We all agree preventing falls is of great importance, but many of us could use some fresh ideas to improve falls prevention in our facilities.   Below are some evidence-based options and strategies to consider.

Decrease use of restraints and alarms

It has been shown in recent years that physical restraints are not effective in preventing falls.   Alarms can also be problematic in a variety of ways.   They often startle residents, creating agitation or even a fear of moving to shift weight in chair or bed.   This can lead to skin breakdown and loss of sleep.   In addition, staff may experience ‘alarm fatigue’ or desensitization to the sound.   When responding to alarms, the common response, “sit back down” does not address the resident’s need such as using the restroom, reaching a tissue or drink of water.

Engage your front line staff

CNAs that are consistently assigned to specific teams get to know ‘their’ residents, their patterns and needs.   Quick reference ‘huddle’ forms help to quickly and efficiently pass this information from shift to shift.

Keep your residents moving

If you don’t use it, you lose it!   It’s important to keep our residents moving at their optimum ability.   Therapy staff can provide Restorative Nursing Plans as well as Functional Maintenance Plans when discharging your long term residents for therapy services targeting functional movement including walk to dine, look up reach up and facility ex groups.

Get to know your residents’ patterns

Targeting a handful of residents at a time, CNAs can keep a 5 day diary of these residents across each shift.   Information gathered would include when they need to use the restroom, when they get tired, if they get hungry between meals and need snacks, etc.   The information gathered can be placed on brief Resident Information Sheets and placed in resident closet where staff can access it.   This will allow anticipation of needs thereby preventing many unsafe situations from arising.   Commercially available identifiers for high fall risk residents are helpful color coded items such as fall management slippers that assist staff in quick ID for safety checks & supervision.

Use your therapy staff as resources in falls prevention

Physical Therapy: PT can evaluate for balance, strength and gait.   Develop resident specific Functional Maintenance Plan (FMP) targeting these areas including:

  • Functional Mobility FMP including walk or self-propel wheelchair to dine
  • Exercise group FMP
  • Bed mobility FMP
  • Provide staff transfer training including safe body mechanics.

Occupational Therapy: OT or ST can evaluate cognition to discover level for development of ADL & activity based dementia management program.   They can address urinary incontinence and develop toileting program as well as UI exercise program.   OT can evaluate and provide support for safe resident positioning in bed and wheelchairs.   They can also provide education on environmental modification and use of falls prevention movement patterns during daily activities and restorative including:

  • Look up, reach up patterns
  • Crossing midline and reaching outside of midline
  • Stand up and step out of comfort zone
  • Strength during activities

Speech Therapy: OT or ST can evaluate cognition to discover level for development of activity based dementia management program.   ST can also provide education on approach and communication strategies for use with residents with cognitive impairment including:

  • Talk face to face
  • Simplify grammar
  • Ask yes/no and 2-choice questions
  • Validation, not confrontation

Many facilities are experiencing success with the use of these out of the box strategies for reduction of falls.   These person-centered approaches may also increase quality of life for our long term care residents resulting in improved physical and psychosocial wellbeing in the process.   Ask your therapy staff about supporting you in your journey to a new approach for falls prevention in your own facility.


Alvear, J. (2006). Fall prevention. Fast Facts: Resources for Nursing Home Professionals, 4(March), Retrieved from www.chcf.org/fastfacts

Frank, B. (2014). Alarming news! Alarms hurt more than help when it comes to fall prevention. Retrieved from http://assistedliving.about.com/od/MDS3.0/a/Alarms-and-Fall-Prevention.htm

Illinois Council on Long Term Care. (n.d.). Developing successful strategies for preventing falls ii. Retrieved from www.nursinghome.org/fam/fam_011.html

– By TMC’s Strategic Innovation Taskforce members: Jennifer Dibble, COTA & Elizabeth Page, MA, CCC/SLP