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Nursing Homes Need Higher Levels Of Staff To Prevent Falls

As the older adult population in the United States continues to grow, falls continue to be a major concern in the healthcare industry. Frail elderly patients in nursing homes and assisted living facilities are especially vulnerable to fall events, which can greatly increase the risk of morbidity and mortality. Decline in functional status, the amount and kinds of medications, health conditions, impairments in vision and hearing, cognitive status, the reliance on adaptive equipment (such as canes, walkers, and wheelchairs), and restraints are all significant risk factors for falls in the care facility. Patients who are newly admitted into a nursing home are especially vulnerable to falls—an unfamiliar environment coupled with unfamiliar staff makes fall risk identification and management more difficult in this patient population. Moreover, these newly admitted patients have often suffered from a recent acute care event, thus increasing their risk of falls due to debilitated functional ability.

A recent study sought to identify the prevalence of falls among this patient population and examine the relationship between newly admitted residents’ rate of falls and the organizational characteristics of nursing homes.

The study found that the prevalence of falls was high among newly admitted nursing home residents. In fact, one out of every five of these residents experience at least one fall. Unlike residents who have stayed in a nursing home for a long period of time and are better known by their staff, short-stay residents are often patients receiving post-acute care who plan on returning back into the community. A fall event experienced by a patient in this population not only results in short-term adverse outcomes (such as readmission to a hospital and risk of injury), but also may diminish the patient’s chance of getting back home. These results show that it is necessary for nursing home staff to be proactive in preventing falls among these newly-admitted nursing home residents. Specifically, nursing homes should provide more certified nursing assistant staff members for nursing home patients who are more vulnerable to experiencing falls.

The study also found that only certified nursing assistant staff (CNA) levels were related to a reduction of patient fall risk. Nursing home facilities that had higher levels of CNA staff often had less fall events. CNAs are responsible for providing most of the hands-on care to nursing home patients. These care staff in particular are present during the times patients are at highest risk of experiencing a fall (such as during toileting and transfers). Thus, these care staff are responsible for decreasing fall risk as much as possible by giving the appropriate assistance required during the times these risky activities occur.

Therefore, nursing home facilities should make sure their CAN staff levels are adequate enough to ensure all patients at risk of falls are given proper assistance during transfers and ambulation to decrease their risk. The findings of this study align with previous studies that have found that greater levels of staff are significantly related to better quality of care, which includes proper resident nutrition during meals, and decreased rates of incontinence, as well as bedsores.