6.1 Fall Prevention in Illinois Long-Term Care Facilities
Key Takeaways
- Falls are the leading cause of injury and injury-related death in adults over 65 and the most common reportable incident in Illinois long-term care facilities
- 50-75% of nursing home residents fall each year versus about 30% of community-dwelling elderly; 10-25% of falls cause serious injury
- Core CNA interventions: call light within reach, bed in lowest position with wheels locked, non-slip footwear, scheduled toileting, and clutter-free pathways
- Never try to catch a falling resident — guide them to the floor protecting the head, then stay with them and call for help
- After a fall, do NOT move the resident until the nurse assesses for injury; complete an incident/occurrence report the same day
- Orthostatic (postural) hypotension after position changes is a major situational trigger — change positions slowly and dangle the legs before standing
Why Falls Dominate the Safety Section of the INACE
Falls are the leading cause of injury and injury-related death in adults over 65, and they are the single most common reportable incident in Illinois long-term care facilities. The Illinois Department of Public Health (IDPH) tracks fall rates during surveys, and a facility with an excessive or rising fall rate can receive a deficiency citation and be required to file a plan of correction. Because the certified nursing assistant (CNA) spends more direct time with residents than any other staff member, you are the front line of both prevention and detection.
Expect several fall-related items on the Illinois Nurse Aide Competency Exam (INACE).
Fall Statistics You Should Know
- 50-75% of nursing home residents fall each year, compared with about 30% of community-dwelling adults over 65.
- 10-25% of falls in long-term care result in serious injury such as fracture or head trauma.
- Hip fractures are the most feared outcome: roughly 25% of elderly hip-fracture patients die within one year, and many never regain prior mobility.
- Most facility falls are considered preventable with proper assessment and consistent intervention.
Fall Risk Factors
Risk factors are grouped as intrinsic (within the resident), extrinsic (environmental), medication-related, and situational. Memorize the categories — exam questions often ask you to pick the factor a CNA can directly change.
| Category | Examples |
|---|---|
| Intrinsic (resident) | Age over 65, prior falls, muscle weakness, unsteady gait, confusion or dementia, poor vision, incontinence/urgency, fear of falling |
| Medication-related | Sedatives, hypnotics, diuretics, antihypertensives, opioids, psychotropics, and polypharmacy (4 or more drugs) |
| Extrinsic (environment) | Wet floors, clutter, poor lighting, loose rugs, wrong footwear, high bed, unlocked wheels, missing grab bars |
| Situational | Toileting attempts, first day after admission, nighttime, and standing too fast (orthostatic hypotension) |
Prevention Strategies a CNA Can Implement
The most testable single answer is the call light within reach — it lets a resident summon help instead of attempting an unassisted transfer. Pair it with these:
| Strategy | How You Do It |
|---|---|
| Call light | Within reach every time you leave the room |
| Bed position | Lowest setting when not giving care; wheels locked at all times |
| Footwear | Non-slip shoes or gripper socks — never bare feet or loose slippers |
| Assistive devices | Walker, cane, or wheelchair within reach and in working order |
| Toileting schedule | Anticipate needs; offer the bathroom on a set schedule |
| Position changes | Move slowly; let the resident dangle legs before standing to avoid orthostatic drops |
| Lighting | Keep a clear, well-lit path to the bathroom, especially at night |
| Personal items | Glasses, hearing aids, water, and phone within arm's reach |
What to Do When a Resident Falls
Do NOT attempt to catch a falling resident — you risk injuring both of you. If you cannot prevent the fall, guide the resident to the floor while protecting the head, ease yourself down with them, and bend at the knees. Once a resident is down:
- Stay with the resident — never leave them alone.
- Call for help — use the call light or call out for the nurse.
- Do NOT move the resident until the nurse assesses for injury (possible fracture or head injury).
- Reassure the resident and keep them calm and warm.
- Observe and report level of consciousness, complaints of pain, bleeding, and how the fall happened.
- Assist the nurse with assessment and a safe transfer when directed.
- Document on an incident/occurrence report the same day.
Incident Reporting in Illinois
Illinois requires documentation of every fall on an incident or occurrence report. Record only objective facts — what you saw, not your opinion about cause.
| Element | Include |
|---|---|
| Date and time | When the fall happened or was discovered |
| Location | Exactly where it occurred |
| Witnesses | Who saw or found the resident |
| Circumstances | What the resident was doing |
| Injuries | Visible injuries or complaints of pain |
| Notification | Who was told (nurse, physician, family) |
| Interventions | What was done afterward and new fall precautions |
Worked Example: A Toileting Fall
Mrs. Alvarez, age 82, presses her call light at 2 a.m. to use the bathroom. She takes a diuretic and a sedative at bedtime and wears glasses. By the time you arrive she is on the floor beside the bed. You should: stay with her, call for the nurse, leave her in place, check her response and any pain, and note that her bed was in a high position with the call light out of reach and the room dim. Each of those findings becomes a new fall precaution: lower bed, night light, bedside commode, and a scheduled toileting round before the diuretic peaks.
This scenario shows how situational (nighttime, toileting), medication (diuretic plus sedative), and environmental (high bed, dim light) factors stack together.
Documentation and the Post-Fall Huddle
After any fall the team often holds a brief post-fall huddle to find the cause and adjust the care plan the same shift. Your objective observations feed it directly. Write what you saw, not why you think it happened: "Resident found on floor on right side, awake, stating right hip pain 6/10, call light on bed pillow out of reach" — not "Resident fell trying to walk because she is stubborn."
Common Exam Traps
Watch for distractors that sound protective but are wrong: keeping a resident in a wheelchair all day, raising all four bed rails, or applying a vest "so they cannot fall" are restraints, not prevention, and actually increase injury risk. The bed belongs in the lowest position, never the highest. The correct first response to a fall you discover is to stay with the resident and call for help, never to leave to find the nurse. And remember that a gait belt is used during transfers and ambulation per the care plan — it is a transfer aid, not a fall restraint left on the resident.
You see a resident beginning to fall in the hallway and you cannot prevent it. What should you do?
Which single measure is the most important fall-prevention step a CNA can take for every resident?