Fall Prevention

Why Falls Matter in Montana Long-Term Care

Falls are the most frequent type of accident in nursing homes, and in Montana's many rural facilities a fall with a hip fracture can mean a long ambulance trip and a permanent loss of independence for an older adult. Under the Omnibus Budget Reconciliation Act of 1987 (OBRA), every resident has the right to an environment as free of accident hazards as possible, and each facility must have an active fall-prevention program. The Montana CNA knowledge exam expects you to recognize fall risks and name the correct prevention and response steps.

Who Is at Risk

Risk comes from two directions: the resident's own condition (intrinsic factors) and the surroundings (extrinsic factors).

Intrinsic (resident-related) risk factors:

• Medications — sedatives, sleeping pills, blood pressure drugs, diuretics, and pain medications can cause dizziness, drowsiness, or sudden urgency to urinate
• Orthostatic hypotension — a drop in blood pressure when standing; let residents sit on the edge of the bed before standing
• Weakness, poor balance, or unsteady gait — common after stroke, with Parkinson's disease, or with arthritis
• Cognitive impairment — residents with dementia may forget they cannot walk safely alone or ignore the call light
• Urinary urgency and incontinence — many falls happen while a resident hurries to the bathroom, especially at night
• Poor vision or hearing — missed hazards and unheard instructions
• History of falls — a resident who has fallen before is far more likely to fall again; report every fall so the care plan can be updated

Extrinsic (environmental) hazards:

• Clutter on floors, cords from call lights or equipment, and throw rugs
• Wet or freshly mopped floors, and spilled water around sinks
• Poor lighting, especially the path from bed to bathroom
• A bed left in a high position or with unlocked wheels
• Missing or broken assistive devices, or a walker left across the room
• Loose shoes, slippery socks, or long robes that catch the feet

Everyday Fall-Prevention Measures

These habits are so standard that the exam treats them as the CNA's basic duty:

1. Answer call lights promptly and always place the call light within the resident's reach before leaving the room. A resident who cannot reach it will often try to get up alone.
2. Keep the bed in its lowest position when the resident is resting, and lock the wheels on beds and wheelchairs before any transfer.
3. Non-skid footwear — shoes or slippers with non-slip soles whenever the resident is out of bed, never socks alone on hard floors.
4. Keep assistive devices within reach — walkers and canes belong where the resident can get them without standing unsupported.
5. Use a gait belt for transfers and ambulation when the care plan calls for it.
6. Scheduled toileting — offer the bathroom regularly so residents do not rush.
7. Clear the path — remove clutter, wipe spills immediately, use wet-floor signs, keep the night light on, and make sure the path to the bathroom is lit.
8. Keep frequently used items close — water, glasses, phone, and tissues on the overbed table within reach.

Post-Fall Response

What you do in the minutes after a fall is a classic exam question. The sequence:

1. Stay with the resident and call for the nurse — use the call light or shout for help; do not leave the resident alone.
2. Do NOT move the resident — never lift or help a fallen resident back to bed yourself. A fracture or head or spine injury may be present, and moving the person can make it worse. The nurse assesses first and decides how the resident will be moved.
3. Reassure the resident and keep them warm while you wait.
4. The nurse performs the assessment — this includes checking vital signs and, for residents on blood thinners or who hit their head, ongoing neurological checks, because bleeding can be delayed.
5. Report and document facts only — write down what you saw and heard: where the resident was found, position on the floor, what the resident said, the time, and the condition of the room (for example, a wet spot or an unlocked bed). An incident report is completed, but it is never mentioned in the resident's chart. Never document guesses or blame — "the resident tripped because the family left bags on the floor" is an opinion, not a fact.

Falls must always be reported to the nurse even if the resident says they are not hurt. Injuries such as hip fractures and internal bleeding may not be obvious right away, and an unreported fall is a serious break in resident safety.

The CNA's Ongoing Role

Fall prevention is not a one-time checklist — it is continuous observation. Because CNAs spend more time with residents than any other team member, you are the early warning system. Report new weakness, a change in gait, confusion that is worse than usual, a new medication the resident says makes them dizzy, or shoes with worn soles. Facilities review every fall at team meetings and adjust the care plan — perhaps adding a bed alarm, a low bed, a fall mat beside the bed, hip protector garments, or more frequent rounding. In Montana's smaller rural facilities, where staffing is lean and residents may be farther from the nurses' station, keeping the call light in reach and answering it quickly carries even more weight. Remember the exam's guiding principle: the CNA prevents falls by controlling the environment and responding to needs promptly, not by restricting the resident's movement.