Falls are a major source of serious injury among older adults. The Centers for Disease Control and Prevention reports that more than one in four adults aged 65 and older fall each year, and falls are the leading cause of injury in this age group. Nearly 319,000 older adults are hospitalized for hip fractures each year, and falls are the most common cause of traumatic brain injuries.

For nursing home residents, those injuries can be especially serious because many already live with mobility limitations, osteoporosis, dementia, cardiovascular disease, medication-related risks, or other conditions that make recovery more difficult.

Nursing homes must take appropriate fall-prevention measures when a resident has a known risk of falling. When a fall has already caused catastrophic harm, however, the investigation must go further. It must determine what happened before the fall, how the facility responded afterward, and whether failures in either phase contributed to the resident’s injury or death.

Why Are Hip Fractures So Serious for Nursing Home Residents?

A hip fracture in an older nursing home resident can become much more than an orthopedic injury.

The fracture may require hospitalization and surgery. Even when the bone is repaired, the resident may lose the ability to walk independently or return to their prior level of functioning. Prolonged immobility can also expose medically fragile residents to additional health problems.

The National Institute on Aging notes that fractures in older adults can result in hospitalization, long-term disability, or death.

After a serious hip fracture, complications may include:

• Loss of mobility and independence
• Surgical or postoperative complications
• Blood clots and pulmonary embolism
• Pneumonia or other infections associated with reduced mobility
• Pressure injuries caused by prolonged time in bed
• Physical deconditioning
• A permanent need for greater levels of care
• Death following the injury or resulting complications

The legal investigation should not stop at the diagnosis of “hip fracture.” It should determine why the resident fell and whether appropriate precautions were actually being followed.

A fracture without a clear explanation may require further investigation, particularly when the injury was unwitnessed or the nursing home’s account does not explain how the fracture occurred.

Can a Nursing Home Fall Cause a Brain Bleed?

Yes. A nursing home resident who strikes their head during a fall can suffer intracranial bleeding, including a subdural hematoma.

A subdural hematoma is a collection of blood between the brain’s outer covering and the brain’s surface. Older adults are particularly vulnerable because age-related changes can stretch the veins in this area, making them more easily injured. Some chronic subdural hematomas develop after relatively minor head trauma and may not produce obvious symptoms immediately.

That delayed presentation matters in a nursing home.

A resident may initially appear stable and later develop confusion, unusual sleepiness, weakness, difficulty walking, problems speaking, seizures, or other neurological changes. Those symptoms can also be mistakenly attributed to dementia, medication effects, or ordinary age-related decline unless staff recognize that the resident recently suffered a head injury.

Residents taking anticoagulants or other medications that affect bleeding may require particular attention after head trauma. Research highlighted by the National Institute on Aging has also identified serious intracranial bleeding as an important consequence of fall-related head injuries in older adults.

A serious head injury can also leave a resident with lasting cognitive, physical, and neurological impairments associated with a traumatic brain injury.

When May a Nursing Home Be Responsible for a Serious Fall?

A fall does not automatically prove nursing home negligence. The issue is whether the facility identified foreseeable risks and took reasonable steps to address them.

Federal nursing home regulations require facilities to keep the resident environment as free of accident hazards as possible and provide adequate supervision and appropriate assistive devices to prevent accidents. Centers for Medicare & Medicaid Services (CMS) guidance states that facilities should identify risks, evaluate them, implement appropriate interventions, monitor their effectiveness, and modify them as needed.

That means a serious fall investigation may examine whether the facility failed to:

assess a resident’s fall risk accurately; update the care plan after a previous fall or change in condition; provide required assistance during walking, transfers, or toileting; ensure walkers, wheelchairs, alarms, or other equipment were available and functioning; respond to medication changes that increased dizziness or instability; address environmental hazards; provide the level of supervision called for in the resident’s care plan; or change ineffective precautions after prior falls.

The key question is not simply whether the nursing home had a fall-prevention policy. The investigation should determine what precautions this particular resident required and whether staff actually implemented them.

These questions overlap with broader patterns of nursing home neglect, particularly when inadequate staffing, poor communication, missed care, or repeated failures affect residents across multiple shifts.

What If the Resident Had Fallen Before?

A prior fall can be important evidence because it may put the nursing home on notice that existing precautions were not enough.

CMS guidance specifically contemplates monitoring safety interventions and modifying them when they are ineffective.

After a resident falls, the facility should evaluate why the event occurred and whether changes are necessary. Depending on the resident, that could involve greater supervision, additional transfer assistance, environmental changes, medication review, revised assistive devices, or other individualized measures.

If essentially the same fall happens again and the facility fails to revise an ineffective plan, the earlier event may become an important part of the negligence investigation.

What Evidence Matters After a Catastrophic Nursing Home Fall?

The facility’s own records can be critical in determining what happened before the fall, how staff responded, and whether required precautions were actually followed.

A proper investigation may require examination of fall-risk assessments, care plans, nursing and aide documentation, prior fall reports, staffing assignments, medication administration records, therapy records, hospital transfer documentation, surveillance footage when available, witness accounts, internal investigations, and records showing when the family and physician were notified.

The medical records after the fall matter as well. They may establish when pain, neurological changes, loss of mobility, or other symptoms began and whether there was a delay in obtaining emergency evaluation.

In unwitnessed cases, documentation can become even more important. If the facility’s explanation changes, records are incomplete, or the resident’s injuries do not align with the account provided by staff, families may need to investigate whether the event was accurately reported.

An unexplained injury or death deserves closer scrutiny when the facility cannot provide a consistent account of what happened or its documentation conflicts with the resident’s injuries.

Can a Nursing Home Fall Lead to a Wrongful Death Claim?

Potentially. A wrongful death claim may arise when negligent nursing home care causes or substantially contributes to a resident’s death, subject to the law of the applicable jurisdiction.

The causal chain is not always immediate.

A resident may fall, fracture a hip, undergo surgery, lose mobility, develop complications, and die weeks or months later. Another resident may suffer a head injury that causes intracranial bleeding and neurological deterioration.

In those situations, determining whether the fall contributed to the death often requires a detailed review of the complete medical course rather than focusing only on the final diagnosis listed at the time of death.

The investigation must also establish the first link in the chain: whether negligent supervision, inadequate fall precautions, unsafe conditions, or another preventable failure caused the original fall.

When negligent care contributes to a resident’s death, the circumstances may support a wrongful death claim, depending on the facts and applicable state law.

A Serious Fall Requires More Than an Explanation That the Resident Was “Old”

Age, frailty, osteoporosis, dementia, or mobility limitations can make nursing home residents more likely to fall and more vulnerable to injury. Those conditions do not eliminate the facility’s responsibility to account for known risks.

In fact, the purpose of individualized assessments, care plans, supervision, and fall precautions is to protect residents whose medical conditions make a fall foreseeable and potentially catastrophic.

A meaningful investigation, therefore, asks specific questions: What did the nursing home know about the resident’s fall risk? What precautions were ordered? Were they actually followed? Had the resident fallen before? Did the facility revise the plan? How quickly did staff recognize and respond to the resulting injuries?

Those answers can determine whether a devastating fall was unavoidable or whether preventable failures contributed to a hip fracture, brain injury, permanent decline, or death.

When a Preventable Fall Leads to Serious Injury or Death

McEldrew Purtell represents individuals and families in serious nursing home abuse and neglect cases involving preventable falls, hip fractures, traumatic brain injuries, unexplained injuries, and wrongful death.

When a nursing home fall causes catastrophic injury or death, our attorneys examine the resident’s complete care history, fall-risk assessments, staffing and supervision, prior falls, facility records, and medical evidence to determine what happened and whether preventable failures contributed to the outcome.

If your loved one suffered a hip fracture, brain bleed, catastrophic injury, or death after a fall in a nursing home, assisted living facility, or rehabilitation center, contact McEldrew Purtell for a free consultation. Attorneys evaluating a potential nursing home neglect referral are also welcome to contact our team to discuss the matter.