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Falls in Care Homes: Legal Obligations, Prevention, and Expert Witness Services

Mr Scott Harding-Lister Ms Samantha Gallagher

Head of practise at Apex Health Associates, Scott Registered Nurse, practising at a senior level for the

Harding-Lister is a trained Nurse, a non-practising past 13 years. During the past 8 years led and

solicitor and an experienced expert witness who is managed a large nursing home and twice achieved

well placed to support any of our panel members. a CQC rating of outstanding.


Falls in care homes, especially among the elderly, are a significant concern in the United Kingdom. In this article, we will delve into various aspects of falls, including the definition of falls, the legal responsibilities of care homes, types of injuries, preventive strategies in line with the National Institute for Health and Care Excellence (NICE) Falls Guidance, the importance of supervision, and more. We'll also introduce Apex Health Associates, a leading Expert Witness Service specialising in falls and clinical negligence cases in care homes.

Defining Falls

Falls are unexpected and involuntary events where an individual comes to rest on the ground or a lower surface. In care homes, falls refer to unintended incidents involving elderly residents within the facility.

Legal Obligations of Care Homes

Regulatory Obligations

Care homes in the UK operate under rigorous regulations, particularly those set by the Care Quality Commission (CQC). These regulations encompass various responsibilities, including:

  • Safeguarding Resident Safety: Care homes must prioritise resident safety, especially in preventing falls.

  • Compliance with Regulations: The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set standards for quality and safety.

  • Regular Inspections: The CQC conducts inspections to ensure adherence to these standards.

Health and Safety Requirements

Ensuring resident health and safety is paramount, involving compliance with stringent health and safety legislation:

  • Health and Safety at Work Act 1974: This law emphasises a safe working environment and extends to resident safety.

  • Management of Health and Safety at Work Regulations 1999: These regulations mandate risk assessments and safety protocols, crucial for managing fall-related risks.

Types of Injuries

Falls can result in various injuries among elderly residents:

  • Fractures: Hip fractures are prevalent and concerning, leading to pain and reduced mobility.

  • Head Injuries: Falls can cause traumatic brain injuries, necessitating long-term care.

  • Soft Tissue Injuries: Soft tissue injuries result in pain and reduced quality of life.

  • Psychological Trauma: Anxiety and depression often follow falls, impacting emotional well-being.

Prevention (Mitigation) Strategies

Preventing falls requires a comprehensive approach aligned with NICE Falls Guidance:

  • Assessment: Regular assessments of mobility and fall risks guide tailored interventions.

  • Care Planning: Detailed care plans address individual needs and fall risks.

  • Mitigation Strategies: Implement fall prevention interventions like handrails and footwear.

  • Reviews: Continuously evaluate and adjust care plans based on evolving needs.

Nursing Care Plan for Falls Prevention

A nursing care plan includes:

  • Assessment: Thoroughly assess each resident's risk factors, including medical history and medications.

  • Individualised Care Plans: Tailor care plans to residents' needs and risk factors, regularly reviewing and adjusting.

  • Environmental Modifications: Ensure a safe environment, removing tripping hazards and improving lighting and dealing with other environmental issues which may have arisen.

  • Education: Train residents, families, and staff on fall prevention.

  • Mobility Assistance: Promote mobility through exercises and therapy.

  • Medication Review: Regularly assess medications for potential fall risks.

  • Supervision and Monitoring: Provide increased supervision for high-risk residents.

  • MDT: Referral to specialist therapists may be required in order to manage the identified risk.

Types of Supervision: Care homes employ different supervision methods, including:

  • Cohorting: Group residents by mobility and fall risk.

  • Regular Rounding: Scheduled checks to assess well-being and mobility.

  • One-to-One Care: Continuous monitoring for high-risk residents.

Falls Aids

Falls aids, such as falls mats, high-low beds, and bed rails, reduce fall-related injuries.

Dangers of bed rails

Bed rails are vital yet potentially risky tools to prevent residents from rolling out of bed. They should not be used as restraints but judiciously in specific situations:

  • Individual Assessment: Assess residents individually for bed rails necessity.

  • Informed Consent: Obtain consent,explaining the rationale and risks.

  • Regular Monitoring: Continuously assess residents with bed rails.

  • Staff Training: Train staff to use bed rails safely.

  • Documentation: Properly document cot side use, reasons, assessments, and risk mitigation.

Ethical and Legal Considerations

Cot sides must align with ethical principles and legal obligations to avoid legal consequences.

Psychosocial Impact

In addition to physical consequences, falls also have psychological and social effects:

  • Anxiety: Many individuals develop heightened anxiety and fear of falling again.

  • Depression: Falls can lead to depression, contributing to social withdrawal.

  • Social Isolation: Residents may become socially isolated, leading to loneliness and reduced quality of life.

Providing Emotional Support

Addressing the psychosocial impact involves:

  • Empathetic Communication: Encourage open communication to understand residents' fears.

  • Individualised Care Plans: Tailor care plans to emotional well-being.

  • Engagement and Activities: Re-engage residents in activities and social interactions.

  • Family Involvement: Include families in the support network.

  • Continuous Monitoring: Regularly assess emotional well-being, facilitating timely intervention.

Expert Witness Services by Apex Health Associates

Apex Health Associates specialises in falls and clinical negligence cases in care homes. Our experienced nurses provide expert witness services, offering in-depth knowledge of falls prevention, care home protocols, and UK regulatory standards. Whether you represent claimants or defendants, our nurses offer comprehensive case reviews and expert opinions.


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