Risk Management

Resident Falls - Accidents or Malpractice?

One of the most frequent incidents occurring within the long term healthcare setting is the fall. It has historically been expected, and every long term facility makes a considerable effort to reduce the frequency and severity of falls.

In recent years, however, we have seen a trend in insurance claims that is disturbing, and that trend is the growing tendency to present claims as professional liability, resulting in significantly higher claims expense and payments.

This trend is the result of the perception that a resident fall was caused by failure to provide adequate care, not that the fall was an accident - preventable or non-preventable.

In a study covering the last three years, when comparing the cost of fall claims in the AAHSA Insurance program presented as "general liability" incidents and those presented as "professional liability," we found that the average GL fall claim cost was approximately $7,000 and the average PL fall claim cost was $28,000 - an alarming difference.

How can you defend your facility against this trend?

By ensuring that there is a clear line of communication between you, the resident, and the resident's family - that they know exactly what you are doing to protect the resident.

• By making sure that you have a Fall Prevention program that provides for immediate and on-going identification of residents at risk, and the development of therapeutic programs to reduce fall risk. By using systems available to sound alarms if a resident does fall.


• By developing a Resident Lifting/Transfer protocol which virtually eliminates manual transfer of residents unable to provide significant assistance in the transfer.


• By maintaining an Incident reporting and investigation procedure which identifies any and all gaps in your Fall protocol and provides immediate action to repair those gaps.


• By an early reporting protocol arranged with your insurance carrier which provides for the "record only" reporting of all fall incidents which result in actual injury or hospitalization.


• By a quality post-incident monitoring system established in the medical record which documents the resident's vital signs and general condition for at least 48 hours (preferably 72), to assure that there was not a hidden injury.
• By communicating with both the physician and family immediately following every incident and documenting that communication in writing - unless there is a formal, written arrangement not to call the family after every incident.

The secret is communication and understanding, the perception that you are doing everything humanly possible to protect the resident. If that perception is not there, expect to see a claim described as "Fall resulting from improper care" on a future claims report.