Fall Risk Care and the CNA

Falls happen in the home, in long- and short-term residential care facilities, in hospitals, in nursing homes, and elsewhere on a frequent basis.  Each year, about 1,800 elderly adults suffer from injuries related to falls, and it only takes one fall for a patient to fracture a bone(s), become permanently disabled, suffer with short- or long-term pain, or die.  Those who survive a fall, frequently sustain multiple types of injuries that are linked to a decreased quality of life, and sometimes-permanent disability. The fear of falling can result in depression, an increased loss of function, and social isolation.

How Severe is the Problem – by the Numbers

More than 1.4 million older adults (over the age of 65) live in nursing or long- and short-term residential homes, or at home under the care of a home health aide.  Because of an aging baby boomer demographic, statistics project that the number of people residing in a nursing home will increase to about 4 million individuals by 2030.  While only about five percent of elderly adults live in nursing homes, falls from people living in a care facility in this age group account for about 20 percent of deaths.  Every year, a nursing home containing one hundred beds reports between 100 and 200 falls, and yet many are not even reported.

Somewhere between one-half and three-quarters of care facility residents fall each year.  That is two-times the rate of falls among people of the same age group living in the community, and most patients will fall more than once.  The average number of falls per person is about three falls each year.  About 35 percent of injuries due to falls happen among individuals who cannot walk.

Why do falls happen more often in nursing and residential care facilities?

Falling can be an indication of other health conditions. Care facility residents usually have more difficulty walking, and many have chronic health conditions.  Some residents also have memory problems, such as dementia, need help getting around, and have difficulty with basic activities. Many of the falls are due to environmental hazards such as slippery floors, poor lighting, incorrect bed height, poorly maintained wheelchairs, and debris in the hallways.

One CNA reported that the hallways in the assistive living facility where she works has nursing/prescription carts, walkers, and wheelchairs in the hallways, which limits the space a resident has to maneuver, and they often have to go around a chair or something when walking to dinner. It’s dangerous.”

In fact, about 16-24 percent of the falls in nursing homes are from environmental hazards.  A significant number of home healthcare falls occurred when caregivers were walking clients in outdoor settings.

Another CNA at a nursing home mentioned, “The sidewalks outside our facility are broken up and cracked in places.  This can be a real safety hazard when trying to walk a resident outside. I’ve been here three years and they have never been fixed, although the staff has complained often.”

But in general, falls happen when patients do not comply with instructions from their caregiver(s), while attempting to self-transfer, self-ambulate or otherwise avoid staff assistance.

A study conducted in 2006 showed that more falls occur when the ratio of CNA’s-to-residents is lower (say, 1-20), and that most residents experienced a fall with 30-days of being admitted to a care facility.  One CNA at a Minnesota assistive living facility mentioned that because of cutbacks in hiring, during a regular shift there are usually only two CNA’s for every 33 residents and, “we can’t answer their call buttons quick enough, so sometimes our residents will try to transfer or walk by themselves. We’ve had a number of falls happen that way.”

CNAs note that approximately 90 percent of the patients who experienced falls in the ambulatory care setting were clinically compromised, often due to the residual effect of anesthesia or medications.

One important aspect of a CNA’s job is to ensure falls don’t happen. Of course, no one can completely prevent falls, but CNA’s are trained to remove common obstacles, like area rugs, clutter, and chairs that swivel or roll, and be aware of other things that may lead to a fall.

Prevention of Falls

It can be difficult for a CNA to prevent falls from occurring.  But one of a CNA’s jobs is dealing with the situation if it does happen.  A few of the typical things a CNA learns during his or her training, includes:

• Teaching residents to avoid any hazardous situations that might cause a fall.
• Using a waist (gait) belt to help steady a resident when walking.
• Making sure all residents have in their possession, and are using their alarm bell.
• Helping residents take advantage of exercise programs that improve strength, balance, coordination, physical functioning, and walking ability.
• Providing nursing home residents with hip pads that may help decrease the risk of a hip fracture, should a fall occur.
• Changing the nursing home environment to make it easier for residents to move around safely. This might include putting in raised toilet seats, grab bars, decreasing bed heights.
• Reviewing residents’ medications to assess the chances a medication might cause a fall.
• Making sure any resident who had a fall is not showing any symptoms of a break, head injury, pain, or other medical condition.
• Help the patient with exercises that help increase strength and balance.
• Make sure there is lots of lighting in the evening hours so your patient won’t trip over something they can’t see.

Protecting patients from fall-related injuries requires is important for the CNA.  So what do you do if you are walking with a patient and he or she begins to fall?

(1 Slide him or her down your leg to the ground

2) Don’t try preventing the fall.  This can cause skin tears and bruising.

3) Stay with the patient and either call the nurse on duty, or have someone get the nurse.

A CNA, who has been on-the-job for the past 13-years says, “Many CNA’s are hired who don’t have a clue what to do if a patient falls.  I have actually seen a CNA pick up a resident from the floor after she fell without first checking to see if she was okay.  Turns out the resident broke her hip. The CNA could have made that break so much worse.”

Another CNA agrees, “My training included knowing what to do in case a resident fell while in my care, but there is no follow-up by senior nurses or additional training when a CNA is hired.” 

CNA’s Role After a Fall

No matter how careful you, your patients, and your co-workers are, accidents and falls will happen. One of the jobs of a CNA is knowing what to do when a fall takes place.  In most cases, keeping a clear head, and thinking back over your training will help you know what to do in this situation.

• Don’t leave the patient alone
• Never move the patient without approval by a nurse or doctor
• Use the patient’s call button to call for help if necessary
• Fill out the appropriate paperwork
• If patient isn’t transferred to a hospital, follow-up over the next few days to ensure the patient isn’t disoriented, bruised, or overly sore and in pain. If the patient is complaining, or you notice any of these problems, notify the nurse on charge.
• Follow-up on the patient’s care plan to ensure a fall for reoccurring.

“In general, I think staff at care facilities are doing a better job preventing falls from ever happening,” says a head nurse at an assistive living facility. “Because it can happen so quickly, we have training sessions about every two months, and when a new CNA is hired, we go over every patient’s history. Then we inform residents how to properly transfer, etc., and educate our staff about what to do if a resident does fall.”