Falls in Nursing Homes: Broken Hips, Head Injuries, What the Facility Must Do and When It Is Neglect
Published by Beverly Law
CDPH and CMS records · English y Español
About half of nursing home residents fall each year, and falls cause most broken hips in older adults. Federal law requires a nursing home to give each resident the supervision and assistance devices needed to prevent accidents. In Los Angeles County, inspectors cited 168 facilities for 276 harm-level accident and supervision deficiencies from 2023 through October 30, 2026, and Cal Health Find lists 3,315 fall and accident complaints, 1675 substantiated.
Falls are common in nursing homes. The federal Agency for Healthcare Research and Quality (AHRQ) estimates that about half of nursing home residents fall each year, about 1 in 3 of those who fall do so two or more times, and about 1 in 10 who fall suffer a serious injury (AHRQ Falls Management Program; long-cited estimates, last reviewed by AHRQ in 2017).
Most broken hips in older adults come from falls. The CDC reports that in 2019, 88% of emergency visits and hospital stays for hip fractures, and 83% of hip fracture deaths, were caused by falls (CDC). For nursing home residents the stakes are higher: in a study of 60,111 residents who broke a hip, 36.2% died within 180 days (Neuman et al., 2014).
A hip fracture is not always obvious. According to the American Academy of Orthopaedic Surgeons, signs include pain, not being able to stand or put weight on the leg, and a leg that looks shorter or turned (OrthoInfo). A resident with these signs after a fall should be seen by a doctor.
Falls are the most common cause of brain injury deaths and hospital stays in older adults (CDC). Blood thinners raise the risk of bleeding in the brain after a head injury, and the CDC says an older adult who falls should be checked by a health care provider (CDC). Some danger signs may not appear for hours or days, so watch for a headache that gets worse and does not go away, repeated vomiting, slurred speech, one pupil larger than the other, new confusion, or being very drowsy or hard to wake. Any of those means 911 or the emergency room.
Federal law requires every nursing home that takes Medicare or Medi-Cal to keep the resident environment “as free of accident hazards as is possible” and to give each resident “adequate supervision and assistance devices to prevent accidents” (42 CFR 483.25(d), inspected as federal tag F689). After an accident that injures a resident and may need a doctor, the facility must immediately tell the resident, consult the physician and notify the resident’s representative, who is often a family member (42 CFR 483.10(g)(14)).
AHRQ’s fall program describes what that looks like in practice: assess fall risk and the help each resident needs for transfers, more supervision for residents who fall repeatedly, individualized toileting schedules, a low bed and floor mat for residents who get up unsafely, safe footwear, and a review of medications that raise fall risk, such as antidepressants, antipsychotics, benzodiazepines and sleep medications (AHRQ, chapter 4). After a fall, a nurse should evaluate the resident right away, monitor closely and chart every shift for 72 hours, and the care team should revise the care plan (AHRQ, chapter 2).
Residents have the right to be free from physical or chemical restraints imposed for discipline or convenience and not required to treat their medical symptoms (42 CFR 483.10(e)(1)). Restraints also do not reliably prevent falls. A 2023 Cochrane review notes that restraints can worsen walking and raise the risk of falling, and it found that programs that reduced restraint use did not lead to more residents falling, though the evidence was rated low-certainty (Cochrane).
Not every fall is negligence. It becomes a question of care when the facility knew the resident was at risk and did not do what the care plan called for. In the inspection summaries on our facility pages that involve falls, the patterns that come up most often are: supervision the care plan required was not provided; a transfer was done without the assistance the care plan required; the resident had fallen before and the plan was not changed; and the fall ended in a fracture, a head injury or a hospital transfer.
When there is an allegation of abuse or neglect, including an injury of unknown source, the facility must report it to the administrator and the state survey agency (CDPH in California): within 2 hours if the events involve abuse or result in serious bodily injury, and otherwise within 24 hours (42 CFR 483.12(c)).
Federal rule F689 requires a nursing home to keep the environment as free of accident hazards as possible and to give each resident the supervision and assistance devices needed to prevent accidents (42 CFR 483.25(d)). After a fall the facility should reassess the resident and change the care plan. Repeated falls, a fall by a resident the care plan said needed two-person assistance, or a fracture found hours later are common patterns in the citations linked from these pages.
What to do now
Ask for the incident report, the fall risk assessment and the care plan in writing.
Make sure the resident is examined and imaged; hip and head injuries can be missed.
We read the inspection record and the chart with you and tell you plainly whether there is a case. You pay no fees and no costs unless we win.
Talk to a Los Angeles nursing home abuse lawyer
Beverly Law represents residents and families in claims against nursing homes for abuse, neglect, bed sores, falls and fractures, sexual abuse, dehydration and malnutrition, medication errors and wrongful death. We start with the same public record shown on these pages, then request the resident’s chart and staffing records.
California’s Elder Abuse and Dependent Adult Civil Protection Act allows added remedies, including attorney fees, when neglect or abuse is proven to be reckless, oppressive, fraudulent or malicious (Welfare and Institutions Code section 15657). Filing deadlines can be as short as one year depending on the claim, so talk to a lawyer early. The consultation is free, in English or Spanish, and you owe no fees and no costs unless we win. Call (310) 552-6959.
What should happen after an unwitnessed fall in a nursing home?
A nurse should examine the resident right away, the physician and the resident’s representative (often family) must be told when there is an injury that may need a doctor, and the resident should be watched closely for the next 72 hours. An injury of unknown source must also be reported to the administrator and the state survey agency.
Should my parent go to the hospital after hitting their head?
The CDC says an older adult who falls should be checked by a health care provider, and blood thinners raise the risk of bleeding in the brain. A headache that gets worse and does not go away, repeated vomiting, confusion, or being very drowsy or hard to wake means 911 or the emergency room.
Is a nursing home responsible when my parent falls?
Not for every fall. It can be when it knew the resident was at risk and did not follow the care plan, left the resident unsupervised, ignored a call light, or delayed treatment after the fall.
How much does a nursing home abuse lawyer cost?
Beverly Law takes nursing home cases on contingency: the consultation is free and you owe no attorney fees and no costs unless we recover money for you.
Do I need a lawyer to report nursing home abuse?
No. Anyone can report abuse to CDPH, the long-term care ombudsman or police. A lawyer helps if you want the facility held financially responsible, and can preserve the chart, staffing records and video before they are lost.
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Important: This page reports findings from public records of the California Department of Public Health and the Centers for Medicare & Medicaid Services. A citation or deficiency is a regulatory finding by a government agency; it is not a court judgment and not proof of civil or criminal liability. Criminal defendants are presumed innocent unless proven guilty. Lawsuit allegations are claims, not findings. This page is general information, not legal advice, and reading it does not create an attorney-client relationship with Beverly Law. Attorney advertising. Prior results do not guarantee a similar outcome. Data as of: October 30, 2026.Methodology and corrections.
