The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities

Appendix B17: Handout for Inservice #1, Why Falls Happen in Nursing Facilities


  • About half of all residents in nursing facilities fall every year.
  • 30-40% of the residents who fall in nursing facilities fall at least twice.
  • One in every ten residents has a serious injury from a fall, such as a fracture, laceration, or serious head injury.
  • One of the most serious injuries from falls is hip fracture.
  • Falls result in a decrease in the resident's quality of life, an increase in staff time and effort, added costs of medical treatment, and an increase in the nursing facility's costs to settle legal claims.

There are many reasons why residents fall. These reasons are called fall risk factors. Many of these we can change.

Fall Risk Factors We Can Change

Residents' Living Space and Personal Safety

  • Clutter, uneven floors and raised thresholds
  • Broken bed wheel locks, poor lighting
  • Unstable furniture, hard to reach personal items
  • Loose handrails and toilet seats, unsafe footwear and poor foot care

Residents' Transfer and Mobility

  • Unsafe transfer and walking without staff assistance
  • Lack of handrail support in bathroom
  • New admissions or health declines
  • Incorrect height of transfer points
  • Hard-to-manage clothing
  • Unsafe behavior


  • Poor maintenance and repair, wheelchair seating problems
  • Improper wheelchair fit, sharing wheelchairs among residents

Psychotropic Drugs

  • Use of benzodiazepines such as Ativan and Xanax
  • Use of antipsychotics such as Haldol and Risperdal
Page last reviewed October 2014
Internet Citation: Appendix B17: Handout for Inservice #1, Why Falls Happen in Nursing Facilities. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.