Falls are well-recognized as a serious risk to the health and well-being of nursing home residents. Due to their age and limited activity levels, many nursing home residents suffer from osteoporosis, or brittle bone disease, which predisposes them to suffering fractures, especially hip fractures as a result of nursing home falls. Hip fractures in turn often start a downward spiral which results in the wrongful death of the nursing home resident.
With all this in mind, fall prevention is one area which is specifically addressed during the care planning process. A fall risk assessment is one specific assessment which is done in determining the risks to the health and well-being of the resident. While there is no standard scale in use in the nursing home industry for fall risk in the way that the Braden Scale is used for assessing risk of developing bed sores, every well-done fall risk assessment tool includes incontinence as a risk factor to be considered in determining overall fall risk.
How does incontinence contribute to fall risk? The basic answer is that nursing home residents don’t want to soil themselves. This leads to them get up to go to the bathroom on their own when they need assistance. It leads them to hurry and not take the steps they need to take to assure their balance. And when they get there, they do not have help disrobing to actually be able to go to the bathroom without soiling themselves. In my practice, probably close to half the nursing home fall cases I have handled involve this kind of scenario.
Having a toileting schedule in place can help to reduce nursing home falls by eliminating this kind of scenario where a resident finds themselves needing to get to the bathroom, needing help, and not having it available.
There are two parts to developing a toileting schedule. The first step is performing what is called a bowel and bladder assessment. During this, aides track when and how the resident goes to the bathroom over a period of several days to try to see if there are recognizable patterns. Once the patterns are identified, the schedule is put into place so that aides know to take a resident to the bathroom during those times of day when the assessment indicates that they are most likely to need to go to the bathroom.
When correctly implemented, the resident should experience fewer episodes where they need to go to the bathroom, but do not have any help or assistance on getting there. In turn, this should reduce the risk of nursing home falls.
The difficulty with accomplishing this is that it takes considerable diligence on the part of the nursing home staff to get this done right. The assessment takes several days of regular observation and once in place, it must be followed day after day. Nonetheless, it offers an opportunity to address one of the more troubling factors which places residents at risk for developing bed sores.