What to Do About Falls from a Wheelchair in a Nursing Home

What to Do about Falls from a Wheelchair in a Nursing Home. GettyImages

If your loved one has fallen out a wheelchair while in the nursing home, this is a situation to address right away by advocating that the proper safety measures be taken.

Between half and three-quarters of nursing home residents fall each year. (1) Patients often fall more than once. The average is 2.6 falls per person per year. (2) So, if one fall has occurred, it is likely to happen again.

There are many steps that can be taken to prevent falls in nursing homes.

The process begins with identifying the possible causes, putting a plan in place, and then getting the whole team on board to reduce the risk of another fall.

Causes of Falls From Wheelchairs

There are three general factors that cause falls from wheelchairs.

  1. Physical weakness or imbalance
  2. Confusion (This may be medication related or part of the advancing disease process.)
  3. Improper environmental fit (Read below for possible solutions to see the scope of this category.)

In many situations, all three factors may be present. A typical example of how a fall can occur is that the patient has slowly regressed in physical strength and mental capacities since they were last fitted for a wheelchair and assessed by the staff at the nursing home. Staff should be monitoring for decline, but sometimes it can be incremental enough to go unnoticed.

Your First Line of Defense- An OT and PT evaluation

As soon as one fall occurs, the best line of defense is to have the above categories assessed: cognition, physical weakness, and environmental fit.

In a typical facility, the physical therapist will assess the patient’s strength, gait, and ability to move from the wheelchair to another surface. An occupational therapist can also play a role in assessing these factors as well as the patient’s cognitive status, the fit of the wheelchair, and physical environment.

Suggestions for Fall Prevention From Wheelchairs

If the problem is with medication, the doctor will have to get involved to find a more appropriate option, during which time the patient will need increased supervision. After the evaluation, the therapists may have the following recommendations:

Increase level of assistance needed when patients stand from wheelchair

Every client in the nursing home should have documented how much assistance they need when standing from their wheelchair. Staff should know the status of each patient, which could range from independent to maximum assistance. With a fall, the level of assistance should increase until the patient is thoroughly assessed and a new level of assistance can be agreed upon.

Therapy program

If strengthen, imbalance, or some other client-related factor is at the core of the fall, the patient may benefit from a therapy program to address the decline. A short course of therapy may also be merited to introduce the patient to measures that are being put in place, such as those suggested below.

Seat alarm

A seat alarm sounds when a patient begins to stand up. This quickly alerts staff that the patient needs immediate assistance. The downside of these is that the alarm can be disorienting to patients and that it may be too late by the time staff arrives.

Drop seat

A drop seat changes the incline of the wheelchair seat from flat to having a slight incline toward the back. This is meant to make it more difficult to slide forward in the chair.

Reminders to patients and staff

This is a very simple measure, but posting a sign in the room to remind staff and the patient of safety precautions can go a long way in making sure everyone is on the same page. Examples may include (Please call for help when you need to stand; Please remember to remove leg rests from the wheelchair, as these are a tripping hazard.)

Rearrangement of room

If the patient fell reaching for an object on a lower shelf, it is time to rearrange the room so that the client doesn’t have to lean too far forward.

Provision of a reacher

A reacher can be a handy device to keep in a bag on the back of the wheelchair, if the patient has the flexibility to reach back and grab it. It can be used to grab small items such a tissues off the floor.

Changes to surfaces where patients transfer

Sometimes the problem is the destination the patient is leaving the wheelchair. Beds may be too high. There may not be enough grab bars in the restroom. A non-slip surface may be needed in the bathroom.

Why Not Use a Seat Belt?

Adding a seat belt to the wheelchair can seem like a good idea, but in the nursing home world, this precaution is counted as a restraint. Restraints have been shown to do more harm than good (3) and facilities try to avoid them at all cost, as they are rightly frowned upon by regulatory agencies. Whether the patient can easily unbuckle to seat belt and is aware of when it would be safe to do so, would likely be required in trying this option.

1.) Rubenstein LZ. Preventing falls in the nursing home. Journal of the American Medical Association 1997;278(7):595–6.

2.) Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Annals of Internal Medicine 1990;113(4):308–16.

3.) Castle NG, Engberg J. The health consequences of using physical restraints in nursing homes. Med Care 2009;47:1164-1173.

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