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

Nurse pushing patient in wheelchair

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

Up to a quarter of all nursing home falls requires admission to a hospital. Patients often fall more than once. The average is 1.5 falls per person per year. 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

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

In many situations, all three factors mentioned above 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 a decline, but sometimes it can be incremental enough to go unnoticed.

An OT and PT Evaluation Is Your First Line of Defense 

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 their 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 the 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 the level of assistance needed when patients stand from a 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 strength, 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.

Wheelchair alarm: A wheelchair alarm sounds when a patient begins to stand up. This quickly alerts the 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 as tissues off the floor.

Changes to surfaces where patients transfer: Sometimes the problem is the destination that the patient is leaving the wheelchair for. 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 and facilities try to avoid them at all costs, 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.

2 Sources
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  1. Vu MQ, Weintraub N, Rubenstein LZ. Falls in the nursing home: are they preventable? J Am Med Dir Assoc. 2004;5(6):401-406. doi:10.1097/01.JAM.0000144553.45330.AD

  2. Centers for Medicare & Medicaid Services. Release of report: “Freedom from unnecessary physical restraints: two decades of national progress in nursing home care”.

By Sarah Lyon, OTR/L
 Sarah Lyon, OTR/L, is a board-certified occupational therapist and founder of OT Potential.