Why Falls Prevention Is More Important Than Ever

On the first day of the American Association for Post-Acute Care Nursing’s (AAPACN) 2026 Quality Virtual Conference on Sept. 1, two of the group’s curriculum specialists tackled the ever-present danger of falls in skilled nursing facilities (SNFs) and why prevention and tracking of incidents is more important than ever.

Jessie McGill, RN, AAPACN’s senior curriculum development specialist, and Lauren Stenson, a nurse practitioner and curriculum development specialist, led the session, and first asked the question, why do falls matter so much?

“Falls are not just isolated incidents or quality measure events,” Stenson said. “They can affect a residence's health, confidence, mobility, independence, and overall quality of life. A fall can also reveal broader concerns related to clinical assessment, communication, staffing, the environment, or follow-through.”

Falls are also an organizational-level gauge of performance and of course impact a resident’s life in the facility.

“A fall can change much more than a resident's physical condition. It can change how safe they feel, how willing they are to move, and how much they participate in daily life. After a fall, some residents begin limiting their own activity. They may walk less, avoid the dining room, or stop attending activities, because they are afraid it could happen again,” Stenson said.

Making it Personalized

That loss of confidence can gradually lead to deconditioning, increased reliance on staff, and a smaller, more restricted daily routine.

“This is why fall prevention must be individualized. The goal is not to eliminate all movement or restrict residents in the name of safety. The goal is to understand each resident's risks, reduce preventable harm, and support the highest level of activity and independence possible,” Stenson said.

When a fall does occur and results in a major injury, she said the consequences can be immediate and long-lasting. Fractures, head injuries, and other serious complications, especially those leading to hospitalization, along with the associated pain and a prolonged recovery, are all part of the picture.

“Even after the resident returns to the facility, they may not return quickly to their previous level of function. Mobility can decline, weakness can increase, and more assistance may be needed with everyday activities,” Stenson said.

“Major injuries can also affect emotional well-being. Residents may lose confidence, become fearful of another fall, or withdraw from activities they previously enjoyed. This is why preventing major injury is about more than avoiding hospitalization. It's about preserving function, independence, and quality of life.”

Facility Impact

McGill focused her initial comments on the ramifications of a fall on a facility’s Quality Measures (QMs), and not just the most obvious measures, like falls and falls with major injury, but also those potentially impacting ADL outcomes, depression, emergency room visits, and rehospitalizations, which has a substantial impact on quality outcomes, publicly reported measures, and Five-Star QMs.

“The facility's performance on Care Compare is also viewed by residents’ families, and other stakeholders, which can impact our Medicare Advantage plan contracts, ATO partnerships, and hospital referrals,” McGill said. “However, the measures of falls is just part of the story. Falls often require additional assessments, care plan revisions, and evaluation of how those new interventions are being implemented. A pattern of falls may also point to opportunities involving assessment accuracy, medication management, staffing practices, environmental safety, rehab, toileting, and communication.”

For this reason, McGill explained, fall data should not be viewed simply as a number to manage. “It should be used to identify patterns, strengthen systems, and improve care. Ultimately, better fall outcomes support both resonant well-being and organizational performance. It requires a change in the culture of the facility, one that demonstrates commitment to preserving function, preventing avoidable harm, and delivering consistent person-centered care,” she said.

Top Down

To get ahead of quality curve on falls, it takes facility and organizational leadership to set the tone for how safety is understood and practiced.

“We need a culture that promotes continuous improvement to identify risks while putting meaningful interventions in place. A strong culture of safety begins when leaders make expectations clear, remain visible, and consistently reinforce that resident safety is everyone's responsibility,” McGill said.

“Staff should know what to report, when to speak up, and how concerns will be addressed. Just as important leaders must create psychological safety.

Staff are more likely to report a near miss, question a change in condition, or identify a system concern when they trust that the response will focus on learning and improvement rather than blame.”

Definitions in Play

McGill noted that since CMS measures falls and major injury by MDS data, “we need to look to the resident assessment instrument or REI User's Manual for these definitions.”

TMS, she said, defines a fault as an unintentional change in position, coming to rest on the ground floor or onto the next lower surface.

“For example, onto a bed, chair, or bedside mat, or the result of an overwhelming external force, such as a resident pushes another resident. If we break down these parts of the fall definition, we're not quite done yet, but first looking at unintentional change, this part of the definition clarifies that if the resident intentionally lowers himself to the ground, say to look under the bed to pick up an object, or really for any reason, as long as it was intentional, it's not a fall,” McGill said.

It has to be an unintentional change of position. The second part of this definition is the overwhelming external force.

Regulatory Push

She said before Oct. 1, 2025, overwhelming external force was specifically excluded from being included in a fall, but the recent change in definition changed that, and now specifically includes a fall related to overwhelming external force as a fall.

There is also the matter of CMS getting more interested in falls as it relates to the Special Focus Facility (SFF) program. In a memo released on Jan. 28, CMS told state survey agency directors that it is revising the SFF program to make falls more of a priority than staffing.

“This action is being taken following the Office of Inspector General’s Report, which highlighted the seriousness of nursing home resident falls and the importance of improving fall safety,” the memo said.

The SFF program focuses on nursing homes that have a persistent record of noncompliance leading to poor quality of care. CMS requires these persistently poorest performing facilities selected in each state to be inspected no less than once every six months, and that increasingly severe enforcement actions are taken when warranted.

At the time of the announcement, a leading expert on the SFF program said the move by CMS is substantial. “CMS’s revised SFF guidance represents a substantive shift from a structural, upstream measure [staffing] to a downstream outcome measure [falls with major injury] as the primary driver of facility selection,” said Steven Littlehale, chief innovation officer, Zimmet Healthcare Services Group.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.