Keeping a Step Ahead of Liability

According to the National Safety Council, more than 30,000 people over the age of 65 are seriously injured in a fall each week, and nearly 250 die from their injuries. Of those who survive a fall, 20 to 30 percent suffer from debilitating and sometimes lifelong injuries. Even non-injurious falls may begin a downward spiral of fear, resulting in decreased mobility, independence and quality of life.

The Centers for Disease Control and Prevention (CDC) report that one-third of adults aged 65 and older fall each year, with half to two-thirds of these accidents occurring in or around the home. CNA HealthPro claims data indicate that for the years 2003-2008, patient injury due to a fall in the home was the most common liability allegation resulting in paid claims against home care providers.

Clearly, reducing the incidence and consequences of falls is a risk control priority. This edition of Home Care Briefing™ examines three core elements of a home care fall-reduction program: risk assessment, staff education and post-incident response.

Risk Assessment

During the initial visit, thoroughly evaluate the client’s condition and home environment, while educating them and their families about risk and basic safety strategies. The assessment process should incorporate the following measures, among others:

Utilize a fall risk assessment tool to assess the client’s level of risk and identify potential contributing factors, including:

  • Environmental hazards
  • Previous fall history and associated injuries
  • Need for mechanical and/or human assistance
  • Use of prescription and over-the-counter medications
  • Gait and balance disturbances
  • Foot and leg problems
  • Reduced vision
  • Medical conditions and disabilities
  • Cognitive impairment
  • Bowel and bladder dysfunction
  • Special toileting needs

Refer higher-risk clients to their physician for a more thorough assessment. These include clients who experience recurrent falls or have multiple risk factors.

Conduct a home safety check and recommend corrective actions to be completed as part of the service agreement.

Ensure that direct care staff are involved in client assessment and reassessment efforts, as they are in the best position to observe changes in condition requiring evaluation and possible modification of services.

Once the assessment process has been completed and the findings incorporated into the service plan, document all measures taken and the rationale for their implementation. In the event of future litigation, these records will be critical to defense efforts.

Staff Education
In-service programs should focus on both skills training–e.g., how to use gait belts and assist with transfers–and examining the extent, causes, consequences and prevention of falls. Emphasize, among other points, the need for caregivers to:

  • Assess clients’ condition at every visit
  • Report changes to supervisor and family in a clear and timely manner
  • Perform frequent home safety checks
  • Reinforce fall-reduction tactics with clients and family
  • Encourage clients to ask for assistance with risky tasks
  • Implement sound documentation practices

Supervisors should recognize the emotional impact a client fall can have on caregiver staff and be prepared to provide appropriate support.

Post-incident Response
Staff diligence and pre-emptive risk assessment can reduce but not eliminate the possibility of falls. To reduce long-term exposure, it is necessary to thoroughly review incidents, analyze trends and measure the effectiveness of safety efforts.

Post-fall analysis should:

  • Describe the circumstances of the fall
  • Identify major causal factors, both personal and environmental
  • Indicate client’s functional status before and after the fall
  • Note medical co-morbidities
  • List names of witnesses
  • Suggest interventions to prevent or mitigate future falls

To protect the organization, all post-fall documentation should be incorporated into quality assurance and/or incident reporting programs. Reducing the frequency and severity of falls is a major component of any risk control program. By focusing on assessment, education and ongoing quality improvement, home care providers can help keep their clients on their feet and their liability exposure under control.


The following websites provide a range of information on fall and injury prevention and gerontological health:

In addition, visit the CDC National Center for Injury Prevention and Control (NCIPC) for information on multifaceted intervention strategies and community based fall reduction programs.

The information, examples and suggestions presented in this material have been developed from sources believed to be reliable, but they should not be construed as legal or other professional advice. CNA accepts no responsibility for the accuracy or completeness of this material and recommends the consultation with competent legal counsel and/or other professional advisors before applying this material in any particular factual situations. This material is for illustrative purposes and is not intended to constitute a contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions and exclusions for an insured. All products and services may not be available in all states and may be subject to change without notice. Use of the term “partnership” and/or “partner” should not be construed to represent a legally binding partnership. CNA is a registered trademark of CNA Financial Corporation. Copyright ©2010 CNA. All rights reserved.