Falls are one of the most common—and most preventable—sources of serious injury in nursing homes. Across Winston-Salem and throughout North Carolina, families trust long‑term care facilities to keep elderly residents safe, supervised, and properly assisted with mobility. Yet thousands of residents fall each year, often because facilities fail to follow basic safety protocols. When a fall happens, the consequences can be life‑altering: hip fractures, brain bleeds, spinal injuries, permanent disability, or even wrongful death.
This guide explains when a North Carolina nursing home may be legally responsible for a fall, what duties the facility owes under state and federal law, the common causes of preventable falls, what evidence matters in a legal claim, and what families should do after a loved one is injured.
Key North Carolina Statistics On Falls For Older Adults
In a 2024 study conducted by the UNC School of Medicine, “falls caused 1,727 deaths and over 138,000 ED visits among North Carolina older adults in 2023.”
The North Carolina Department of Health and Human Services reports that in every year from 1999 to 2019, falls are the number one cause of injury death for individuals 65 and older. From 2010-2019, the death rate from falls has increased 59.6 percent for all ages, and 27.6 percent in the 65 and older population. Rates of non-fatal fall injuries are also on the rise, with a 226.7% increase in fall-related hospitalizations and a 25.8% increase in ED visit rates among the 65 and older population (2010-2019).
Why Nursing Home Falls Occur
Most nursing home falls are not “accidents” in the traditional sense. They happen because safety rules were ignored or because staffing and supervision were inadequate. Common systemic problems include:
1. Chronic understaffing
When too few aides are responsible for too many residents, staff cannot respond promptly to call bells, bathroom requests, or mobility needs. Residents attempt to walk on their own—often with disastrous results.
2. Poor training or lack of supervision
Untrained aides may use unsafe transfer techniques, fail to monitor high‑risk residents, or leave residents unattended in unsafe positions. Many falls occur during transfers, toileting, or hallway ambulation when staff cut corners.
3. Failure to conduct or update fall‑risk assessments
Under the North Carolina Administrative Code, nursing homes must assess each resident’s fall risk and update that assessment after any significant change in condition. Many facilities perform superficial assessments—or fail to update them—leaving high‑risk residents without necessary protections.
4. Unsafe facility conditions
Falls frequently occur because of:
- Wet or slippery floors
- Poor lighting
- Missing handrails
- Cluttered hallways
- Broken or unstable furniture
- Improper bed heights
Facilities must maintain safe premises, yet basic hazards often go uncorrected.
5. Ignoring prior falls
A prior fall is a red‑flag event that requires a full care‑plan revision. When facilities do nothing—or merely “chart the fall”—residents remain at high risk.
Legal Duties of North Carolina Nursing Homes
Under federal law, state regulations, and the North Carolina Administrative Code, nursing homes must protect residents from foreseeable harm. This includes the duty to:
- Conduct comprehensive fall‑risk assessments
- Implement individualized fall‑prevention care plans
- Provide safe mobility assistance
- Supervise residents according to their needs
- Maintain safe, hazard‑free premises
- Ensure adequate staffing at all times
- Properly train all employees in safety and transfer techniques
- Investigate and document every fall event
A failure to comply with any of these duties may constitute negligence.
When a Nursing Home Is Legally Responsible for a Fall
A nursing home may be liable when its actions—or failure to act—directly contribute to a resident’s fall. Examples include:
Failure to follow or create a care plan
If a care plan calls for two‑person transfers, bed alarms, grab bars, or supervision and staff ignore these requirements, the facility can be held responsible.
Ignoring call bells or leaving residents unattended
Many falls happen when residents wait too long for help and try to move on their own.
Inadequate staffing
Low staffing levels often violate state requirements and are a major factor in liability. A facility that chooses to understaff to save money may be responsible for resulting injuries.
Lack of safety devices
Facilities must provide walkers, wheelchairs, non‑skid footwear, bed alarms, chair alarms, and other tools when appropriate. A lack of these devices is strong evidence of negligence.
Unsafe conditions
If a fall occurs due to wet floors, broken equipment, or poor lighting, the nursing home may be liable for failing to maintain safe premises.
Delayed or improper response after a fall
Failure to properly monitor, check for injuries, call emergency services, or notify family can worsen outcomes and indicate systemic neglect.
Common Types of Injuries from Nursing Home Falls
Falls can cause severe and permanent injuries, including:
- Hip fractures
- Pelvic fractures
- Traumatic brain injuries (including subdural hematomas)
- Spinal fractures
- Shoulder and wrist fractures
- Internal bleeding
- Skin tears and lacerations
- Wrongful death
Elderly residents often decline rapidly after a fall because healing is difficult and complications arise quickly.
Evidence Used to Prove Negligence
A strong legal claim requires a detailed investigation. Key evidence may include:
Incident reports
Facilities sometimes minimize what happened, so obtaining the full report promptly is important.
Medical records
Documentation may show prior falls, mobility limitations, medication issues, dehydration, infections, or other conditions contributing to fall risk.
Staffing schedules and logs
These records may reveal dangerously low staffing levels at the time of the fall.
Surveillance footage
Video from hallways or common areas can show what really happened—but must be preserved quickly.
Care‑plan documentation
A lawyer will examine whether the facility created, updated, and followed an appropriate plan.
Witness statements
Other residents, visitors, or staff may provide insight into what occurred.
Regulatory violations
Prior citations from the North Carolina Division of Health Service Regulation (DHSR) can demonstrate a pattern of unsafe conditions. Also, the NCDHHS may have investigated your particular case and issued a Statement of Deficiencies, which can also serve as evidence of negligence.
What Families Should Do After a Nursing Home Fall
If your loved one has suffered a fall, take these steps as soon as possible:
- Photograph injuries, assistive devices, and the area where the fall occurred.
- Request immediate medical evaluation, preferably outside the facility.
- Ask the facility for a copy of the incident report.
- Document all conversations with staff.
- Contact an attorney before the facility alters records or memories fade.
How a Lawyer Helps
Falls in nursing homes are often preventable. An experienced attorney will:
- Preserve critical evidence before it disappears
- Obtain internal facility records the nursing home will not voluntarily provide
- Consult medical and nursing experts
- Identify regulatory violations
- Build a case that demonstrates the facility’s negligence
- Pursue compensation for medical expenses, pain and suffering, and wrongful death if applicable
Your Loved One Deserves Protection
A fall should never be brushed off as “just an accident.” When a resident falls in a nursing home, it is often a symptom of deeper systemic neglect.
If your loved one suffered a fall in a North Carolina nursing home, the Law Office of Kevin J. Williams can help. We represent families throughout Winston‑Salem and surrounding counties who need answers, accountability, and justice.
Contact our office today for a free consultation.
Learn more about how Kevin J. Williams Law can help you navigate the complexities of nursing home and assisted living facility negligence.
