Plan for overnight toileting and transfers

Start with what the resident typically does at night. Do they get up as soon as they feel the urge to use the bathroom? Do they usually call for help, or are they used to walking there on their own? Ask the resident and the overnight team what happens in practice, then use that information to review the care plan.

Walk the route from bed to bathroom with the night team. Check whether the resident can reach the call light, whether the path is clear and adequately lit, and whether the right mobility aid is available. If the resident needs help, specify which parts of the transfer require assistance and what staff should do if those needs change.

If a resident repeatedly gets up without the planned assistance, review what happened before each attempt. A resident who cannot reach the call light needs a different response from one who can reach it but often needs to use the bathroom before help arrives. Agree on a change the overnight team can carry out, then check whether it makes the transfer safer for the resident.

Source: AHRQ’s On-Time Falls Prevention materials for nursing homes

Reassess fall risk when a patient arrives or returns from the hospital

A patient may have walked to the bathroom independently at home and now need hands-on help after a hospital stay. On admission or return, review the hospital handoff and confirm what the patient can do safely today. Check how much help they need to get out of bed, stand, transfer, and use the bathroom, along with any equipment or mobility restrictions documented in the handoff.

Turn that assessment into instructions the next shift can use. Specify the level of assistance and equipment needed for each activity. For example, if the assessment calls for one-person assistance and a walker for the bed-to-bathroom transfer, spell that out in the care plan and shift handoff.

Include the patient in the conversation. Ask how they usually get up at night, show them how to call for help, and check that they can reach the call light from bed. As their mobility changes during rehab, update the plan and pass the new instructions to the next shift.

Source: AHRQ’s On-Time Falls Prevention materials for nursing homes

Use the first fall to prevent the next one

Once the resident has been assessed and immediate care needs have been addressed, reconstruct what happened. Ask the resident, when possible, what they were trying to do. Ask the staff who responded what they observed. Note the time, location, activity, and any recent changes in the resident’s condition or level of assistance.

Use what you learn to make a specific care-plan change. For example, if a resident fell while reaching for a walker from bed, have nursing and therapy review where the walker should be placed and what assistance the resident needs before standing. Give the next shift clear instructions about what changed and who will follow up.

Check the change on the shift when the fall occurred. Could staff carry out the revised plan? Did the same unsafe attempt happen again? Use what you observe to decide whether the plan needs another adjustment.

Source:  AHRQ Falls Management Program for Nursing Facilities — Fall Respons

What does F689 mean for fall prevention in skilled nursing facilities?

Under F689, skilled nursing facilities must keep the resident environment as free of accident hazards as possible and provide each resident with adequate supervision and assistive devices to prevent accidents. CMS guidance calls for identifying risks, putting interventions in place, and checking whether they work.

To see what that looks like in practice, pick one resident’s fall-prevention plan and follow it across shifts. Can staff explain what assistance the resident needs today? Is the equipment available where it’s needed? If the resident has fallen again, can the team explain what changed and how they checked whether it helped?

If you’re getting ready for a survey, use our 2027 CMS recertification survey preparation guide for skilled nursing facilities to review repeat falls, care-plan updates, and transitions of care.

CMS State Operations Manual, Appendix PP — F689 guidance

How can skilled nursing teams tell whether fall prevention is working?

Track all falls, repeat falls, and falls with major injury. Review where and when they occur and what the resident was doing. Look at short-stay rehab and long-stay care separately so a facility-wide total doesn’t hide a recurring problem on one unit or shift.

Pair those outcomes with a check on how care is delivered. If the team revised an overnight toileting plan, ask whether staff knew about the change, could provide the planned assistance, and saw fewer attempts to get up without help. If falls continue, use what staff and residents observed to decide what to change next.

Bring recurring patterns to the facility’s Quality Assurance and Performance Improvement (QAPI) team. Give each change an owner and a review date so the team can see whether it was put into practice and whether it helped.

AHRQ Falls Management Program for Nursing Facilities — Monitoring Progress

What does the evidence say about preventing falls in skilled nursing?

A Cochrane review found that fall-prevention programs probably reduce both the rate of falls and the risk of falling when they tailor interventions to each resident’s circumstances and involve facility staff in putting them into practice.

For a skilled nursing team, that means starting with what puts a particular resident at risk. A short-stay rehab patient who now needs help standing after a hospital stay may need a different plan from a long-stay resident who repeatedly gets up to use the bathroom overnight. Ask the staff who will carry out the plan what they observe and what they can reliably do on their shift.

Cochrane review — Interventions to prevent falls in older people in care facilities

How can continuous monitoring support fall prevention in skilled nursing?

A resident’s overnight routine can change between scheduled checks. A short-stay rehab patient may start getting out of bed more often as they regain mobility. A long-stay resident may begin making more trips to the bathroom than usual. Seeing those changes gives the care team a reason to check whether the resident’s current plan still fits their needs.

Zemplee uses camera-free, wearable-free sensors to help staff see changes in bed activity and room movement. If a resident starts getting out of bed more often overnight, the night team can share that pattern at handoff. Nursing and therapy can then assess what has changed and decide whether to adjust toileting support, transfer assistance, or supervision.

Start with one resident and one shift

At your next huddle, choose a resident who recently returned from the hospital or has had a repeat fall. Ask the staff on the shift when the resident is most likely to need help to walk through the current plan. Check whether they can find the instructions, access the equipment, and provide the planned assistance when it’s needed.

If you find a gap, agree on one change, give someone responsibility for it, and set a date to check whether it helped.

Frequently Asked Questions About Fall Prevention in Senior Living

A More Proactive Approach to Fall Prevention

Fall prevention is most effective when care teams can see more than individual incidents. Understanding each resident’s normal patterns — and recognizing meaningful changes in movement, sleep, bathroom activity, health status, and daily routines — can provide valuable context for earlier assessment and intervention.

Zemplee gives senior living communities an additional layer of visibility through passive, camera-free monitoring. By helping care teams recognize changes between staff interactions, Zemplee supports more proactive resident oversight while preserving privacy and keeping caregivers at the center of care.