The Impact of Falls on Length of Stay in Care Homes

A fall can be a turning point in a resident's life. Some residents recover quickly, while others experience lasting declines in wellbeing, require more care, or ultimately leave the care home.

Understanding how residents' lives change after a fall is the first step toward better support. At Teton, we make the point of care machine-readable. Our technology continuously monitors residents' activity, wellbeing, and interactions with care staff, giving us a unique view into how care needs change over time. By analysing this data across more than 100 care homes, we can study what happens after a fall at a scale and level of detail that traditional care records alone cannot provide.

Our analysis reveals three important findings.

• Repeat falls are strongly associated with residents leaving their care home. Within six months, 32% of residents who fell repeatedly left the care home, compared with 15% of residents who did not fall.
• Long lies after a fall are linked to similarly poor outcomes. Residents who spent 30 minutes or more on the floor were nearly twice as likely to leave the care home as those who spent less time on the floor.
• Falls can also mark the beginning of a lasting increase in care needs. Some residents need substantially more staff time and experience declines in wellbeing. Others recover to their previous levels.

Together, these findings show why understanding what happens after a fall is just as important as detecting the fall itself.

In this study, move-outs include the resident moving to another setting, recorded passings and departures with no recorded reason.

Are residents who keep falling more likely to move out?

Repeat fallers make up about 10% of residents, but they account for 79% of all falls.

Residents who fell repeatedly were more likely to move out of the care home than those who fell once. Among residents who had a second fall within two weeks, 32% moved out over the following six months. This compared with 18% of residents who fell once and 15% of residents who did not fall.

Residents who spend longer on the floor face worse outcomes

Residents who spent 30 minutes or more on the floor after a fall were about twice as likely to move out as similar residents who spent less than 30 minutes on the floor.

By six months, 30% of residents with a long lie had moved out, compared with 16% of residents who spent less than 30 minutes on the floor. They were already spending more time in bed in the week before the fall. In the first two weeks after, they averaged about 38 minutes more a day than matched residents. They were also more likely to fall again within 14 days: 42% compared with 27% of residents who spent less than 30 minutes on the floor.

Across all our sites, Teton reduces long lies on the floor after a fall by 96%. We collect four weeks of baseline data after installation, before staff start using the system. This lets us compare outcomes before and after staff start using Teton.

How do care needs change after a fall?

After their first fall, residents needed more care, spent longer in bed and had lower wellness scores. The wellness score is a single measure of a resident's wellbeing, built from the data Teton collects (activity, gait, sleep, respiration and more) and grounded in clinical standards for health. In the measures we tracked, we did not see a clear decline before the fall.

This suggests a fall may be a turning point in a resident’s health, rather than simply a sign of decline already underway. Some residents recovered. Others had not returned to their previous level by three months.

On average, a first fall added about 1.5 hours of staff time in total, across the day of the fall and the two weeks after it, compared with non-fallers. Below, we show how daily staff time changed in the month before a first fall and the two weeks afterwards.

For residents who later moved out, the rise was much steeper. In the two weeks after their fall, daily staff time rose from about 65 to 88 minutes. These residents spent about 1.2 more hours in bed each day, and their wellness score dropped by about 5 points.

An early decline did not always mean a resident would move out. Residents who later recovered showed similar increases in time in bed and declines in wellness score to those who moved out. But they needed only 7 extra minutes of staff care a day, compared with 23 minutes for those who moved out.

For residents who fell and later moved out, the increase in care continued beyond the first two weeks. Over the rest of their stay, these residents needed around 21 extra hours of staff care compared with their usual care needs before the fall. Their remaining stay averaged about six weeks. Some residents stayed in the home but experienced a lasting decline. In the second and third months after their fall, they needed about 11 extra minutes of staff care a day compared with the month before the fall. They also spent longer in bed and had lower wellness scores.

Residents also remained at risk of another fall beyond the first two weeks. Among those who stayed in the home and had not fallen again during those two weeks, about 35% fell again before three months.

When are residents most likely to fall?

Residents are most likely to fall in the first weeks after moving in. In their first few days, new residents' fall rate was about twice what it became once they'd settled. Half of that extra risk had gone by about two weeks and most of it by four weeks, and the fall rate levelled off at around two months. About 20% of new residents fell within their first four weeks.

A fall soon after moving in was also more likely to be followed by another. About half of residents whose first fall came in their first week fell again within two weeks. That dropped to about a third for first falls in weeks two to four, a quarter between one and three months, and a tenth after that.

Clinical leads, including Kim Elliott, point to unfamiliar surroundings and changes in medication as possible reasons, though we didn't measure either as part of this study. Earlier studies have also found a higher fall risk after admission or a move.¹

Below, we show how residents' fall rate changed in the months after moving in. We grouped falls by week and measured the rate per 1,000 resident-days.

Although residents were more likely to fall soon after moving in, these early falls were not clearly linked to leaving the care home. Within three months, 36% of residents who fell early had left, compared with 25% of those who had not fallen. Most of this difference reflected which home residents lived in. When we compared residents within the same home, the gap narrowed to about four extra departures per 100 residents. This difference was too small to draw a firm conclusion. Unlike repeated falls, an early fall after moving in was not a clear warning sign for leaving.

Below, we compare residents who fell in their first four weeks with those who did not. All were still living in the care home after those four weeks. We then tracked who moved out.

What does this mean for care homes?

Our customer success team works with care-home leaders on three priorities:

• Treat the two weeks after a first fall as a watch window. A second fall in that time was the clearest warning sign we found. Repeat fallers make up about 10% of residents but account for 79% of falls.
• Don't stop watching after the first fortnight. About 35% of residents who got through the first two weeks without another fall still fell again before three months, and some declined slowly over months two and three.
• Reduce long lies. Long lies are linked to worse outcomes after a fall. Fall detection technology can almost eliminate these.

August Health published a similar look at the 90 days that's worth a read. Teton integrates with August Health.

Common questions about falls and move-outs