Nursing Home Falls and Fractures in Las Vegas

A fall is one of the most common ways a resident is seriously hurt in a care facility, and it is also one of the most commonly explained away. Families are told their mother slipped, that she was confused, that these things happen at her age. Sometimes that is true. Often it is not. This page looks closely at falls and the fractures that follow them; our overview of nursing home abuse and neglect claims in Nevada covers the other injuries that bring families to us.

Every Medicare- and Medicaid-certified facility in Nevada operates under federal rules requiring that the resident environment remain as free of accident hazards as is possible and that each resident receive adequate supervision and assistance devices to prevent accidents (42 CFR 483.25(d)). That is a duty to plan ahead. It is not a duty to react well after someone is already on the floor.

O'Reilly Law Group has practiced in Las Vegas since 1972. If a fall in a Nevada facility left your parent with a broken hip, a head injury, or a permanent loss of independence, you can call us at 702-382-2500 and we can discuss what the records may show. Nothing here is legal advice about your particular situation, and no result can be promised.

How a Preventable Fall Actually Happens

Falls in care facilities are rarely random. They cluster around a small number of predictable moments: getting to the bathroom at night, transferring from bed to wheelchair, standing up too quickly after a new blood pressure or sedating medication, or walking to the dining room without the walker that was left across the room.

Federal rules require a facility to know these risks in advance rather than discover them afterward. A baseline care plan must be developed within 48 hours of admission, and a comprehensive assessment must be completed within 14 calendar days after admission, repeated at least once every 12 months, reviewed quarterly, and redone within 14 days after the facility determines, or should have determined, that the resident's condition has significantly changed (42 CFR 483.21(a), 483.20(b)–(c)).

The assessment asks about falls directly. The federal Minimum Data Set records whether the resident fell in the month before admission, whether they fell in the two to six months before that, and whether they suffered any fracture related to a fall in the prior six months (items J1700A through J1700C). A resident who arrives with that history documented, and who is then left to walk to the bathroom alone at 3 a.m., raises a question the chart should be able to answer: whether the supervision actually provided matched the risk the facility had already written down.

Why a First Fall Changes Everything

In many of these cases the single most important fact is that the fracture was not the first fall.

A fall is a signal. It should prompt someone to ask why it happened: a new medication, a drop in blood pressure on standing, an unrecognized infection, a change in vision, unsafe footwear, a walker out of reach, a call light that went unanswered for twenty minutes. It should also prompt a fresh look at the plan of care, which the interdisciplinary team is required to review and revise after each assessment (42 CFR 483.21(b)).

When a resident falls a second and a third time and the care plan reads identically each time, that repetition is worth examining. It may indicate that the facility recorded a known risk and changed nothing about how the resident was supervised, toileted, or moved.

Alarms deserve a specific mention, because they are frequently offered as proof that something was being done. A cluster-randomized trial of nearly 28,000 patients in a single urban community hospital, published in Annals of Internal Medicine in 2012, found that a program that sharply increased bed-alarm use produced no difference in fall rates, injurious fall rates, or the number of patients who fell. That trial was conducted in a hospital rather than a long-term care facility, so its results do not transfer directly to the nursing home setting. It is still a reason not to treat an alarm as a complete answer: an alarm announces that someone is already standing, and it is not a substitute for a toileting schedule, an answered call light, or a person in the room.

Unwitnessed Falls and What the Records Should Show

Many falls in care facilities have no witness. That does not make them unknowable, and it does not shift responsibility onto the resident. Under the federal assessment manual, a fall is an unintentional change in position coming to rest on the ground, floor, or onto the next lower surface, and it counts whether it was witnessed, reported by the resident, or identified when a resident is found on the floor. The manual is explicit that if an individual is found on the floor, a fall is assumed to have occurred.

A fall that is handled properly leaves a paper trail. An incident record and the surrounding chart entries should show:

• The time the resident was found, by whom, and where in the room or hallway
• What the resident was attempting to do, in the resident's own words if they can give them
• Vital signs, a head-to-toe assessment, and neurological checks over the following hours, which matter enormously for a resident on blood thinners
• When the physician and the resident's representative were notified, which federal rules require immediately upon an accident involving the resident that results in injury and has the potential for requiring physician intervention, a significant change in the resident's physical, mental or psychosocial status, a need to alter treatment significantly, or a decision to transfer or discharge the resident (42 CFR 483.10(g)(14))
• What imaging was ordered, when it was read, and what it showed
• A post-fall review identifying a probable cause, and a care plan revision that actually differs from the previous version
• Consistent coding of the fall and its injury level on the next assessment (items J1800 and J1900)

Injuries of unknown source fall inside the federal abuse and neglect reporting rule. An allegation must be reported to the administrator and to the state survey agency no later than two hours after it is made if the events involve abuse or result in serious bodily injury, and no later than 24 hours if they do not. The results of all investigations must be reported to the administrator and to other officials in accordance with State law, including the State Survey Agency, within five working days of the incident (42 CFR 483.12(c)). Gaps in that sequence are themselves informative.

What a Hip Fracture Means for an Older Adult

Families are sometimes told that a fractured hip is a setback. In an older adult it is usually more than that. A 2025 narrative review of hip-fracture outcomes, available through the National Library of Medicine, reports one-year mortality in older adults commonly in the range of 15% to 30%, with fewer than half of survivors regaining their pre-fracture functional status. Those figures come from that single review rather than from a body of pooled research, individual outcomes vary a great deal with baseline health, and they describe populations rather than any one person.

Under the federal fall-reporting definitions, bone fractures, joint dislocations, closed head injuries with altered consciousness, and subdural hematoma are classified as major injury. Skin tears, abrasions, lacerations, superficial bruises, hematomas, sprains, and any fall-related injury that causes the resident to complain of pain are recorded separately as injury other than major.

This matters in two ways. Clinically, the harm is rarely the broken bone alone; it is the surgery, the immobility that follows, the delirium, the risk of pneumonia and pressure injury, and often a permanent move to a higher level of care. Legally, it means that a defense built on the phrase "she was already frail" has the argument backwards. Frailty is precisely the reason the fall-prevention plan existed.

The Nevada Law That Applies

Enhanced damages for older and vulnerable residents. NRS 41.1395 provides that if an older person or a vulnerable person suffers a personal injury or death caused by abuse or neglect, the person who caused it is liable for two times the actual damages incurred by the older person or vulnerable person. An older person is someone 60 years of age or older. A vulnerable person is someone with a physical or mental impairment that substantially limits one or more major life activities and who has a medical or psychological record of that impairment or is regarded as having it. The statute also provides that where it is established by a preponderance of the evidence that a liable person acted with recklessness, oppression, fraud or malice, the court shall order that person to pay the attorney's fees and costs of the person who brought the action.

The deadline, and why it is not simple. NRS 11.190(4)(e) sets a two-year limit on an action to recover damages for injuries to a person or for the death of a person caused by the wrongful act or neglect of another. But Nevada also has a separate chapter for professional negligence, NRS 41A, which carries its own limitation period and requires that the complaint be filed with a supporting expert affidavit under NRS 41A.071. For injuries occurring on or after October 1, 2023, NRS 41A.097(3) bars an action commenced more than three years after the date of injury or two years after the plaintiff discovers, or with reasonable diligence should have discovered, the injury, whichever occurs first. Earlier versions of that statute set different periods, so the date of injury matters. Skilled nursing facilities are staffed by people who do and people who do not meet the statutory definition of a provider of health care, so which framework governs depends on what actually went wrong. That is a reason to have a file reviewed early rather than near a deadline.

Regulators and advocates. Facilities in Nevada are licensed under NRS Chapter 449. Nevada's Long-Term Care Ombudsman and its advocates are authorized to investigate acts or policies that may adversely affect the health, safety, welfare or civil rights of residents and to enter facilities at reasonable times (NRS 427A.135), and retaliation against a person who files a complaint is prohibited (NRS 427A.138). Under NRS 200.5093, the professionals the statute lists — physicians, nurses, other licensed medical personnel and facility staff among them — who, in their professional or occupational capacity, know or have reasonable cause to believe an older person or vulnerable person has been abused, neglected, exploited, isolated or abandoned must report it as soon as reasonably practicable and no later than 24 hours. Family members are not on that mandatory list, but anyone may make a voluntary report.

What a Family Should Do Now

You do not need to decide whether to sue anyone in order to start protecting the record.

1. Request the complete chart in writing. A resident has the right to inspect their records within 24 hours of an oral or written request, excluding weekends and holidays. Copies are obtained by making a request and giving the facility two working days' advance notice, and the facility may charge a reasonable, cost-based fee (42 CFR 483.10(g)(2)). Ask for the whole file rather than a summary: assessments, care plans and every revision, nursing and physician notes, medication administration records, therapy notes, nursing assistant flow sheets, and the fall or incident report.
2. Write down what you were told. Note who said it, their role, and the date. Verbal accounts given in the first days often differ from what appears in the chart later.
3. Photograph the injury and the room. Bed height, the position of the walker or wheelchair, the call light, flooring, and lighting all change quickly.
4. Keep the admission packet intact. These packets sometimes include an agreement to arbitrate disputes. Bring all of it rather than only the pages you signed.
5. Raise the concern with the Ombudsman or the state. A regulatory complaint runs on its own track and does not replace a claim, but it creates a contemporaneous record.
6. Do not wait for the facility's internal investigation to finish. It may conclude that nothing went wrong. That conclusion is not binding on anyone, and the deadline keeps running while you wait.

If you want a second set of eyes on the records, you can reach O'Reilly Law Group at 325 South Maryland Parkway in the Nevada Professional Center, Las Vegas, Nevada 89101, or by phone at 702-382-2500. Nothing on this page is legal advice about your particular situation, and no result can be promised.

Terms you may hear

Fall

Under the federal assessment manual, an unintentional change in position coming to rest on the ground, floor, or onto the next lower surface such as a bed, chair, or bedside mat. It counts whether it was witnessed, reported by the resident or an observer, or identified when the resident was found on the floor.

Intercepted fall

A fall the resident would have taken if they had not caught themselves or been caught by another person. Federal guidance still treats this as a fall, which is why "she didn't actually go down" does not end the analysis.

Major injury

In federal fall reporting, bone fractures, joint dislocations, closed head injuries with altered consciousness, and subdural hematoma. Skin tears, abrasions, lacerations, superficial bruises, hematomas, sprains, and any fall-related injury causing the resident to complain of pain are recorded as injury other than major.

Baseline care plan

The initial written plan a nursing home must develop within 48 hours of admission, setting out the instructions staff need to provide effective and person-centered care while the full comprehensive assessment is being completed.

Significant change

A major decline or improvement in a resident's status that will not normally resolve itself without further intervention, that affects more than one area of health status, and that requires the interdisciplinary team to review or revise the care plan.