Falls with major injury impact care quality and star ratings—learn how to reduce risk, respond effectively, and improve outcomes.
In long-term care, resident safety is a top priority. While comprehensive assessments and proactive interventions play a vital role in fall prevention, it is important to acknowledge that not all falls can be prevented due to the complex medical and functional needs of the population we serve.
Today, we’re focusing on the Long-Stay Quality Measure: Falls with Major Injury—a publicly reported quality measure that significantly impacts a facility’s Five-Star Quality Rating. This measure tracks the percentage of long-stay residents who experience falls resulting in major injury, including fractures, dislocations, closed head injuries with altered consciousness, or subdural hematomas.
Why It Matters
Falls with major injury can lead to life-altering consequences—loss of mobility, independence, hospitalization, and even mortality. CMS prioritizes this measure because it reflects real harm and long-term outcomes, not just processes. It remains visible on quality reports for up to 12 months, driving transparency, accountability, and continuous improvement.
Risk Factors to Consider
Falls are typically caused by a combination of:
- Intrinsic factors: Weakness, cognitive impairment, chronic illness, and medication side effects.
- Extrinsic factors: Environmental hazards, inadequate lighting, poorly maintained equipment, and insufficient supervision.
Prevention Starts with Teamwork
Reducing fall risk requires a proactive, interdisciplinary approach:
- Conduct thorough risk assessments upon admission and regularly thereafter.
- Review medications, monitor cognitive and physical changes, and ensure safe environment.
- Develop individualized care plans with input from nursing, therapy, providers, and families.
- Routine therapy screening and implementation of therapy services to optimize residents’ balance, strength, and proper use of assistive mobility devices.
Responding to a Fall
When a fall occurs, the team must act swiftly and thoroughly. Best practices include:
- Conducting post-fall huddles and root cause analysis
- Implementing or updating therapy programs
- Modifying environments to prevent recurrence
- Educating staff and engaging residents and families in prevention strategies
- Actively updating care plans to reflect immediate interventions
Documentation Matters
Accurate MDS coding, especially in Section J1900C, ensures data integrity and proper quality measure reporting. Documentation should be timely, well-supported, and regularly reviewed to identify trends.
A Strategic Tip
If permitted by state guidelines, consider scheduling an MDS assessment near or after day 276 following the triggering MDS to help the fall with injury roll off the measure as efficiently as possible without compromising accuracy.
Looking Ahead
Falls with major injury remain a focus for CMS because they reflect critical aspects of care quality. By addressing this measure thoughtfully, facilities not only protect their ratings—they protect their residents’ well-being.
Stay tuned for next month’s "Quality Measure Drill Down" spotlight, where we will continue exploring practical strategies to support strong outcomes across your facility.
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