🚨 The Silent Trigger Behind So Many Falls in Long-Term Care

🚨 Bathroom Attempts: A Leading Factor in Resident Falls in Long-Term Care

Hey boo hey 💕Let’s talk about something that every DON, ADON, RN Supervisor, and CNA has heard at least a thousand times:

“I rang that call bell and nobody came.”

And most of the time, when a resident is found on the floor — sitting frustrated by the bedside or lying halfway between the bed and the bathroom door — that’s the sentence that follows.

Not because staff don’t care. Not because we’re careless. But because bathroom urgency is real, and even 60 seconds can feel like eternity when your body isn’t as quick or stable as it once was.

For our residents, especially those who were fiercely independent just months ago, waiting for help with something as personal as toileting is emotional.

It stings. It reminds them that life has changed. And so instead of waiting, they try to do it themselves — and that’s when falls happen.

Bathroom attempts remain a leading cause of resident falls in long-term care.

Not weakness. Not wandering. Just needing to go to the bathroom and wanting dignity while doing it.

And as nurse leaders, we must address that with compassion and systems.

🧠 Prevention Starts on Admission

I say it all the time: Every outcome has roots. If we want fewer falls, we start with better assessments and proactive planning.

When a resident admits, our job isn’t just to collect data — it’s to use that information to prevent incidents before they happen.

We should know:

✔️ Incontinent patterns

✔️ Urgency vs. functional incontinence

✔️ Bowel/bladder frequency

✔️ Mobility and transfer status

✔️ Strength and gait

✔️ Assistive devices required

✔️ Need for toileting schedules

✔️ Proper footwear for ambulation

✔️ High-risk medications for dizziness or hypotension

And this part matters deeply:

During admission, determine whether the resident is likely to attempt toileting independently — especially if they have urgency, quick-transfer tendencies, or strong-willed personality traits.

Some residents will always “try first,” especially if they used the bathroom independently prior to admission. That insight alone can predict bathroom falls before they ever happen.

This information must turn into action:

• toileting plans

• staff reminders

• footwear checks

• assistive devices in reach

• staff education on call light urgency

• intentional rounding

We don’t react to falls — we prevent them.

🩺 Trend, Track, Tighten

I’ve reviewed more fall reports than I can count. Almost all of them tell a story if you look beyond the narrative:

• Was it during shift change?

• Were call lights heavy at that time?

• Did the resident ring more than once?

• Was there a pattern tied to diuretics?

• How many bathroom falls happen between 5pm–10pm?

  
  

Patterns are everything. Patterns give DONs the blueprint to fix the root.

But you can’t fix what you’re not tracking.

When you trend bathroom-related falls, you begin to see:

• Which halls need rounding support

• Which rooms require closer observation

• Which residents must be toileted before med pass

• Unsafe footwear patterns

• Which shifts show delayed call light response

• Behavioral cues that predict attempts

  
  

Data tells the truth. And then YOU — as the DON — build the solution.

And yes… surveyors pay close attention to this. They review falls and expect documentation that connects toileting triggers, call bell response, interventions, and prevention. They want to see proactive systems — not repeated patterns.

🪜 3 Quick Wins to Reduce Bathroom-Related Falls

Here are simple interventions that prevent falls BEFORE they happen:

✔️ Proactive toileting before and after meals This reduces urgency spikes and prevents “I’ll do it myself” moments.

✔️ Ensure assistive devices are always in reach if appropriate. Walkers, gait belts, and transfer tools should never be on the opposite side of the room.

✔️ Build toileting into your rounding routine Instead of asking “Are you okay?”, ask: “Do you need the bathroom before I leave?”

It’s simple. It’s prevention. It’s dignity.

🧩 The Call Bell Matters

One-minute feels like ten when you’re trying to get to the bathroom. And ten minutes feels like forever.

Answering call bells faster isn’t only courtesy —it’s fall prevention. It’s dignity. It’s regulatory compliance. It’s the DON doing their job well.

Surveyors ASK about call lights. Surveyors OBSERVE response times. Surveyors READ toileting plans on the care plan.

And they want to see prevention woven into your system — not a stack of fall incident reports proving you reacted after the fact.

🦾 Leadership Means Anticipation

We don’t wait for a fall to tell us what we should’ve been trending.

We lead proactively:

• 3-day bowel/bladder reviews

• medication side-effect audits

• proactive toileting timing

• footwear rounds

• rounding frequency

• documentation alignment

• communication patterns at shift change

  
  

And most important: We educate the team on WHY quick response matters.

Sometimes just sharing the truth —“That bathroom attempts are a leading cause of resident falls in LTC.”— is enough to shift staff urgency.

Purpose fuels compliance.

📝 Ready to Track, Trend, and Tighten?

If you’re a DON looking to strengthen fall prevention, trend patterns, and use data to build proactive solutions…

I created tools for that very reason. DON 2026 Planner by @bilquisbali | Stan

Because preventing falls isn’t luck —it’s leadership.

And the system becomes clearer when you have a tool that keeps you organized, consistent, and survey-ready every single day.

Lead with prevention. Lead with intention. Lead with love.

And before you go boo, let me ask you this as a reflection point:

When was the last time you reviewed your fall logs and identified how many were tied to bathroom attempts?

If that answer isn’t clear — the work begins today 💜

Yourfavnurseleader

Bilquis Ali