Serious Falls Resulting in Hospitalization Among Medicare-Enrolled Nursing Home Residents, July 2022–June 2023

Why OIG Did This Review

• This data snapshot is being released as a companion to our report Nursing Homes Failed To Report 43 Percent of Falls With Major Injury and Hospitalization Among Their Medicare-Enrolled Residents (OEI-05-24-00180).
• That report found that nursing homes failed to report almost half of serious falls among Medicare-enrolled residents, as required, in resident assessments, leading to inaccurate nursing home fall rates on CMS’s Care Compare website.
• Because most nursing home residents in the United States are enrolled in Medicare, analysis of falls among Medicare-enrolled residents provides insights that are broadly relevant to nursing home safety.

What OIG Did

• Using Medicare hospital claims, we identified Medicare enrollees who experienced a hospitalization due to a fall with major injury during the 1-year review period from July 1, 2022, through June 30, 2023. We determined the subset of those enrollees who were nursing home residents at the time of the fall using Minimum Data Set (MDS) assessments.
• We then used the hospital claims and MDS assessments to describe the prevalence and outcomes of these serious falls; the demographic characteristics and risk factors of the residents who fell; and the characteristics of the nursing homes in which the falls occurred.

What OIG Found

• Medicare-enrolled nursing home residents experienced 42,864 falls with major injury and hospitalization and 1,911 residents died while hospitalized.
• Medicare and enrollees paid more than $800 million for the resulting hospital care.
• Most residents had fall risk factors identified by nursing homes prior to their falls.
• Female residents, older residents, and residents with short stays had the highest fall rates.
• Nursing homes with lower nurse staffing levels and lower quality ratings had higher fall rates.

What OIG Concludes

More than 40,000 Medicare-enrolled nursing home residents experienced serious falls—those resulting in major injury and hospitalization—over this 1-year review period. These falls reduced residents’ quality of life and were costly for the Medicare program. More robust fall prevention programs and other quality improvement initiatives can help reduce falls among nursing home residents.

More than 40,000 Medicare-enrolled nursing home residents experienced serious falls—those resulting in major injury and hospitalization—over this 1-year review period. These falls reduced residents’ quality of life and were costly for the Medicare program. More robust fall prevention programs and other quality improvement initiatives can help reduce falls among nursing home residents.