Fall Risk Assessment

The current OASIS, OASIS-E2, has no item asking whether a fall risk assessment was done; its manual lists the MAHC-10 fall risk tool as a resource. A multi-factor tool looks across contributors such as fall history, mobility and balance, medications, and cognition, not a single gait observation. Commonly used tools include the MAHC-10 (Missouri Alliance for Home Care), the Timed Up and Go (TUG), and Tinetti-based assessments. At transfer, death at home, and discharge, Section J items capture whether the patient fell since the most recent start or resumption of care and whether falls caused injury, which turns fall events themselves into reportable data.

Falls are among the most consequential adverse events in the home setting: they drive fractures, head injuries, ER visits, hospitalizations, and the functional decline that follows immobility and fear of falling. The home environment adds hazards a facility never has, loose rugs, stairs, poor lighting, pets, and bathrooms without grab bars, while polypharmacy contributes through orthostatic hypotension, sedation, and dizziness. A fall-related hospitalization also lands in the agency's claims-based measures, so prevention is one of the places where patient safety and measured performance point in exactly the same direction.

A documented risk score that changes nothing is a survey finding waiting to happen. High risk should trigger visible responses in the plan of care:

• Therapy referral for gait, balance, and strengthening when indicated
• A home safety evaluation addressing lighting, pathways, rugs, and bathroom equipment
• Medication review targeting sedatives, antihypertensives, and other fall-contributing drugs
• Patient and caregiver teaching on safe transfers, footwear, and assistive device use
• Escalation and re-screening after any fall or near-fall during the episode

Surveyors and auditors read the chart for exactly this linkage: risk identified, interventions planned, interventions delivered.

The recurring failures are process-shaped. Clinicians document a score but never translate it into interventions. Agencies use a homegrown checklist that is not a validated tool. Re-screening never happens after a mid-episode fall, so the care plan reflects admission risk, not current risk. Falls during the episode go uncaptured until the discharge assessment forces the question, hiding events QAPI should have reviewed in real time. The fix is a closed loop: validated screening, care plan response, event reporting, and QAPI review of every fall with injury.