Falls in Memory Care: How Many Are Normal, and Who Calls You?

Lilisity · October 26, 2026

There is no normal number of falls in memory care. Falls are common in older adults, and dementia raises the risk. The CDC reports that more than one in four older people fall each year, and that falling once doubles the chance of falling again. A community can do everything right and your parent may still fall.

What you can expect is a good response every time: someone checks your parent for injury, a nurse or doctor is told, you are called the way the care plan says you will be, and the staff look for the cause and change something. If you found out about a fall from the emergency room or from a bruise on a visit, that is worth a calm, direct conversation with the community this week.

Why falls happen so often in dementia

The National Institute on Aging says older adults with mild cognitive impairment or certain types of dementia are at higher risk of falling. People with Alzheimer's often have changes in depth perception, so a change in the floor, such as carpet meeting tile, can look like a step.

The NIA lists other causes that show up in memory care every day:

• Medicines that cause dizziness or confusion, and taking many medicines at once
• Rushing to the bathroom, for example because of incontinence
• Blood pressure that drops on standing up
• Weak muscles and problems with balance or walking
• Backless shoes, slippers with smooth soles, or socks on a bare floor
• Poor lighting and things to trip over

Many people in memory care also forget that they need a walker, or that they need help to stand. They get up anyway, because they want to go somewhere. That is a big reason falls keep happening even with good staff.

Why they can't just keep her in bed

Families often ask why the community doesn't raise the bed rails or keep their parent in a chair. Restraints and bed rails carry their own risks, and the rules limit them.

In nursing homes, federal rules say a resident has the right to be free from physical or chemical restraints imposed for discipline or convenience and not required to treat medical symptoms (42 CFR 483.10(e)(1) and 483.12(a)(2)). When a restraint is used, it must be the least restrictive option for the shortest time. Before a nursing home puts up a bed rail, it must try other options first, assess the risk of the resident getting trapped, and get informed consent (42 CFR 483.25(n)).

Assisted living and most memory care is licensed by the state, so state rules apply. Ask the community what its state allows and what it uses instead. Common answers include low beds, floor mats, motion lights, bed or chair alarms, a regular bathroom schedule, and more staff checks at the hours your parent tends to get up.

What a good fall response looks like

Every community should have a written fall policy. A good response usually includes these steps:

1. Check before moving her. Staff look for pain, injury, or a change in how she is acting before they help her up.
2. Get a nurse or doctor to look. A nurse assesses her, and her doctor is told. If she may be hurt, they decide with her doctor whether she needs the hospital.
3. Call the family the way the plan says. Who gets called, for what kind of fall, and how fast, should be written in her care plan or service plan.
4. Watch her closely afterward. Injuries such as a head bleed or a hip fracture can show up hours later, and a person with dementia may not be able to say what hurts.
5. Look for the cause. A post-fall review asks what happened before the fall. Was it a new medicine, the wrong shoes, a trip to the bathroom, a dark room, or a sudden change that could mean an infection? MedlinePlus lists infections such as urinary tract infections among the causes of delirium, the sudden confusion that can make a fall more likely.
6. Change something. The fall prevention plan is updated, and the family is told what changed.

Head injuries and blood thinners

If your parent takes a blood thinner, a fall where she hits her head needs a medical check, even if she seems fine. The CDC says blood thinners increase the risk of bleeding in the brain after a head injury, and it names warfarin, apixaban, clopidogrel and aspirin among them.

The CDC says to call 911 or go to an emergency department right away for signs such as a headache that gets worse and does not go away, repeated vomiting, slurred speech, weakness, unequal pupils, more confusion, or trouble waking up. In a person with dementia, new confusion can be easy to miss, so tell the staff what is normal for her.

Ask the community now, before any fall: "If she hits her head, or nobody saw the fall, what do you do? Do you send her out, call her doctor, or watch her here?" Then talk about that answer with her doctor.

When should they call you?

This is where the rules differ by setting.

Nursing homes. A nursing home that takes Medicare or Medicaid must immediately inform the resident, consult the resident's doctor, and notify the resident's representative when there is an accident that results in injury and could need a doctor's care, or a significant change in the resident's condition (42 CFR 483.10(g)(14)). If you are your parent's representative, you should hear about an injury fall.

Assisted living and memory care. State rules apply, and they vary. Some states set a notice rule, and some leave it to the community's policy and the resident's service plan. Ask the community what its state requires, and look up your state's assisted living licensing rules.

Either way, you can ask for more than the minimum. Agree on it in writing, for example:

"Please call me after any fall, day or night, even if she isn't hurt. If she hits her head or goes to the hospital, call me right away. My cell is the best number."

Ask them to add that to her care plan or service plan, and check that your number is current.

What to ask for after a fall

You have a right to understand what is happening to your parent. Ask, kindly and in writing:

• A written summary of the fall. The community may not give you the incident report itself. You can still ask for a written summary: when and where it happened, who found her, what they checked, and who they called.
• The fall prevention plan. What they are doing to lower her risk, and what changed after this fall.
• A care conference. A meeting with the nurse, and the doctor or therapist if possible, to go over her medicines, her walking, her footwear and her nights.
• A medicine review. Ask her doctor or the pharmacist whether any medicine could be adding to the falls. Do not stop or change a medicine on your own.
• A therapy evaluation. Ask her doctor whether physical or occupational therapy could help with strength, balance or a better walker.

Questions to ask after a fall

When falls keep happening

A run of falls can be a sign that your parent's needs have changed. Sometimes the answer is more help, a different room, hospice, or a move to a setting with more staff. Sometimes a community says it can no longer keep her safe. Ask what would need to change for her to stay, and ask for that in writing too.

If you think the community is not responding to falls, or not telling you about them, you can call your Long-Term Care Ombudsman. Ombudsman services are free and confidential. You can also file a complaint with the state agency that licenses the community.

How to use Lilisity to check a community

Lilisity is free for families. For nursing homes, Medicare's Care Compare reports the percentage of long-stay residents who had one or more falls with major injury, and Lilisity shows each nursing home's CMS ratings and inspection history. For memory care and assisted living, Lilisity shows the state license and inspection records where the state makes them public. In an inspection report, look for citations about falls, accidents, supervision or care plans, and ask the community what it changed.

Before a move, ask the night questions in our post on memory care at 3 a.m., including "If she falls at night, who responds, and when do you call me?"

This is not medical or legal advice. Ask her nurse and doctor about her care, and an elder law attorney about your rights in your state.

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