Concussions in Nursing Homes

When a Fall Becomes a Brain Injury

Your mother fell getting out of bed at her nursing home. The staff said she was fine. They put an ice pack on her forehead and helped her back to sleep. Two days later, she could not remember your name.

Falls are the most common cause of brain injury in older adults. They account for 51% of all cases. A study of over 153,000 long-stay nursing home residents found that 6.6% suffered at least one fall-related injury. Many of those injuries involved a blow to the head.

If someone you love suffered a head injury in a nursing home, your family may have the right to take action. Nursing homes must prevent falls and respond quickly when a resident hits their head. When they fail, families can seek answers — and compensation.

Request a Free Case Review

What Is a Concussion?

A concussion is a brain injury caused by a bump, blow, or jolt to the head. The impact makes the brain shift inside the skull, stretching and harming brain cells. Doctors call it a “mild brain injury,” but the word “mild” is wrong for older people.

Older adults face higher risk because the brain grows more fragile with age. Blood vessels weaken over time. Even a slow fall — from a bed, a chair, or standing height — can cause serious harm.

Blood thinners make things worse. Many nursing home residents take warfarin or newer drugs called DOACs. These drugs stop strokes and blood clots, but they also make it harder for the body to stop bleeding. After a head injury, a resident on blood thinners faces a much higher risk of bleeding in the brain.

One study found that DOAC users had a 43% lower risk of brain bleeding compared to warfarin users. But both groups still face far greater danger than residents not on any blood thinner. Nursing homes must know which residents take these drugs and have a clear plan if those residents fall.

Signs of a Concussion in an Elderly Person

After any fall or head impact, watch for these warning signs. Some appear right away. Others may take hours or days to show up.

• Headache that does not go away — even a mild headache after a fall can mean a concussion.
• Confusion or being lost — the resident may not know where they are or what day it is.
• Dizziness or trouble with balance — they may seem unsteady on their feet.
• Nausea or vomiting — even one episode after a head injury needs medical attention right away.
• Slurred speech or trouble finding words — any change in how the resident talks is a red flag.
• Changes in behavior or mood — sudden anger, withdrawal, or unusual sleepiness can point to a brain injury.
• Loss of consciousness — even briefly passing out after a fall is a medical emergency.
• Worsening symptoms hours or days later — brain bleeding can develop slowly over 24 to 72 hours.

In older residents, these signs are easy to miss. Confusion may be blamed on dementia. Sleepiness may be blamed on drugs. If your loved one seems different after a fall, insist on a full medical exam and a CT scan.

When Is a Nursing Home Responsible?

Nursing homes have a legal duty to keep residents safe. Federal rules under 42 CFR 483.25 require every facility that accepts Medicare or Medicaid to assess fall risk and take steps to prevent falls.

A nursing home can be held at fault when it fails at any of these three stages:

Failure to prevent the fall. The facility must find at-risk residents and put a prevention plan in place. This may include bed rails, non-slip mats, grab bars, good lighting, and enough staff to help residents move safely. If the facility knew a resident was at risk and did nothing, it may be at fault for the injuries that followed.

Failure to respond after a head injury. When a resident falls and hits their head, the nursing home must act fast. Staff should check for concussion signs, call a doctor, and watch the resident closely for 24 to 72 hours. Many injuries get worse because staff did not watch the resident closely.

Failure to account for blood thinners. Residents on blood thinners need special care after any head injury. The care plan should note which residents take these drugs. If the nursing home knew a resident was on blood thinners and still failed to get them to a hospital after a fall, that is negligence.

How Concussions Harm Elderly Residents

A concussion in an older adult is not just a headache that goes away. The harm can be grave, lasting, and even fatal.

Brain bleeding. The worst outcome is bleeding inside the skull. For residents on blood thinners, the risk is much higher. A study found that warfarin users had a 25% in-hospital death rate after fall-related brain bleeding, compared to 18.2% for those not on blood thinners.

Mental decline. A concussion can cause lasting damage to thinking and memory. Older adults may have trouble focusing, forget recent events, or struggle to make choices. For residents who already had some mental decline, a concussion can push them into a much worse state.

Repeat brain injury. A second concussion before the first one heals is very dangerous. Research shows that 12% of older adults with an initial brain injury suffered at least one more within five years. After a repeat injury, the risk of epilepsy was 1.44 times higher and dementia 1.32 times higher.

Death. For older residents on blood thinners, a concussion can be fatal. The mix of a fragile brain and the body’s failure to stop bleeding makes even a “minor” head injury life-threatening. Families who lose a loved one may have grounds for a wrongful death claim.