Going Home From the Hospital After a Fall

A fall is often the moment families realize things have changed. Even when nothing is broken, a fall shakes everyone's confidence, especially your loved one's.

The weeks after a fall matter a great deal. Falls are the leading cause of injury in adults over 65, and one fall is the strongest predictor of another. Pain, new medications, weakness from time in bed, and fear of falling all raise the risk during those first weeks at home.

The good news: many second falls can be prevented. This guide walks you through what to watch for in the first few days, how to make the home safer, and how to help your loved one get their strength and confidence back.

The first 72 hours at home

The first few days are the highest-risk window. Your loved one may be sore, tired, unsteady, and taking new medications.

• Plan for someone to stay. If possible, have a family member, friend, or paid caregiver with them around the clock for the first 2 to 3 days, especially at night.
• Help with every trip to the bathroom at first. Most falls happen getting up from bed or the toilet, often at night. A bedside commode can remove the riskiest walk of the day.
• Stay ahead of pain. Give pain medication on schedule as directed instead of waiting until pain is bad. Pain makes people move awkwardly and avoid moving at all.
• Watch for side effects of pain medication. Opioids can cause dizziness, confusion, and constipation, all of which raise fall risk. Ask about a stool softener.
• Encourage gentle movement. Short, supervised walks a few times a day prevent stiffness, weakness, and blood clots.
• Keep the walker within reach at all times, including next to the bed and the bathroom.

Warning signs: call 911

Some injuries, especially head injuries, don't show up right away. Bleeding in the brain can develop hours or days after a fall, particularly in people taking blood thinners like warfarin, Eliquis, or Xarelto.

Call 911 for:

• A headache that gets worse, repeated vomiting, or new confusion or drowsiness
• Weakness, numbness, slurred speech, or trouble walking that's new
• A seizure, or being hard to wake
• Pain that suddenly gets much worse, or a leg that looks shorter or turned outward
• Chest pain, shortness of breath, or a swollen, painful calf (possible blood clot)

Call the PCP or nurse line for increasing pain, new bruising or swelling, signs of infection around a wound, or no bowel movement in three days.

Make the home safer this week

You don't need a remodel. Most of the biggest fixes are free or inexpensive and can be done in an afternoon, ideally before your loved one comes home.

Throughout the house

• Clear a wide path from bed to bathroom to kitchen to favorite chair
• Remove throw rugs, or tape them down firmly
• Move cords, clutter, and pet bowls out of walkways
• Put commonly used items between waist and shoulder height, so there's no reaching or bending

Bedroom

• Add a nightlight between the bed and bathroom, or motion-sensor lights
• Put a lamp, phone, glasses, and water within reach of the bed
• Check bed height: feet should rest flat on the floor when sitting on the edge

Bathroom

• Non-slip mat or strips in the tub or shower
• Shower chair and handheld shower head
• Raised toilet seat or toilet safety frame
• Grab bars professionally installed (towel bars aren't strong enough to hold weight)

Stairs and entries

• Sturdy handrails on both sides of stairs
• Good lighting with switches at the top and bottom
• Consider setting up a temporary bedroom on the main floor

Footwear and clothing

• Well-fitting shoes or slippers with closed backs and non-slip soles. No socks alone on hard floors.
• Pants that don't drag on the floor

A home health physical or occupational therapist can do a home safety check and point out risks you might miss.

Find out why the fall happened

A fall is usually a symptom, not just an accident. Treating the injury without finding the cause leaves the door open for the next fall. Schedule a PCP visit within a week or two of coming home, and ask specifically about fall risk.

Common causes worth checking:

• Medications. Sleep aids, anxiety medications, pain medications, blood pressure pills, and some antihistamines (like Benadryl or "PM" sleep products) can cause dizziness or unsteadiness. Taking five or more medications also raises the risk. Ask: "Could any of these be contributing to falls? Can any be reduced or stopped?"
• Blood pressure that drops when standing. Ask the doctor to check blood pressure lying down and then standing.
• Vision. Outdated glasses, cataracts, and bifocals on stairs are common culprits. Schedule an eye exam if it's been more than a year.
• Infection or dehydration. A urinary tract infection can cause sudden weakness or confusion in older adults, sometimes with no other symptoms.
• Foot problems and footwear. Pain, numbness, or poorly fitting shoes all affect balance.
• Weakness and balance. Ask for a referral to physical therapy if it wasn't started at discharge.
• Memory changes. New or worsening confusion can affect judgment about what's safe.
• Bone health. If a bone broke from a simple fall, ask about a bone density test and osteoporosis treatment.

Rebuilding strength and confidence

Home health. If your loved one has trouble leaving the house and needs skilled care like nursing or physical therapy, Medicare may cover home health visits at no cost, with a doctor's order. The hospital case manager or PCP can make the referral, and you can request a specific agency.

Outpatient physical therapy. PT is one of the most effective ways to prevent another fall. A therapist builds strength and balance, teaches safe ways to get up from a chair, bed, and toilet, and makes sure the walker or cane is the right height. Do the home exercises between visits; that's where most of the progress happens.

Fear of falling. After a fall, many older adults start moving less because they're afraid. It makes sense, but it backfires: less movement leads to weaker muscles and worse balance, which makes another fall more likely. Signs to watch for include staying in one chair all day, avoiding stairs or outings, and turning down activities they used to enjoy.

How to help:

• Acknowledge the fear instead of dismissing it
• Celebrate small wins, like walking to the mailbox
• Ask the physical therapist to practice the tasks they're most afraid of
• Once they're stronger, look for a community balance class, such as tai chi or a senior center program
• Watch for signs of depression, which is common after a fall, and mention it to the PCP

What should you do if they fall again?

Have a plan before it happens, and talk it through with your loved one so they know what to do if they're alone.

Don't rush to pull them up. Lifting someone the wrong way can injure them and you. First, stay calm and check:

• Did they hit their head? (Even a light bump counts if they take a blood thinner.)
• Are they in severe pain, especially in the hip, back, or neck?
• Are they confused, or did they pass out?
• Can they move their arms and legs normally?

If the answer to any of the first three is yes, or they can't move normally, keep them still and warm and call 911. On hospice? Call hospice first.

If they seem uninjured, help them get up slowly: roll onto their side, get onto hands and knees, crawl to a sturdy chair, and push up with their arms, one leg at a time. Let them rest before standing. If they can't get up on their own, don't lift them yourself; many fire departments offer non-emergency "lift assist" help.

Even if there's no injury, let the PCP know about every fall.

Medical alert devices. A wearable button or watch lets your loved one call for help if they fall when no one is around. Look for automatic fall detection, a model that works both inside and outside the home, and one comfortable enough to wear in the shower, where many falls happen. Long periods on the floor after a fall can cause serious complications, so this is one of the most valuable tools for someone who lives alone. Compare a few models on fall detection, GPS coverage outside the home, and whether the button is waterproof before choosing one.

When home isn't safe enough

Sometimes, even with every precaution, home stops being the safest place. Signs it may be time to talk about more help:

• More than one fall in a few months, or falls that keep sending them to the ER
• They can't get to the bathroom safely, even with equipment
• They need help at night and no one is available
• The family caregiver is exhausted or getting hurt helping
• Memory changes make it hard for them to remember safety steps

More help doesn't have to mean a nursing home. Options include in-home personal care aides, adult day programs, assisted living, short-term rehab, and, for people with serious illness, palliative care or hospice. These conversations are hard, and it often helps to start them early, while your loved one can be part of the decision.

Be ready next time. Read Packing an ER Go-Bag for an Older Adult and download the free printable checklist.

This article is general information for family caregivers, not medical advice. Always follow the instructions from your loved one's care team.