Unexplained Bruise or a Fall at Your Parent's Facility: What to Ask

Few things shake a family more than finding a bruise nobody can explain, or hearing after the fact that your parent fell. The first response is often alarm, and the second is a vague explanation that does not settle anything. Here is how to find out what actually happened.

Start by asking what happened, not who is to blame

Ask calmly and specifically: when was it noticed, who noticed it, where did it happen, and what was done about it. Staff are more likely to give you a real account when the question is about the facts. You can always raise your concern about the answer afterward.

Ask whether it was documented

A fall or an injury should generally lead to an incident report, a nursing assessment, and a note in the chart. Ask whether one exists, who completed it, and whether the physician and family were notified. A fall that was never written down, or an injury with no record of how it happened, is worth taking seriously in itself.

Ask about the cause, not just the injury

A fall is usually a symptom of something else: a new medication, low blood pressure, an infection, poor lighting, footwear, a bed or chair alarm that was not working, or no one available to help with toileting. Ask what the team thinks caused it and what has changed to prevent another one. "We reminded her to use the call light" is not a plan, especially for someone with memory loss.

Don't assume a bruise is harmless

Older adults bruise easily, especially on blood thinners or some other medications, and many bruises are harmless. Still, someone should be able to tell you how it happened. Ask when it appeared, whether it was reported, and whether anyone looked into how it happened. Bruising in unusual places, several bruises at once, or bruises that keep recurring deserve a closer look.

Know when to escalate right away

If an injury has no explanation, if the explanation keeps changing, or if anything suggests neglect or abuse, take it to the administrator or executive director at once. You can also contact Tennessee's Long-Term Care Ombudsman program and Adult Protective Services. If your parent is in immediate danger or needs urgent medical care, call 911.

When the explanation still does not add up

Sometimes the answers you get are accurate but incomplete, and it is hard to tell the difference from the outside. Someone who has managed these communities knows what a complete answer should include, what records should exist, and which questions to ask next.

If you have asked these questions and the answers still do not add up, call me at (703) 867-0540. And if you do not feel able to take these steps yourself, I can do it for you.