Not every fall is preventable. But patterns common to busy facilities can make preventable falls more likely, such as:
- Unassisted or rushed transfers during peak activity between meal times, medication rounds, or shift handoffs
- Inconsistent use of fall-prevention tools (gait belts, alarms, mobility assistance, proper footwear)
- Bathroom and hallway hazards that persist after notice—wet floors, poor lighting, cluttered walkways, worn grab bars
- Care plan gaps after condition changes, especially when residents develop dizziness, weakness, or balance issues
- Delayed response to alarms or call buttons, increasing the chance of head injury or fractures
When families later learn that warning signs were documented but not acted on, the focus often shifts to whether the facility met Illinois standards of reasonable care.


