Nursing homes fail to report 43% of falls causing major injury and hospitalization

A 2025 HHS Office of Inspector General report found that nursing homes failed to report 43% of falls that caused major injury and hospitalization among Medicare-enrolled residents. This is not a minor paperwork gap — falls are the single most common adverse event in nursing facilities, affecting 50-75% of residents annually (a rate 2-3 times higher than community-dwelling older adults). Roughly 65,000 nursing home residents suffer hip fractures from falls each year, and one in three residents who falls will fall again within the same year. The failure to report means the problem compounds invisibly. When a fall is not documented, the facility has no obligation to investigate root cause, update the resident's care plan, or implement prevention measures. The next fall becomes more likely, not less. In Massachusetts, the rate of falls with injury increased nearly 25% between 2018 and 2022 (from 27.9 to 34.8 per 1,000 residents). Families are not notified of unreported falls, so they cannot intervene, request care plan changes, or make informed decisions about whether the facility is safe for their loved one. For the resident, an unreported hip fracture often triggers a cascade: surgery, immobility, pressure ulcers, pneumonia, and death within 12 months. This underreporting persists because there is no independent verification system. Facilities self-report adverse events, and the incentive is to underreport: more reported falls mean lower quality scores, more regulatory scrutiny, and potential liability. CMS relies on periodic inspections (which happen roughly once per year and are often announced in advance) to catch discrepancies, but inspectors review a sample of records and cannot audit every fall. The 2024 staffing rule that would have required 24/7 RN presence — someone with the clinical authority and training to document and investigate falls properly — was rescinded before it took effect.