The Rise of Nursing Home Falls and Medication Errors: Litigation Trends and the Crucial Role of Medical Experts

Nursing homes across the United States are facing increased scrutiny as falls and medication errors among residents become alarmingly common. In recent years, a growing number of lawsuits allege that such incidents result from substandard care, often yielding large verdicts in favor of injured residents or their families. This article examines the rise in nursing home falls and medication errors, highlights notable recent malpractice cases with substantial plaintiff awards, and explains why medical expert testimony is pivotal in establishing liability and causation in these cases.

Rising Incidence of Nursing Home Falls

Falls are a pervasive hazard in long-term care facilities. Studies show that between 50% and 75% of nursing home residents experience at least one fall each year, and nationwide roughly 1,800 nursing home residents die annually from fall-related injuries. Despite the frailty and mobility issues common in elderly residents, many of these falls are preventable with proper care and supervision. Unfortunately, only about 57% of nursing home falls are ever formally reported, suggesting that the true scope of the problem is even larger than official data indicates.

Several factors underlie the rise in fall incidents. Chief among them is chronic understaffing in nursing homes – a long-standing issue exacerbated by the COVID-19 pandemic. When facilities operate with inadequate staffing levels, residents may not receive timely assistance with mobility or transfers, increasing the likelihood of unassisted falls. In fact, a study of nursing homes during the first year of COVID-19 found a 72% increase in resident falls from 2019 to 2020, correlating with pandemic-related staffing shortages and disruptions in routine care. This trend aligns with broader surveys indicating that as of 2022, 87% of nursing homes faced moderate to high staffing shortages, a condition that can directly translate to lapses in monitoring and fall prevention.

Nursing homes are required by federal and state regulations to assess each resident’s fall risk and implement reasonable safeguards (such as bed alarms, assistive devices, and adequate supervision) to prevent accidents. While not every fall is avoidable, a pattern of injuries from falls often signals negligence. Falls are the second most common injury alleged in nursing home negligence cases, second only to pressure ulcers. When a facility fails to meet the applicable standard of care in fall prevention – for example, by leaving a known high-fall-risk resident unattended or using improper transfer techniques – it can be held liable for resulting injuries. The rise in litigation suggests families are increasingly pursuing claims when an avoidable fall leads to serious harm.

Medication Errors in Long-Term Care Facilities

Medication management is another critical area where lapses can be catastrophic. The average nursing home resident is on 7 to 8 medications at a time, making careful administration a vital (and challenging) task for staff. Facilities are expected to keep medication error rates below 5%. In reality, studies have found that up to 27% of nursing home residents have been victims of medication errors – and this figure is likely underreported. These errors range from incorrect dosages and wrong medications to missed doses or harmful drug interactions. While many errors cause no lasting injury, a significant number result in serious adverse effects or fatalities.

Federal inspectors have identified medication errors as a major source of harm in nursing homes. In one study, 37% of adverse events in skilled nursing facilities were related to medication management failures. Blood-thinning drugs like warfarin are a well-known danger area – between 2011 and 2014 at least 165 nursing home residents died or were hospitalized after errors involving warfarin. Common medication mistakes in long-term care include giving the wrong drug to a resident, administering an incorrect dose, or failing to account for a resident’s allergies and contraindications. Because elderly patients often have multiple comorbidities, even a “small” pill mix-up can trigger life-threatening complications.

As with falls, systemic issues like understaffing and inadequate training play a big role. Many facilities struggle to retain experienced nursing staff or pharmacists, leading to increased workloads and fatigue-related mistakes. In some cases, profit-driven cost cutting results in fewer nurses per resident, increasing the odds of a drug error. Polypharmacy (residents taking many drugs) also heightens the risk; the more complex a medication regimen, the more opportunities for something to go wrong. All of these factors have contributed to a wave of negligence claims centered on medication mistakes, especially when an error causes a resident’s decline or death.

Recent Litigation and Large Verdicts

In the past few years, juries have returned notable verdicts holding nursing homes accountable for fall-related injuries and medication errors. These cases underscore the substantial liability exposure facilities face when failing to protect their vulnerable residents. Below are a few illustrative examples:

• Fall-Related Verdicts: In a 2018 Pennsylvania case, a 90-year-old wheelchair-bound resident fell and fractured her hip while being transferred to a shower. The transfer was being done by a single nursing aide who slipped on a wet floor, dropping the resident. Evidence showed the resident was designated a high fall risk requiring extensive assist, yet proper precautions were not taken. A jury awarded $300,000 in compensatory damages and $2.7 million in punitive damages to the resident’s estate. In another case in Iowa, a nursing home was hit with a $6 million verdict after an 82-year-old female resident suffered multiple falls and abuse by staff, leading to fatal injuries. Likewise, an Arkansas jury in 2025 returned a $6.6 million verdict in a negligence suit involving a resident who died from preventable complications (severe dehydration and infected bedsores) linked to understaffing.
  
  
• Medication Error Verdicts: Lawsuits over drug mistakes have also yielded significant awards. In Maryland, the family of an 83-year-old resident obtained an $8.5 million jury verdict in 2024 after the woman died from a cascade of neglect that included medication errors. The facility had failed to resume her critical anticoagulant (blood thinner) after surgery, resulting in a fatal blood clot, alongside allowing extreme weight loss and bedsores. In another striking case, a Utah nursing home was found liable for the death of a patient to whom a nurse administered the wrong medication, then tried to conceal the mistake. The jury’s $1.4 million wrongful death award was upheld on appeal. Even relatively modest errors can lead to liability – for example, one facility settled for $250,000 after giving a patient the wrong diet, causing a fatal choking incident.
  
  

Many of these verdicts include a punitive damages component or are accompanied by regulatory penalties. Regulators and juries alike tend to view preventable falls and drug errors in the elderly as egregious violations of trust. Large awards (sometimes in the millions) are seen not only as compensation for the victims but as a deterrent to substandard practices in the long-term care industry. However, many states impose caps on damages in medical malpractice cases, which can limit the actual payout regardless of a jury’s award. Attorneys litigating these cases must be mindful of how caps and post-trial motions may affect final judgments.

The Crucial Role of Medical Experts in Proving Liability

To reduce the incidence of diagnostic errors and associated legal liabilities, healthcare institutions can iWhether a case involves a fall or a medication error, medical experts are often the linchpin in establishing liability and causation in nursing home malpractice lawsuits. These cases typically fall under medical malpractice (healthcare negligence) law, meaning the plaintiff must prove two key elements: (1) that the nursing home staff breached the applicable standard of care, and (2) that this breach directly caused the resident’s injury or death, to a reasonable degree of medical certainty. Meeting this burden almost always requires expert testimony.

Standard of Care: In a nursing home context, the standard of care may be testified to by a geriatric physician, a nursing expert (such as a long-term care nurse or administrator), or other healthcare professionals. They explain what a reasonably careful facility and staff should have done in the situation. For instance, an expert in a fall case might testify that a bedridden resident at high risk of falls should have been monitored one-on-one or provided with proper bed rails, and that failing to do so was a deviation from nursing home protocols. In a medication error case, a pharmacology or nursing expert might outline how a competent nurse should verify patient identity and dosage to avoid a mix-up.

Causation: Perhaps even more critically, experts are needed to link the negligence to the injury. Elderly plaintiffs often have complex medical histories, so the defense may argue that an injury was due to the resident’s pre-existing conditions rather than the facility’s lapse. A qualified medical expert can assess the evidence and offer an opinion that “within a reasonable degree of medical certainty,” the fall or medication error triggered or substantially contributed to the harm. In fact, courts have made clear that when the cause of an injury is not obvious to a layperson, expert testimony is required to prove causation in nursing home cases.

Conversely, when plaintiffs do marshal strong expert support, they can overcome defenses. In the Utah medication error case mentioned above, the trial included dueling experts on whether the wrong drug caused the patient’s demise. The plaintiff’s medical expert convinced the jury (and later the appellate court) that the medication error was a proximate cause of death. Similarly, in the Maryland case, expert testimony traced the link from the nursing home’s failure to restart anticoagulation therapy to the resident’s fatal embolism, establishing causation for the jury.

Evaluating Liability: Beyond trial testimony, medical experts also assist behind the scenes in evaluating the merits of a case. Before filing suit, plaintiff’s counsel will often consult medical experts to review records and determine if the nursing home’s care fell below standards and if the injury was likely caused by that substandard care. This initial expert review is not only crucial for building a case but is also required by law in many jurisdictions. During litigation, expert witnesses prepare reports and help attorneys understand complex medical information, ensuring that the legal arguments are grounded in sound medical science.

In high-stakes nursing home trials, the battle of the experts can effectively decide the outcome. Jurors often have to choose between competing narratives – was the resident’s injury a tragic but unpreventable result of age and illness, or did the facility’s negligence cause it? Compelling expert testimony, supported by medical records and data, gives the jury a factual basis to assign liability. A well-qualified expert can also bolster credibility. On the other hand, if an expert’s opinions are speculative or unsupported, the opposing side will move to exclude that testimony, thereby undermining the case. Thus, success in nursing home malpractice lawsuits often hinges on the strength, clarity, and admissibility of medical expert evidence.

Conclusion

Nursing home falls and medication errors are a growing concern, reflected in both troubling statistics and an uptick in legal actions against long-term care providers. The past few years have seen plaintiffs secure multi-million dollar verdicts – some with punitive damages – in cases where juries found egregious lapses in care. For attorneys navigating these complex cases, a thorough understanding of the medicine is as important as the law. Medical experts play an indispensable role in identifying where the standard of care was breached and in drawing the crucial line from negligence to injury. As the population ages and more families entrust loved ones to nursing facilities, the industry may face increasing litigation pressure to improve patient safety. Large verdicts for falls and medication mistakes send a clear message: if nursing homes do not invest in proper staffing, training, and protocols to protect residents, they may pay a high price in court.

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