Types of risk for residents at long term care facilities


Credit: FontAwesome.com

Credit: FontAwesome.com


Each year, more than one-quarter of older adults fall, making falling the No. 1 cause of death and injury among people age 65 and older, according to the Centers for Disease Control and Prevention. To help prevent falls, senior living facilities should have strategies to protect residents, including these:

  • Train staff on prevention measures.
  • Supervise residents at high risk of falls more closely.
  • Correct unsafe conditions like torn carpets or slick floors.

Water temperature

Our skin thins when we get older. Thin layers of skin can burn more quickly, so water that is too hot can put seniors at risk. At 124 degrees, a person in a high-risk group can be severely burned in three minutes. At 127 degrees, severe burns can happen in one minute, according to the American Burn Association. Georgia requires that water temperatures in long-term care facilities be no higher than 120 degrees.

Medication errors 

Big problems can arise when employees who are not nurses administer medications, says the U.S. Agency for Healthcare Research and Quality. Deaths and injuries can result when residents don't get prescribed drugs, are given the wrong ones or wrong doses, or are given medication at the wrong time. In Georgia, those who administer medications at assisted living communities at a minimum must be certified medication aides. At personal care homes, most residents must administer their own medications, though trained workers known as proxies may supervise the self-administration.

Improper transferring 

Many assisted living communities have residents who need staff help moving among their bed, wheelchair, shower or other places. If workers aren't properly trained and following protocol during this process, or if the equipment is defective, the resident may fall, twist arms or legs, get friction burns or skin tears, or suffer other serious injuries, the CDC says.


People with Alzheimer's disease or another dementia are at risk of wandering away from a facility. This is called eloping. Georgia residents who eloped from assisted living or personal care homes have wandered onto roadways, spent the night outdoors in the elements and suffered injuries from falling, the AJC examination found. In Georgia, facilities that have a specialized memory care unit must have effective systems to alert staff when anyone leaves without authorization. They also must have enough staff to supervise residents.

Improper food 

Assisted-living communities and personal care homes must provide at least three regularly scheduled meals a day. The meals must be well-balanced and meet residents' nutritional needs. Snacks must be nutritious, too. Other requirements:

  • If a physician has ordered a therapeutic diet, it must be provided.
  • The Department of Community Health requires that foods be protected from spoilage and contamination and be safe for human consumption.
  • Facilities with 25 or more beds must obtain a food facility license from the Department of Public Health and pass its inspections.

Failure to seek medical attention 

Personal care homes and assisted living communities are not medical care facilities, and most do not have a doctor on staff. But after an accident or when there is a sudden adverse change in a resident's condition, homes are responsible for immediately obtaining needed care. Inadequate response to health conditions or failure to seek medical care for illnesses or injuries can be considered elder abuse or neglect.

Inadequate staffing 

Staffing is the crux of a facility's ability to provide quality care. Georgia sets a minimum staffing ratio for assisted living and personal care homes, but homes must staff above that level to meet the specific needs of residents. For example, if people with dementia would have trouble evacuating in an emergency, the facility must have enough staff to help them get out quickly. Staffing is also key to ensuring that residents receive medications on time and that workers respond quickly when residents use their emergency call devices.

Unsafe conditions 

  • Infestations of bedbugs, ants, roaches, rats and mites can spread disease and cause suffering.
  • Extreme heat or cold can trigger dangerous dehydration or other health issues.
  • In a fire, blocked exits and malfunctioning smoke alarms, sprinkler systems or fire extinguishers can cost lives.
  • Residents with memory issues can suffer poisoning, burns or other health crises when household cleaners are left in areas accessible to them.


Pressure ulcers, also known as bedsores, are caused by prolonged pressure to the skin and are a risk for those who spend long hours in bed or in a chair. The AJC found these can be an issue at personal care and assisted living homes if they admit someone who already has a wound without ensuring that it is treated, or if residents with limited mobility aren't repositioned in beds or chairs or provided with special mattresses or cushions to relieve pressure. Some Georgia facilities have been cited for failing to seek medical attention for bedsores.

—Icons in illustration courtesy of FontAwesome.com


» The AJC’s ‘Unprotected’ series on senior care facilities

» The AJC's consumer guide to senior care