Resident Monitoring and Fall Prevention Technology and Privacy

According to CNA Aging Services 2022 Claim Report data, resident falls account for over 40% of closed claims across aging services settings, with an average paid indemnity of over $226,000.

  • Falls are the most frequent allegation, accounting for 54.8% of assisted living setting claims and 36.1% in skilled nursing.
  • 8% of falls are unwitnessed.
  • 7% of fall related claims involve a resident who had a history of a previous fall, and those claims are typically more costly. This history may result in higher expectations on the facility to implement measures to prevent recurrence, including additional monitoring.
  • Care plans should reflect increased monitoring expectations for residents with a prior history of falls and dementia.

As noted in CNA’s resource Resident Falls: A Collaborative Strategy for Risk Mitigation, no strategy can completely prevent falls.  The most common fall-related allegations include failure to monitor, improper care by staff and unsafe residential environment.  However, artificial intelligence (AI) systems including wearable sensors, video cameras and other tools can detect fall-related warning signs.  In a recent technology survey of senior living executives, fall detection and/or prevention and remote monitoring were ranked as the most important to the organization’s operations.


Many vendors offer AI tools to assist in fall detection and prevention.  The usefulness of these monitoring tools was highlighted during the pandemic with residents isolated in their rooms and challenges with staffing.  One case example using real-time video monitoring revealed over a 60% reduction in emergency services calls and reduced participating resident falls by 31%.  Tools such as video management systems (VMS) allow for remote patient monitoring of several patients by one nurse, who can quickly alert a nearby caregiver to a potential behavior that could cause a fall.  Some systems utilize advanced vision AI sensors to detect falls and notify response teams, with video clips blurred to protect privacy.  Some systems collect data which can be used to predict falls and develop prevention strategies.

Privacy/Legal Issues:

HIPAA privacy and security measures must be a component of any video monitoring program, as full-face photos/images are considered protected health information (PHI) if captured by a healthcare provider/HIPAA-covered entity.  These measures include technical, physical, and administrative safeguards to protect PHI.  It is recommended that cameras used in patient/resident rooms are non-recording in order to protect patient privacy and comply with HIPAA regulations.  If there is storage of the recorded video, the facility must have clear policies and procedures in place in concerning access, use, and disposal.  Videos should be encrypted, users should have unique log-in credentials, and audits should be conducted on a regular basis.

Several states have passed laws permitting the use of cameras in resident rooms.  These surveillance cameras play a role in fall monitoring, but also provide data regarding staff performance and quality of care.  Most of these state laws include a requirement to obtain a roommate’s permission to install a camera and signage indicating a camera is in use.

Comprehensive Program:

Video monitoring/AI systems are only part of an overall fall mitigation program, which includes, but is not limited to, pre-admission screening, resident and family education, staff training, updated comprehensive care plans (that may involve technology/AI utilization), assessment of environmental risks, and thorough documentation of incidents.  Excelas can assist senior care facilities in the development/improvement of a fall mitigation program, as well as in the defense of a fall-related claim.  Utilizing our Comprehensive Integrated Timeline Tool, our medical-legal experts will review and develop a thorough analysis of the relevant documentation to assist administrators and counsel in risk mitigation and ultimately improving resident care.


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