"A lot of people come into a nursing home because they've been falling at home," says Nancy Leveille, the Executive Director of the Foundation of Quality Care for the New York State Health Facilities Association. She recommends that upon intake, residents should be evaluated for the many factors affecting fall risk.

"Could be their effort getting out of bed. It could be they're gait is off a little," says Leveille.

Understanding the cause helps prevent falls. But if a resident has dementia, they may not be able to remember safety recommendations.

So, the key is preventing injury and that takes a little detective work on the part of the staff. They have to figure out just when a resident falls; can routines be changed to prevent falls? It may be as simple as more supervised trips to the bathroom.

What nursing homes won't do is put rails along the bed to keep residents in, some will climb over leading to injury.

"They can get caught in the side rails. So, if they're not physically functioning well, they can try to get out. They can get their leg stuck, their head stuck. There are more deaths related to side rails than there are from falls," says Leveille.

Death from asphyxiation if their head gets stuck between the rails and the mattress.

"There's low beds, actually. When they use a low bed a person could still roll out of bed. They actually get mats to put next to the beds. So, if they roll out they don't get hurt," says Leveille.

And restraints are not an option. Leveille says they are rarely used and then only in specific, medically recommended cases such as a patient who's pulling out life-saving tubes, like the one through which they're breathing.

If you have ongoing concerns about your loved one, talk with the unit manager.

"If you don't get results at that level then you should be sitting down with the administrator or director of nursing at the facility," says Leveille.

When you have that talk with the Home Administrator, be sure you cover; balance, vision, medication and their environment. Are there enough handrails or furniture to hold onto and is the lighting bright enough for them to see during the day and at night?