Q: The way that the falls definitions have changed in the new RAI Manual, do you have any concerns over the new “fall” definition, i.e., I was wondering if you think that the new definitions mean that any loss of balance during therapy will not have to be reported as a fall? For example, I have personally been working with a resident that lost balance and we moved from standing to sitting, not in the most graceful way. Would this now be considered a fall as the chair is the next lowest surface?
A: This is a great question. The updated manual has some significant revisions. There are some clarifications related to challenging the loss of balance in therapy. See the revised definitions below in italics.
FALL
Unintentional change in position coming to rest on the ground, floor or onto the next lower surface (e.g., onto a bed, chair, or bedside mat) or the result of an overwhelming external force (e.g., a resident pushes another resident).
An intercepted fall occurs when the resident would have fallen if they had not caught themself or had not been intercepted by another person – this is still considered a fall.
CMS understands that challenging a resident’s balance and training them to recover from a loss of balance is an intentional therapeutic intervention and does not consider anticipated losses of balance that occur during supervised therapeutic interventions as intercepted falls. However, if there is a loss of balance during supervised therapeutic interventions and the resident comes to rest on the ground, floor or next lower surface despite the clinician’s effort to intercept the loss of balance, it is considered a fall.
So to answer the specific question, there are some losses of balance as the result of therapy challenges that will need to be considered a fall. While an intercepted fall that occurs in these limited circumstances would not be considered a fall, the fall described in the question would be.
Even though the therapist attempted to intercept the fall, the resident was moved from standing to a sitting position. That meets the RAI definition of a fall which is the “Unintentional change in position coming to rest on the ground, floor or onto the next lower surface”.
If the therapist had truly “intercepted” the fall, since the resident’s balance was being challenged in a therapy situation, and the resident did not end up on a lower surface, then this would not be a fall according to the FY 2026 revised RAI Manual.
