Falls and Wounds in Post-Acute Care: The Conundrum We Can No Longer Ignore

CMS just released new Falls with Injury and QM Respecification training to address gaps in data collection across post-acute care, given persistently high rates of falls with injury and known inaccuracies in reporting. The training is a meaningful call to action: falls are absolutely an issue. But there is a compounding effect that the current quality framework does not capture, the wound.

As a physical therapist with decades of experience in post-acute care, I have long observed a pattern that the research now confirms. The patient who falls is very often the patient who has a wound. The two highest areas of litigation in post-acute care today are falls and skin integrity, and it is frequently the same person generating both claims. Add rehospitalization rates to that picture, and the convergence becomes impossible to dismiss. The same patient. The same risk factors. Often, the same outcome.

This is not coincidence. It is a systems problem.

The Evidence Is Clear

Peer-reviewed literature establishes a bidirectional relationship between falls and wounds in older adults with compounding chronic disease. Falls cause acute wounds: skin tears, lacerations, abrasions. Chronic wounds cause falls, through pain-altered gait, restricted mobility, and the mechanical burden of treatment itself. Both conditions share an almost identical risk-factor profile, and yet in most post-acute settings they are assessed separately, treated by different disciplines, and reported as unrelated quality metrics.

The financial and human cost of this siloed thinking is staggering:

• Healthcare spending attributable to non-fatal older-adult falls reached $80 billion in 2020, with the majority borne by Medicare (Haddad et al., 2024).
• Acute fall-related care alone accounts for $19.8 billion annually, driven by over 3 million hospital encounters (Falvey et al., 2024).
• Chronic wounds consume approximately 3% of total healthcare expenditure in developed nations, a figure widely believed to underestimate true costs due to chronic underreporting (Olsson et al., 2019).

Shared Risk Factors: The Convergent Profile

When you place the fall risk profile and the wound risk profile side by side, the overlap is striking. Almost every factor that increases the likelihood of a fall also increases the likelihood of a wound, or impairs the body's ability to heal one.

The Conundrum: When Interventions Oppose Each Other

Here is where it gets clinically complex, and where I believe we can start some important team conversations. The interventions are not always compatible, and optimizing for one outcome can actively worsen the other unless the clinical team is explicitly considering both.

This is the conundrum. Good for safety, bad for skin. Good for skin, bad for mobility. Without a clinical team explicitly weighing both outcomes, optimizing for one can quietly create the other.

The First Step: Naming the Problem

We continue to silo our risk assessments, our interventions, and our disciplines to the point that we fail to see the connections, and create solutions that can inadvertently generate new problems. Falls programs do not consistently include wound care clinicians. Wound care programs do not consistently integrate fall risk. Skin risk assessments and fall assessments are rarely administered in tandem. Nutrition, which is foundational to both wound healing and fall prevention, is often the last consultation rather than the first.

The post-acute care setting is precisely where these two problems collide most dangerously: arriving together in patients with the highest comorbidity burden, the greatest deconditioning, and the fewest physiologic reserves. It is also the setting with the most opportunity for integrated, proactive, interdisciplinary intervention.

The research supports this unequivocally. A 2017 article published in Advances in Skin & Wound Care, a continuing education piece written for wound care clinicians, argued that appropriate fall-risk assessment is of direct relevance to wound care practice, precisely because chronic wounds increase fall risk and falls generate wounds (Cheung, 2017). That was nearly a decade ago. We have not moved fast enough.

Jeanine Maguire, PhD, MPT, CWS, FCPP

President, Post-Acute Wound & Skin Integrity Council (PAWSIC)

Physical therapist and certified wound specialist with decades of clinical and leadership experience in post-acute care. Founding president of PAWSIC, working at the intersection of evidence-based wound care, quality improvement, and interdisciplinary practice.