Managing “long lies” after falls in care homes: early qualitative findings from a mixed-methods study

Introduction

Falls are a major public health problem, costing an estimated £2.3 billion annually in the UK. In older age, falls may leave people unable to get up even with assistance. Without life-threatening symptoms, calls may be triaged as low priority and people may remain on the floor (“long lie”), risking dehydration, pressure injury, muscle damage and psychological distress. This study explored how residential and nursing homes manage residents after a fall while awaiting emergency response.

Method

Semi-structured online interviews were conducted with 15 managers of residential and nursing homes in England. Interviews were recorded, transcribed verbatim and analysed using structured analysis tables within a framework approach.

Results

There was no shared definition of a “long lie”; thresholds ranged from 1hr to >6hrs, and many described the concept as person- and context-dependent. Calling 999 was generally a last resort. Where available, homes contacted alternative services, but access varied by geography and capacity. When 999 was required, prolonged time on the floor primarily reflected waiting for an ambulance after a fall, and residents were perceived as deprioritised because care homes were viewed as a “place of safety”. Practices while awaiting help prioritised dignity and comfort (e.g. screening, pillows/blankets), but advice from ambulance services on hydration, movement and medication was inconsistent. Prolonged waits were distressing for residents with cognitive impairment and reduced staffing capacity, especially overnight.

Conclusion(s)

Findings reveal variation and uncertainty in care-home management of long lies, reflecting tensions in cross-service working during prolonged waits, including perceived de-prioritisation and inconsistent advice. These results highlight a need for co-produced, standardised guidance across ambulance, hospital and social care interfaces. Ongoing phases will integrate these insights with staff perspectives and patient outcomes to refine a harm-based definition of long lie and develop practical recommendations.