Falls are an important safety concern in residential and nursing care. For an older person, a fall can result in injury, pain, reduced confidence and a loss of independence. Even when a fall does not cause a serious physical injury, the fear of falling again can affect someone’s willingness to move around and participate in everyday activities.
Preventing falls, however, does not mean preventing people from moving.
High-quality falls prevention is about understanding each person’s individual circumstances, recognising factors that may increase their likelihood of falling and taking proportionate steps to support them to remain as safe, active and independent as possible.
Care workers have an important role in this process. Because staff often spend considerable time with residents, they may be among the first to notice changes in mobility, behaviour, confidence, health or the environment that could contribute to a fall.
This guide explores practical ways care staff can contribute to falls prevention while maintaining dignity, choice and person-centred care.
Why Are Falls Important in Care Homes?
Many people living in residential and nursing care have complex health and support needs.
Some residents may be living with:
- Reduced mobility
- Frailty
- Dementia
- Parkinson’s disease
- Arthritis
- Diabetes
- Visual impairment
- Hearing impairment
- Continence difficulties
- Dizziness
- Muscle weakness
- Several long-term health conditions
Medicines, environmental factors and changes in a person’s health may also contribute to falls.
The important point is that falls rarely have one simple cause.
Effective falls prevention therefore requires staff and relevant healthcare professionals to consider the whole person, rather than concentrating on a single risk factor.
Falls Prevention Should Be Person-Centred
Every resident is different.
One person may require significant mobility support, while another may walk independently but become less steady when tired.
Someone else may have excellent mobility but experience dizziness after standing.
Falls prevention should therefore be based on individual needs rather than applying the same restrictions to everyone.
This closely reflects the principles discussed in our guide to person-centred care.
Staff should consider:
- What matters to the person?
- What can they do independently?
- What support do they need?
- Have their abilities recently changed?
- Are they worried about falling?
- What could help them remain active?
- Are there environmental hazards?
- Does their care plan accurately reflect their current needs?
The aim should be to support the person’s life, not simply manage a risk.
Do Not Assume That Preventing Movement Prevents Falls
Following a fall, there can be a natural temptation to become extremely cautious.
Staff or relatives may feel that someone should remain seated or ask for assistance every time they want to move.
Sometimes additional support will be appropriate.
However, unnecessary restriction can have unintended consequences.
Reduced activity can contribute to loss of:
- Muscle strength
- Balance
- Mobility
- Confidence
- Independence
Residents should therefore be supported to remain appropriately active according to their individual abilities, care plan and professional recommendations.
Falls prevention and independence should work together.
Recognise Changes in Mobility
Care workers often know residents’ normal abilities extremely well.
This means they may notice subtle changes before anyone else.
For example:
“Mrs Williams normally walks confidently to the dining room, but today she is holding onto the furniture.”
That observation matters.
Changes might include:
- Walking more slowly
- Becoming unsteady
- Holding onto furniture
- Difficulty standing
- Difficulty transferring
- New weakness
- Reluctance to walk
- Increased need for assistance
- Complaints of dizziness
- Changes in posture
- Increased tiredness
Staff should report significant changes according to organisational procedures so that the person’s needs can be reviewed appropriately.
Keep the Environment Safe
Environmental hazards can contribute to slips, trips and falls.
Staff should remain alert to potential problems such as:
- Wet floors
- Clutter
- Loose cables
- Poor lighting
- Furniture obstructing walkways
- Damaged flooring
- Items left on stairs or corridors
- Inappropriate furniture positioning
- Difficult-to-reach call bells
- Mobility equipment left in unsuitable locations
A hazard should not simply be ignored because dealing with it technically belongs to another department.
Our guide to duty of care in health and social care explains why recognising and responding appropriately to foreseeable risks forms an important part of professional care practice.
Consider Lighting and Visibility
Good visibility can make a significant difference to someone’s ability to move around confidently.
Care environments should consider lighting in:
- Bedrooms
- Corridors
- Bathrooms
- Toilets
- Stairways
- Communal areas
Night-time arrangements can be particularly important when residents need to use the toilet.
Staff should also be aware that an individual’s eyesight may change over time.
If a resident appears to have difficulty seeing objects, judging distances or navigating familiar areas, this should be communicated appropriately.
Footwear and Foot Condition Matter
Poorly fitting or unsuitable footwear can affect stability.
Care staff should be observant where footwear appears:
- Too loose
- Too tight
- Damaged
- Difficult to walk in
- Unsuitable for the activity
Residents’ personal preferences remain important, but concerns should be communicated and addressed appropriately.
Foot discomfort or changes in foot condition may also affect how someone walks and should not simply be ignored.
Mobility Equipment Must Be Used Correctly
Some residents use mobility aids such as:
- Walking sticks
- Walking frames
- Wheelchairs
- Transfer equipment
Equipment should be suitable for the individual and used according to the relevant assessment, care plan, training and instructions.
Care staff should not improvise with equipment or alter someone’s mobility arrangements simply because another approach appears quicker.
If equipment seems damaged, unsuitable or no longer appropriate, staff should report the concern.
Our guide to Moving and Handling in Care Homes provides further information about safe staff practice when supporting people’s movement.
Nutrition and Hydration Can Be Relevant
Falls prevention is not limited to walking and environmental hazards.
A person’s wider health and wellbeing can influence their stability.
NICE includes diet, fluid intake and weight loss among the factors that may need consideration within a comprehensive falls assessment.
Care workers should therefore remain alert to changes such as:
- Reduced food intake
- Drinking less than usual
- Unexplained weight loss
- Reduced appetite
- Changes in general wellbeing
Staff should record and report concerns according to the person’s care plan and organisational procedures.
Our guides to nutrition and hydration in care homes and preventing dehydration in care homes provide further practical information.
Medicines Can Contribute to Falls Risk
Some medicines can contribute to factors associated with falling.
For example, a medicine might be associated with effects such as dizziness, drowsiness or changes in blood pressure.
This does not mean care workers should decide to stop or change someone’s medicine.
Medication decisions should be made by appropriately qualified professionals.
However, care workers can play an important observational role.
If a resident becomes noticeably more drowsy, dizzy or unsteady — particularly following a medication change — staff should record and report the concern appropriately.
Medication review forms part of comprehensive falls management in residential care.
Our Medication Awareness in Care Homes guide provides further information about the role care staff can play in supporting safer medication practices.
Dementia and Falls Prevention
People living with dementia may experience additional factors that affect their safety.
These can include changes in:
- Spatial awareness
- Perception
- Memory
- Judgement
- Communication
- Familiarity with surroundings
However, dementia should never automatically be used as a reason to remove someone’s independence.
Staff should understand the individual and consider what may be influencing their behaviour.
For example, a resident repeatedly getting out of their chair may not simply be “wandering”.
They could:
- Need the toilet
- Be uncomfortable
- Be looking for someone
- Want a drink
- Be following a familiar routine
- Need meaningful activity
- Be responding to something in the environment
Understanding the reason behind behaviour can lead to safer and more compassionate support.
Our Dementia Awareness Training for Care Staff guide explores person-centred dementia support in greater detail.
Toileting and Continence Should Be Considered
A resident who urgently needs the toilet may attempt to stand or walk more quickly than usual.
They may also try to mobilise without requesting assistance.
Continence needs should therefore form part of person-centred falls prevention where relevant.
Staff should:
- Understand the person’s normal routine
- Respond appropriately when assistance is requested
- Ensure call systems are accessible
- Follow the individual’s care plan
- Report significant changes in continence
The objective is to support dignity as well as safety.
Fear of Falling Can Affect Independence
After experiencing a fall, some people lose confidence.
They may begin avoiding activities they previously enjoyed because they are frightened of falling again.
This can create a difficult cycle.
Less movement may contribute to reduced strength and confidence, which may make mobility more difficult.
Care staff should therefore listen to people’s concerns and avoid dismissing their fears.
Encouragement should remain realistic and person-centred.
Where appropriate, relevant professionals may be able to support the person with mobility, strength, balance or confidence.
Encourage Appropriate Activity
Residents should have opportunities to remain active according to their abilities and preferences.
This might include:
- Walking
- Standing regularly
- Participating in appropriate activities
- Following professionally recommended exercise programmes
- Maintaining everyday routines
Exercise programmes designed specifically to address falls risk should be appropriately tailored and delivered by people with the necessary training and competence.
Care workers should follow the person’s care plan and recommendations from relevant healthcare professionals rather than creating their own exercise programme.
What Should Staff Do When Someone Falls?
Care staff should follow their organisation’s falls and emergency procedures.
The immediate response will depend on the circumstances and the person’s condition.
Staff should not automatically attempt to lift someone from the floor without appropriate assessment and consideration of possible injury.
Depending on the situation, actions may include:
- Remaining calm
- Reassuring the person
- Checking for immediate danger
- Following the organisation’s post-fall procedure
- Seeking appropriate clinical or emergency assistance
- Avoiding unnecessary movement where injury is suspected
- Reporting the incident
- Recording relevant information accurately
- Monitoring the person according to instructions
Staff should know how to summon assistance and understand the limits of their own role.
When Is Emergency Help Needed?
Care staff should follow organisational procedures and clinical guidance regarding emergency escalation.
A fall may require urgent medical attention, particularly where there are concerns such as serious injury, significant pain, loss of consciousness or a sudden deterioration in the person’s condition.
Staff should never delay seeking appropriate assistance because they are worried about completing paperwork or explaining how the fall occurred.
The person’s immediate safety comes first.
Record Falls Accurately
Good documentation helps organisations understand what happened and identify potential patterns.
Records should be factual and completed according to organisational procedures.
Useful information may include:
- Where the fall occurred
- When it happened
- What the person was doing
- Whether anyone witnessed it
- Environmental conditions
- Relevant observations
- What action was taken
- Who was informed
Staff should avoid assumptions.
For example, rather than recording:
“Mrs Brown fell because she wasn’t using her walking frame.”
a factual record might state:
“Mrs Brown was found sitting on the floor beside her bed. Her walking frame was positioned approximately two metres away.”
The second statement records what was observed without assuming the cause.
Learn From Falls and Near Misses
Falls should not simply be recorded and forgotten.
They can provide valuable information about a person’s changing needs or the environment.
Managers and relevant professionals may need to consider:
- Has the person fallen before?
- Is there a pattern?
- Do falls happen at a particular time?
- Has mobility changed?
- Has medication changed?
- Is toileting involved?
- Are environmental hazards contributing?
- Does the care plan need reviewing?
- Is additional professional assessment required?
Near misses can also be useful.
If a resident nearly falls but is supported before reaching the floor, there may still be something important to learn.
Avoid Blaming the Person
Language matters.
Descriptions such as:
“She keeps falling because she won’t listen.”
are neither useful nor person-centred.
Instead, staff should consider what may be contributing to the situation.
Perhaps the person:
- Does not remember to use their walking aid
- Cannot easily reach their call bell
- Needs the toilet frequently
- Is experiencing dizziness
- Does not understand instructions
- Finds the equipment uncomfortable
- Values independent movement highly
Understanding the reason behind behaviour creates opportunities for better support.
Falls Prevention and Mental Capacity
Some situations involving falls risk may raise questions about capacity and choice.
A person may choose to continue an activity that staff consider risky.
An unwise decision does not, by itself, mean the person lacks capacity.
Where there are genuine concerns about capacity for a particular decision, staff should follow the Mental Capacity Act framework and organisational procedures.
Our guide to Mental Capacity Act & DoLS awareness explains this important principle in more detail.
Communicate Changes During Handover
Falls prevention depends heavily on good communication.
Important information should not remain with one member of staff.
Handovers may need to include relevant changes such as:
- A recent fall
- A near miss
- New dizziness
- Changes in mobility
- Increased assistance requirements
- Medication changes
- New equipment
- Changes to a care plan
- New professional recommendations
Clear communication helps the whole team provide consistent support.
Falls Prevention and Health & Safety
Environmental safety is part of wider health and safety practice.
Care staff should understand how to identify hazards and how to report or address them appropriately.
Regular environmental awareness can help identify risks before an incident occurs.
Our guide to Health & Safety Awareness Training in Care Settings explores wider safety responsibilities for care workers.
Falls Prevention and CQC Inspection Readiness
Falls management can provide evidence about how effectively a service identifies risk, responds to incidents, learns from events and supports people’s individual needs.
Providers should be able to demonstrate that falls are not simply being recorded but appropriately assessed and reviewed.
Evidence might include:
- Current care plans
- Individual assessments
- Incident records
- Post-fall reviews
- Staff training
- Professional referrals
- Medication reviews
- Environmental checks
- Evidence of learning from incidents
- Communication with residents and families where appropriate
Our CQC inspection staff training checklist provides further guidance for managers preparing their teams.
You can also read our guide to CQC training requirements for care homes.
Training Staff in Falls Prevention
Falls prevention is a team responsibility.
Training can help care workers understand:
- Common contributing factors
- Environmental hazards
- Changes in mobility
- Safe use of equipment
- Reporting procedures
- Record keeping
- Person-centred risk management
- Their role following a fall
- When to seek additional help
Training should be reinforced through supervision, care-plan reviews, competency assessment where appropriate and learning from real incidents.
Ongoing professional development helps staff maintain awareness rather than treating falls prevention as a one-off training topic.
A Practical Falls Prevention Checklist for Care Staff
During everyday care, staff can ask:
- Has this person’s mobility changed?
- Are they more unsteady than usual?
- Have they reported dizziness?
- Is their walking aid accessible?
- Is the environment clear of obvious hazards?
- Is lighting adequate?
- Does their footwear appear suitable?
- Are they eating and drinking as expected?
- Have there been recent medication changes?
- Are toileting needs contributing to urgency?
- Is the person frightened of falling?
- Does their care plan reflect their current needs?
- Have recent falls or near misses been reviewed?
- Am I supporting independence rather than unnecessarily restricting it?
- Do I need to report a change or seek advice?
These simple observations can contribute significantly to safer care.
Creating a Positive Falls Prevention Culture
Effective falls prevention does not depend on one member of staff remembering a checklist.
It requires an organisational culture where everyone understands that changes and concerns should be communicated.
Managers can support this by:
- Providing appropriate training
- Reviewing incidents and near misses
- Keeping care plans current
- Encouraging staff to report changes
- Acting on environmental concerns
- Involving relevant healthcare professionals
- Listening to residents
- Supporting appropriate activity
- Sharing learning across the team
Most importantly, staff should understand that the objective is not simply to achieve “zero falls at any cost.”
Care involves supporting real people to live meaningful lives.
A resident’s independence, dignity, preferences and quality of life matter alongside their physical safety.
Supporting Safer, More Independent Lives
Falls prevention in care homes is about much more than removing trip hazards.
It requires staff to understand each person, recognise changes, communicate concerns, maintain safe environments and work alongside residents, colleagues and relevant healthcare professionals.
Some falls may still occur despite appropriate care and risk management.
The goal is to identify modifiable factors, respond appropriately when circumstances change and learn from incidents when they happen.
For care workers, everyday observations can make an important difference.
Noticing that someone is walking differently, drinking less, becoming dizzy or struggling with their usual footwear may provide an early opportunity for their needs to be reviewed.
The strongest approach combines safety with independence.
That means helping people remain active, involved and confident while taking reasonable and proportionate steps to reduce avoidable harm.
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