Falls Prevention in Care Homes: A Practical Guide for Care Staff
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: 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: 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: 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: 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: 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: 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: 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: 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: 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: However, dementia should never automatically be used as a reason to remove someone’s independence. Staff should understand the individual