Falls prevention in care homes

Falls are a significant problem for care homes, as residents are three times more likely to fall than their counterparts who live in their own homes, and 10 times more likely to sustain a significant injury as a result of falling. What’s more, 40% of admissions from care homes to hospitals are related to falls.

In 2021, the largest study to date of falls in UK care homes was published by the University of Nottingham. The team had studied more than 1,600 residents across 84 care homes in different areas of England for three years. They tested a new approach to falls called the ‘Guide to Action for Care Homes’ – the ‘GtACH’ programme, which had been devised in collaboration with care home staff and families of residents in long-term care settings. The study found that this coordinated approach to fall prevention cut the number of falls by 43% – a significant reduction. 

So, how did the researchers reduce falls with the GtACH programme? The method was grounded in a holistic approach, covering everything from training to staff working patterns to the care home environment. A key focus was on increasing staff awareness and knowledge about falls management, emphasising that multiple small actions can dramatically reduce fall risks. The programme included the following measures:

• One hour of dedicated training on falls and fall prevention for all care home staff (not just those directly involved with resident care)
• A manual with resources such as fall incident charts
• A risk assessment and checklist for all residents
• Focusing on residents as individuals
• Considering and adapting the care home environment
• Adapting staff working patterns
• Designating a 'Falls Champion' within care home staff
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Using this multi-factor approach, the GtACH programme aimed to:

• Reduce falls without limiting residents’ freedom, mobility or regular activities
• Improve residents’ quality of life, wellbeing and sense of independence
• Increase staff confidence in dealing with falls
• Reduce hospital admissions
• Offer cost-effective measures for reducing falls

• Staff training and education: One of the cornerstones of the GtACH approach is staff training. The programme provided one-hour training sessions for all care home staff – which crucially included those in non-care roles. These sessions, delivered by fall specialists in small groups, used case studies and role play to teach the GtACH approach. This inclusive training ensured that everyone in the care home environment was equipped to contribute to fall prevention.
• Comprehensive assessment tools: The GtACH programme introduced a 33-point checklist for fall risk assessment, along with 33 associated actions corresponding to identified risks. This systematic approach allowed for a thorough evaluation of each resident’s fall risk and provided clear guidance on how to address these risks. Additionally, the programme included a Falls Incident Analysis template. This tool helped staff detect patterns in falls, enabling more targeted prevention strategies.
• Resources: To support ongoing implementation, the GtACH programme provided a manual summarising the approach, which remained in care homes for reference. It also included a ‘drug and falls risk chart’ and a poster to remind staff to use the GtACH programme consistently.

A key aspect of preventing falls is adapting the care environment – installing extra handrails, having the right equipment to help with mobility and movement, and making sure there is good lighting and visibility throughout the care home. 

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The following factors all contribute to a safer environment where fall risk is reduced:

• Staff education: Encourage all staff to adopt a ‘falls prevention mindset’, including understanding and mitigating risks
• Personalised care plans: Assess individual risk factors and tailor care plans accordingly for each resident
• Medication reviews: Some medications may raise the risk of falls due to side-effects like dizziness, so ensure that medication is carefully managed and reviewed for all residents
• Exercise and activity: When planning activities and exercise for residents, include movements that will help enhance physical strength and balance, reducing the risk of falls

Adhering to COSHH regulations is not just a legal obligation – it’s a fundamental aspect of ensuring safety in care homes. By conducting thorough risk assessments, implementing effective control measures, and providing comprehensive training, care homes can create a safer environment for both residents and staff, maintaining good levels of well-being for everyone. Regular reviews and updates to COSHH policies will help maintain compliance and adapt to any changes in the care home setting.