Falls prevention in homecare

In caring for your service users, it’s your duty to minimise the risk of them injuring themselves. Slips trips and falls are a regular cause of injury even for those who are able-bodied. Given the fact that your service users have come to require care at home, they’re likely to be at a higher risk of falling than most if preventive measures aren’t put in place.

Here, we look at the assessment of the risk to your service users, what preventative measures you can put in place to minimise that risk, and what care workers should do in the event of the service user having a fall.

Assessment

Risk of falls will be covered in each service users individual care assessment. In considering the level of risk, you should consider and monitor:

  • If there’s been any recent falls,
  • If the individual is visually impaired,
  • Mobility – non-ambulant people will suffer from stiff joints and muscles, making them less steady and standing more difficult,
  • Mental illness – conditions which cause delusions or the ‘visual cliff effect’,
  • Medication – high levels or some mixes of medication can cause confusion, dizziness and drowsiness which can increase the risk of falls,
  • Frequent activity during the night – insomnia and incontinence might mean the individual is up and down out of bed.

You should also consider any medical conditions that could impact the following:

  • Balance – people with Parkinson’s, arthritis, multiple sclerosis, strokes etc,
  • Sudden drop in blood pressure – things like postural hypotension,
  • Confusion -conditions like Alzheimer’s and other forms of dementia.

And, it’s not only the individual’s physical and mental conditions which pose a risk. The setting, environment and everything around them will also have an effect. Ask yourself:

  • Is the ground flat and even?
  • Does the individual wear appropriate footwear? Shoes with a heel, poor fitting or slippery soles put the service user at higher risk.
  • Are mobility aids the right size and being properly used? If not, they can cause more harm than good.
  • How’s the lighting in the home? Poor lighting, not only reduces visibility, but prevents obstacles from being seen and creates shadows.
  • Are there any hazards you can remove? Rugs, bumps in the floor, wires, wet surfaces etc can all lead to an increased risk of slips, trips and falls.

Prevention

If the care assessment identifies any risk of falling, you’ll need to undertake a falls risk assessment. Do this as soon as the risk is identified and include details of the preventative measures to be put in place to reduce the risk. We’ve listed some examples of preventative measures and considerations below:

Shock absorbent pads: Designed to be worn in undergarments, these can be very effective in preventing hip fractures. Make sure they’re worn at all times and are the right size and fit.

Adjustable beds: Reduce the risk of falls when getting in and out of bed.

Pressure alarms or pads: Immediately alerts care workers when a service user is out of their bed or chair, so they can respond quickly.

Personal alarms: Allows the service user to quickly summon help if they fall.

Exercise and activity: The risk of falls can be significantly reduced for the majority of people when balance, strength and mobility are increased. Consider working with external trainers to create individual programmes and armchair workouts, in addition to balance and falls prevention classes provided by physiotherapists.

Look out for community centre exercise classes for older/less able people. Getting your service users out to these will improve social interaction as well as the physical benefit.

Calcium and vitamin D: Both help to strengthen bones and prevent fractures. Supplements may be prescribed, to prevent brittleness and osteoporosis. But remember, calcium and vitamin D levels should be carefully monitored by a GP. Excessive levels of each, come with their own health issues, like kidney problems, for example.

Medication: Medication should be regularly reviewed by a pharmacist or GP. Don’t forget to renew the falls risk assessment when drugs are changed.

Vision: Stability and balance are largely affected by the quality of a person’s sight. Encourage regular eye tests and look out for unsuitable glasses. Reading glasses, for example, aren’t suitable for much more than reading! The unsuitable focal point can be dangerous in certain situations.

Footcare: It’s not just appropriate shoes which need to be considered. Feet which are in poor condition can cause pain and unbalance. Keep an eye out for the need for creams and chiropodist treatment in order to reduce the risk.

Seating: Seats should be adapted to a safe height. Low seating will make standing up harder and high seating can cause over balancing. Consider adjustable seating to make getting up and down easier.

Walking Aids: A great way of improving balance – if used and maintained properly. Is the individual using the walking aid properly and confidently? Make regular checks for damage and replace the rubber ends when needed, to prevent slipping. Don’t forget to make sure walking aids are left within easy reach when you leave a visit.

Postural hypertension: A medical condition causing the rapid fall of blood pressure when the body changes position. It’s common amongst the elderly and occurs most often after sitting or standing for long periods of time, so sufferers are at risk when getting out of bed, the bath or a car for instance. Teach your service users to move slowly when getting up to help reduce the risk.

Consent

One of the biggest advantages of care at home is that it maintains the service user’s independence. Of course, any decision to put prevention means in place needs to be made with the involvement of the service user or their family, depending on the level of capacity. Review of any part of the care plan should be signed and consented to.

In the event of a fall

If there’s no obvious sign of injury and the individual is not complaining of any pain, you can help them to their feet and sit them down comfortably to recover. Once they are suitably recovered, try to establish the cause of the fall.

If the individual is unable to get up with a small amount of assistance or is complaining of any pain, they must not be moved, and paramedics should be called.

Either way, care workers must report the incident to the main office so that the relevant notifications can be made under RIDDOR and to the CQC. If the cause of the fall is not obvious, it might be necessary to notify a GP so that further tests can be done to determine the cause.

Use all of the above to make sure your staff are well trained and understand who is at risk, why they’re at risk, and what they can do to reduce that risk.

Get in touch

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