How do Care Homes prevent falls?

‍Care homes prevent falls through a combination of individual risk assessment, environmental modification, targeted exercise programmes, medication review, staff training, and structured post-fall analysis. Good homes use a whole-system approach that treats fall prevention as a continuous clinical process, not a one-time intervention.

Falls are the most common safety concern for families considering residential care. Understanding what a well-run care home actually does — practically and systematically — to reduce the risk can make a significant difference to the confidence families feel when a loved one makes the move.

Why Are Falls Such a Significant Risk in Care Settings?

Older people in care homes fall at roughly three times the rate of older people living independently in the community, reflecting the higher levels of frailty, cognitive impairment, and complex medication regimes in residential populations.

The data is unambiguous. Research consistently shows that between 30 and 40% of people aged 65 and over experience at least one fall per year, with the rate rising to one in two for those over 85. In care home settings, where residents often have multiple health conditions simultaneously, these rates are significantly higher.

The consequences are serious. Hip fractures — one of the most common fall-related injuries in older adults — cost the NHS and social care system an estimated £2 billion per year in hospital costs alone, with the broader societal cost of fragility fractures estimated at £4.4 billion annually. Beyond the physical injury, falls carry secondary consequences: fear of falling again, reduced mobility, loss of independence, and — in dementia patients in particular — significant distress.

Falls are also a leading reason for care home admission in the first place. Addressing them proactively is therefore not only a safety obligation but a core component of maintaining the quality of life and independence that residents come to a care home to preserve.

What Does a Falls Risk Assessment Involve?

A falls risk assessment is a structured clinical evaluation of all the individual factors — physical, cognitive, environmental, and pharmacological — that increase a specific resident's likelihood of falling. It is used to create a personalised prevention plan and is reviewed regularly as needs change.

Effective risk assessment is the foundation of any evidence-based falls prevention strategy. In line with NICE guideline NG147 (Falls in older people: assessing risk and prevention), a comprehensive assessment should cover:

• Gait and balance: How a resident moves, stands from a chair, and navigates uneven surfaces.
• Muscle strength: Lower limb weakness is a primary predictor of falls.
• Cognitive status: Dementia and other forms of cognitive impairment significantly elevate fall risk because residents may lack awareness of their own limitations.
• Postural hypotension: A drop in blood pressure on standing — common in older adults — can cause sudden dizziness and loss of balance.
• Vision: Poor eyesight reduces the ability to detect hazards.
• Footwear and foot health: Ill-fitting footwear and conditions such as bunions or toe deformities affect stability.
• Continence: Urgency incontinence leads residents to move quickly and inattentively, particularly at night.
• Polypharmacy: Multiple medications — particularly sedatives, antihypertensives, and psychotropic drugs — interact to increase fall risk. Medication review is a clinical priority.
• Previous fall history: One fall significantly increases the probability of another.

At Ashberry Care Homes, we use the Falls Risk Assessment in the Elderly (FRASE) tool as part of our structured risk assessment process. FRASE scores residents across multiple risk domains, enabling our teams to identify those at highest risk and concentrate prevention resources accordingly. Assessments are reviewed regularly, and any significant change in health status triggers an immediate reassessment.

What Is the ACTiON FALLs Programme?

ACTiON FALLs is a multifactorial falls prevention programme designed specifically for care home settings. It uses a structured assessment framework to identify individual risk factors and creates a coordinated, personalised prevention plan that is reviewed continuously rather than at fixed intervals.

ACTiON FALLs addresses the evidence that single-intervention approaches — installing a grab rail, for instance, or reviewing medication alone — have limited effect on falls rates. Meaningful reduction requires multiple risk factors to be identified and addressed simultaneously, with progress monitored and plans adjusted as circumstances change.

The programme includes:

• Systematic identification of modifiable risk factors for each resident.
• Targeted environmental modifications linked to individual risk profiles, not just general home safety.
• Personalised exercise and mobility plans to address gait and balance deficits.
• Medication review coordination with prescribing clinicians.
• Structured communication between care staff, clinical leads, and families.
• Regular audit of falls data to identify patterns and emerging risks.

The Falls in Care Homes (FinCH) study, a significant body of research examining whole-system approaches to falls prevention, found that designating a trained Falls Champion within care home staff — a named individual responsible for driving falls prevention culture and practice — produces meaningful improvements in outcomes. Falls Champions receive enhanced training and act as an internal resource and audit function, keeping prevention practice current and embedded.

Ashberry Care Homes has adopted this model across our homes, with Falls Champions trained and supported by our clinical leads and home managers.

"Falls prevention is not a task you complete — it is a discipline you maintain. The residents at highest risk are often those whose circumstances change most frequently: a new medication, a change in mobility, a period of illness. The teams that get this right are those who treat every reassessment with the same rigour as the first one." — Ashberry Healthcare

What Environmental Measures Are Used to Prevent Falls?

Environmental fall prevention involves identifying and removing or reducing physical hazards in the care home setting, including lighting, flooring, furniture placement, access to bathrooms, and the provision of mobility aids.

The care home environment itself is a significant modifiable risk factor. Our maintenance and care teams carry out regular safety inspections across all our homes, addressing:

• Lighting: Adequate illumination — particularly at night and along routes to bathrooms — reduces the risk of residents misjudging steps or surfaces. Motion-activated lighting in corridors and bedrooms is used where appropriate.
• Handrails and grab rails: Strategically positioned in corridors, bathrooms, and around beds to provide safe support points for residents who are mobile but unsteady.
• Flooring: High-contrast floor markings, non-slip surfaces, and the removal of loose mats or trip hazards across high-traffic areas.
• Furniture arrangement: Clear pathways and appropriately positioned furniture that can support a resident who needs to steady themselves.
• Call systems: Accessible call bells positioned so residents can summon assistance rather than attempting to move independently when unsteady.
• Bed height adjustment: Beds set at appropriate height for individual residents, with appropriate bed rails where assessed as necessary and appropriate under Mental Capacity Act considerations.

Environmental modifications are always linked to individual risk assessments — a general approach to home safety is a starting point, not a substitute for understanding each resident's specific challenges.

How Does Exercise Help Prevent Falls?

Targeted exercise programmes reduce falls risk by improving lower limb strength, balance, coordination, and confidence. Evidence supports the use of group and individual exercise in care home settings as an effective, low-risk intervention.

Physical deconditioning — the gradual loss of muscle strength and coordination that accompanies inactivity — is one of the most significant and most preventable contributors to falls in older adults. NICE guideline NG147 includes strength and balance training as a core component of falls prevention for older people in all settings.

At Ashberry, our wellbeing coordinators design and deliver activity programmes that incorporate:

• Chair-based exercises targeting lower limb strength, ankle stability, and core balance.
• Standing balance exercises for residents with the capacity to participate safely.
• Gentle walking programmes that maintain mobility and gait confidence.
• Group activity sessions that combine physical movement with social engagement — which also addresses the fear of falling that often leads residents to restrict their own movement, paradoxically increasing risk.

Falls prevention exercise is not a stand-alone programme — it is integrated into daily activity planning across all our homes. Our article on easy exercises for seniors with mobility limitations explores some of the specific approaches we use.

Maintaining mobility and independence is a core part of the experience we offer across our residential care and nursing care services, and our article on maintaining independence in a care home covers how we approach this more broadly.

How Is Medication Managed to Reduce Falls Risk?

Polypharmacy — the concurrent use of multiple medications — is a well-established risk factor for falls in older adults. Care homes reduce this risk through regular medication reviews, carried out in collaboration with prescribing GPs and clinical pharmacists, to identify and where possible reduce medications that increase fall risk.

Many of the medications commonly prescribed to older adults — including antihypertensives, diuretics, sedatives, antidepressants, and antipsychotics — have side effects that contribute directly to fall risk: dizziness, postural hypotension, sedation, and impaired coordination. When multiple such medications are taken simultaneously, the combined effect on balance and reaction time can be significant.

At Ashberry, our clinical leads coordinate regular medication reviews for all residents, with particular attention to:

• Medicines associated with postural hypotension, where blood pressure drops sharply on standing.
• Sedating medications prescribed for sleep, anxiety, or behavioural symptoms of dementia.
• Any recent change in medication regime, which may alter balance and alertness in ways that require a temporary adjustment to a resident's supervision and care plan.

Medication review is not a one-time process. Any new prescription, dose change, or change in a resident's physical status prompts a clinical review of the full medication picture.

How Do Care Homes Prevent Falls in Residents with Dementia?

Dementia significantly elevates falls risk because affected individuals may have impaired spatial awareness, reduced insight into their own physical limitations, altered gait patterns, and difficulty communicating pain or dizziness. Prevention in dementia care requires additional layers of specialist assessment and an adapted environment.

As a specialist provider of dementia care, Ashberry recognises that standard falls prevention protocols are necessary but not sufficient for residents living with dementia. The additional dimensions we address include:

• Specialist staff training focused on the specific gait and movement characteristics of dementia — including shuffling gait, difficulty judging distances, and sudden stops or direction changes.
• Environmental adaptation that goes beyond standard safety measures: dementia-specific design principles that use colour contrast to help residents distinguish floors from walls and furniture, reducing spatial confusion that can lead to missteps.
• Behavioural pattern monitoring — tracking when and where falls tend to occur, which can reveal environmental triggers or times of day when a resident is particularly at risk and requires more active supervision.
• Family involvement in risk management, with open communication about a resident's changing presentation and joint decision-making about interventions that balance safety with dignity and autonomy.
• Transparent falls reporting shared with families so that prevention strategies can be reviewed collaboratively.

What Is the ISTUMBLE® App and How Does Ashberry Use It?

ISTUMBLE® is an NHS-accredited app and clinical algorithm developed by Winncare and the Welsh Ambulance Services NHS Trust to guide care home staff in assessing and responding to a resident who has fallen. It reduces the time residents spend on the floor by providing clear, evidence-based guidance on whether to summon emergency assistance or to safely assist the resident using manual handling techniques.

A key but often overlooked dimension of falls safety is what happens after a fall occurs. Residents who remain on the floor for an extended period — a "long lie" — are at serious risk of hypothermia, pressure injuries, dehydration, and pneumonia. Reducing the time between a fall and appropriate response is therefore a clinical priority in its own right.

The ISTUMBLE® algorithm guides staff through a structured assessment process, providing clear decision support on the safest course of action for each individual situation. The app has recorded over 140,000 downloads and holds Orcha accreditation for use within the NHS — a robust quality benchmark for digital health tools.

Ashberry Care Homes has been piloting ISTUMBLE® as part of our falls response protocol, evaluating its effectiveness in guiding staff decision-making in the critical moments after a fall occurs.

What Happens After a Fall in a Care Home?

After any fall, a good care home conducts a structured post-fall review covering the resident's immediate clinical needs, an examination of contributing factors, and a reassessment of the care plan and environment. The aim is both to ensure the resident's safety and to understand whether the fall was preventable.

At Ashberry, every fall — regardless of whether injury occurred — triggers a formal review process:

1. Immediate clinical assessment to identify any injury requiring medical attention.
2. Incident documentation in the resident's care record, including the circumstances, any witnesses, and the response taken.
3. Post-fall monitoring for signs of injury that may not be immediately apparent, including confusion or distress in dementia residents who may be unable to communicate pain.
4. Care plan review examining whether any aspect of the resident's assessment or environment requires adjustment.
5. Family notification and, where appropriate, a conversation with family members about the circumstances and any changes being made.
6. Pattern analysis — individual falls are reviewed in the context of the resident's fall history and compared against home-wide data to identify emerging patterns.

"Every fall is a question we need to answer. Was there something we could have foreseen? Was there something in the environment we can change? Did a medication adjustment change how the resident moves? The review process is not about apportioning blame — it is about learning, and about giving residents and their families confidence that we take every incident seriously." — Ashberry Healthcare

Frequently Asked Questions

How often do care home residents fall?Research indicates that care home residents fall at approximately three times the rate of older adults living independently. Studies estimate that between 30 and 40% of people aged 65 and over fall at least once per year, with rates higher in care home populations due to the concentration of frailty, cognitive impairment, and complex health conditions.

What is a Falls Champion in a care home?A Falls Champion is a designated member of care home staff who receives enhanced training in falls prevention and takes lead responsibility for maintaining and improving falls prevention practice across the home. Evidence from the FinCH study found that having a named Falls Champion produces measurable improvements in the quality and consistency of falls prevention in care settings.

Can falls in care homes be eliminated entirely?No — and any care home that claims zero falls should be treated with scepticism. The goal of evidence-based falls prevention is to reduce the frequency and severity of falls, not to eliminate them entirely. Some residents have fall risk factors that cannot be fully mitigated without unacceptably restricting their independence and quality of life. The balance between safety and dignity is a continuous, individual judgement.

What should I ask a care home about falls when visiting?Ask whether the home has a named Falls Champion and a formal falls prevention protocol. Ask how falls are documented and reviewed, how families are notified, and what the home's falls data looks like compared to sector benchmarks. Ask specifically about the home's approach to falls in residents with dementia, if relevant. Our article on what to look for and ask on your care home visit provides a broader framework for this conversation.

Does the CQC assess care homes on falls prevention?Yes. The Care Quality Commission evaluates safety as one of its five key domains when inspecting care homes. Falls prevention protocols, post-fall reviews, and incident documentation are all reviewed as part of this assessment. Our article on care home quality ratings explains how CQC inspection works in practice.

If you would like to understand more about how we approach falls prevention across our homes, or to discuss care options for a loved one, our team would be happy to talk with you.

Get in touch with the Ashberry team or learn more about how we keep residents safe.

Falls prevention clinical practice referenced in this article reflects NICE guideline NG147: Falls in older people: assessing risk and prevention (updated 2024) and the FinCH (Falls in Care Homes) research programme. ISTUMBLE® is a registered trademark of Winncare. Orcha accreditation information correct as of publication.

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