Spot fall risks early, make the room and the home safer, help people walk and transfer, and know what to do right after a fall.
ForNursing home, Home health, Hospice staff
TimeAbout 72 minutes
Lessons10, each with a quick check
FinishA quiz (80% to pass) and a printable certificate of completion
What you will learn
Know how common and serious falls are for older adults.
Name common reasons people fall.
Do a quick safety check when you enter and before you leave.
Help people wear safe shoes and clothing.
Check the care plan before every transfer.
Know that rushing to the toilet is a common reason people fall.
Know that bed rails carry risks, including getting trapped.
Stay with the person, keep them still, and get the nurse.
Spot common fall hazards in a patient's home.
Know what to do if a patient falls while you are there.
Written by Pact Compliance from federal rules and CDC, CMS, OSHA and NIH guidance (sources under each lesson), checked October 2026. Where your facility's policy is different, follow your facility's policy.
Lesson 1: Why Falls Matter
In this lesson you will:
Know how common and serious falls are for older adults.
Know what counts as a fall, including near-falls.
Know your part in preventing falls.
Falls are common
Often hidden
Falls happen a lot. CDC says more than one out of four older people falls each year. But less than half tell their doctor. Falling once doubles the chance of falling again. CDC also says falls are the leading cause of injury death for adults 65 and older. In 2024, falls in that age group caused over 43,000 deaths.
Hips and heads
Serious injuries
Falls can break bones. CDC says 88 percent of emergency visits and hospital stays for hip fractures were caused by falls. Falls are also the most common cause of brain injury in older adults. CDC says an older person who falls and hits their head should see a doctor right away. This matters even more for people who take blood thinners. So a fall with a bump to the head is always something to tell your nurse at once.
More than injury
Fear of falling
NIA says a broken bone can be the start of more health problems and long-term disability. CMS lists other results of falls: pain, a higher risk of death, loss of function, and fear of falling. Fear may cause a person to cut down on everyday activities. Then they get weaker and more alone. NIA says staying active actually helps prevent falls.
Show the answer
Yes. A near-fall that staff stopped still counts. CMS says a loss of balance that would have been a fall, if not for another person, is a fall.
What counts
Near-falls too
CMS defines a fall as coming to rest on the ground, the floor, or another lower level without meaning to. If a person loses their balance and would have fallen, but someone caught them, that still counts as a fall. A fall with no injury is still a fall. And if you find a person on the floor, it counts as a fall, unless there is proof it was something else. CMS uses this for nursing homes. It is a good habit in every setting: report near-falls and people found on the floor.
Many can be prevented
Look for causes
The good news: CDC says falls can be prevented. NIA says that most of the time, falls do not just happen for no reason. Exercise, managing medicines, checking vision, and a safer home all help. CMS also says that not every fall can be avoided. Our job is to find the risks we can change, and change them.
The rules
Safe place, right help
In nursing homes, a federal rule says the facility must keep each resident's surroundings as free of accident hazards as possible. Each resident must also get enough supervision and the devices they need to prevent accidents. CMS says all staff should help find hazards. In home health and hospice, aide training must cover a clean, safe home and safe ways to transfer and walk with patients.
Your role
See, fix, report
You are with people more than anyone else. You see the risks first. Know each person's fall plan in their care plan, and follow it. Fix simple hazards you can fix safely. Report the ones you cannot. Report every fall and near-fall. Home health and hospice aides must report changes to the nurse. CMS says a safe place has a way to report risks without blaming the person who reports.
On your shift
A close call
Mr. Lopez trips in the hall. You grab his arm, and he does not hit the floor. He laughs and says, 'I'm fine. Don't tell anyone.' You smile and say, 'I'm glad you're OK. I do need to let the nurse know, so we can keep you safe.' Then you tell your nurse what happened, where, and what he was doing. A near-fall is a warning. It counts.
Quick review
Every fall counts
Let's review. More than one in four older adults falls each year, and many do not tell anyone. Falls can break hips and hurt the brain. Fear of falling can make people less active. A near-fall, a fall with no injury, and a person found on the floor all count. Many falls can be prevented. Follow the care plan, fix what you safely can, and report every fall.
Lesson 2: Who Is at Risk: Changes to Watch and Report
In this lesson you will:
Name common reasons people fall.
Help people stand up slowly.
Report changes that raise fall risk.
Many causes
Often together
Falls often have more than one cause. CMS lists many of them. Wet floors, poor lighting, a bed at the wrong height, and a wheelchair that does not fit. Unsafe shoes or no shoes. Loose clothing. Long-term illness, like arthritis or heart failure. A new illness, like a fever or infection. Medicine side effects. Weak legs, poor balance, a weak grip, and trouble getting up from a chair or toilet.
The body
Sight and strength
CMS also lists problems with walking, memory, eyesight, pain, and bladder control. NIA adds that eyesight, hearing, and reflexes may not be as sharp with age. Diabetes, heart disease, and thyroid, nerve, or foot problems can affect balance. Many older adults lose muscle. CDC names lower body weakness and trouble with walking and balance as risk factors. So does foot pain.
Memory loss
Higher risk
NIA says people with mild memory problems or some types of dementia are at higher risk of falling. A person with dementia may not remember to ask for help. They may forget their walker. CMS says the right amount of supervision depends on each person's needs. It can change from day to day. So follow the checks in the care plan, and tell your nurse if the person needs more help than before.
Show the answer
Problems with bladder control. CMS lists incontinence as a factor that can lead to falls.
Dizzy on standing
Go slowly
For some people, blood pressure drops too much when they stand up. NIA says this can make a person feel wobbly. Help people stand up slowly. Have them sit on the edge of the bed for a few moments first, with feet flat on the floor. MedlinePlus says to wait a little in case they feel dizzy. Then stand, holding something steady. If they feel dizzy, help them sit back down and tell your nurse.
Medicines
Watch and tell
NIA says some medicines raise the risk of falling because they cause dizziness or confusion. The more medicines a person takes, the more likely they are to fall. CDC names medicines like sedatives and antidepressants. Even some over-the-counter medicines can affect balance. You do not change or hold medicines. But if a person seems sleepy, dizzy, or unsteady, tell your nurse. Say when it started.
Sudden change
Report fast
A sudden change can mean a new illness. CMS lists fever, infection, and sudden confusion as fall risks. If a person is suddenly weaker, more confused, or more unsteady than usual, report it right away. Do not wait for the end of your shift. Home health and hospice aides must report changes in a patient's condition to the nurse.
A past fall
A big clue
CDC says falling once doubles the chance of falling again. MedlinePlus says to contact the provider after a fall or even a near-fall. Tell your nurse about every fall and near-fall. CMS says the team should find what caused it and change the plan if needed. Your report is how the plan gets better.
On your shift
Not herself today
Mrs. Grant usually walks well with her walker. Today she shuffles and holds onto the wall. She called you by her sister's name, which is new. You help her sit down in a safe chair. You stay with her and call your nurse. You say, 'Mrs. Grant is shuffling and more confused than usual. It started this morning.' A sudden change like this is a fall risk and may be an illness.
Quick review
Know the risks
Let's review. Falls often have more than one cause. Weak legs, poor balance, eyesight, foot pain, dementia, and bladder problems all raise risk. Help people stand up slowly, and sit first. Tell your nurse if someone seems dizzy, sleepy, or unsteady, or suddenly weaker or more confused. And report every fall and near-fall.
Do a quick safety check when you enter and before you leave.
Spot and fix common hazards.
Report hazards and broken equipment you cannot fix.
Hazards cause falls
Look every time
Many falls start with a hazard in the room. CMS names wet floors, poor lighting, and a bed at the wrong height. It also names torn carpets, cords on the floor, and uneven floors. A good habit: look around each time you walk into a room, and again before you leave. It takes a few seconds and can prevent a fall.
Call light
Within reach
Nursing homes must have a call system at each bed and in each toilet and bathing area. CMS says the call system must be within the resident's reach, and should even be reachable from the floor. Before you leave, put the call light where the person can reach it and use it. In a home, NIA suggests keeping a phone near the bed. Help the patient keep their phone close.
Bed low
Brakes locked
CMS lists a bed at the wrong height as a fall hazard. MedlinePlus says a bed should be low enough that the person's feet touch the floor when they sit on the edge. If you raise the bed for care, lower it again to the height in the care plan before you leave. Lock the wheels on beds, wheelchairs, and commodes. CMS says not locking wheelchair brakes can lead to falls.
Show the answer
Put the call light where she can reach it. The call system must be within the resident's reach.
Clear the path
Cords and clutter
Keep walking paths clear. CDC says to keep shoes, papers, and other things off the floor. Move furniture so the path is clear. Keep cords along the wall, out of the way, so no one trips. CMS lists cords on the floor as a hazard. Pay most attention to the path from the bed to the bathroom.
Spills
Wipe right away
Wet floors cause falls. NIA says to clean up spills right away, and not to walk on slippery, newly washed floors. MedlinePlus says to keep the floor outside the tub or shower dry. If you cannot clean a spill yourself, stay by it or mark it, and call for help the way your workplace says. Do not walk away from a wet floor.
Lighting
Not too bright
CMS says falls are more likely with too little light, or with too much light that causes glare. Most older people need more light to see. But a person with cataracts or glaucoma may find bright light hard to see in. Ask the person what works. Turn on a light near the bed at night if they get up. CDC suggests a nightlight on the path to the bathroom.
Things in reach
Walker too
People fall when they reach or stretch for things. CMS says a walker or wheelchair the person cannot reach can cause a fall. Storing a wheelchair across the room from someone who can use it is a problem. Before you leave, put the walker, glasses, water, and other needed items close by. NIA suggests keeping things used often at waist level.
Broken equipment
Report it
CMS says equipment can be a hazard when it is broken or not used the right way. Report broken brakes, a loose grab bar, a call light that does not work, or a burned-out bulb. Do not use broken equipment. Follow your workplace's steps to report it. In home health and hospice, tell your nurse about hazards you see.
Quick review
Check before you go
Let's review. Look around the room when you enter and before you leave. Call light or phone in reach. Bed low and locked. Wheelchair brakes on. A clear path, with no cords or spills. Good light without glare. Walker and needed items in reach. Report broken equipment and hazards you cannot fix.
Lesson 4: Shoes, Glasses, Hearing Aids and Walking Aids
In this lesson you will:
Help people wear safe shoes and clothing.
Make sure glasses and hearing aids are on and working.
Use walkers and canes the way the care plan says.
Safe shoes
Nonskid soles
Shoes matter. CMS lists unsafe shoes, or no shoes, as a cause of falls. CDC names poor footwear too. NIA says to wear nonskid, rubber-soled, low-heeled shoes. Do not let people walk on floors in socks, or in slippers with smooth soles. Backless shoes and high heels also raise the risk. Put shoes on before the person stands up.
Clothing
Not too long
CMS also lists loose clothing, or clothing worn the wrong way, as a fall risk. Pants that drag on the floor can catch a foot. A long robe or loose belt can get tangled. Untied laces can trip a person. Help the person dress in clothes that fit. Tie laces, and fasten straps before they walk.
Glasses on
Clean and theirs
NIA says even small changes in sight are linked to more falls. Make sure the person wears their own glasses, the way the eye doctor advised. Keep them clean. NIA says new glasses take time to get used to. CDC says eyes should be checked at least once a year, and glasses replaced as needed. Tell your nurse if glasses are broken, lost, or the person says they cannot see well.
Show the answer
Nonskid, rubber-soled, low-heeled shoes. NIA recommends these to support the feet and prevent slips.
Hearing aids
In and working
NIA says hearing changes are also linked to falls. If a person has a hearing aid, NIA says it should fit well and be worn. A person who can hear you can follow your words when you help them walk or move. Help put hearing aids in, as the care plan says. Tell your nurse if a hearing aid is not working.
Walking aids
The right fit
CMS says walkers, canes, and wheelchairs can cause falls if they do not fit or are not kept in good shape. NIA says a cane or walker must be the right size, and walker wheels should roll smoothly. MedlinePlus says walker handles should be at hip level, and a cane handle at wrist level. Check tips and wheels for wear. A therapist decides which device a person uses and teaches them how.
Use it right
Watch and report
MedlinePlus gives walker tips. All four tips or wheels touch the ground before the person leans on it. Look ahead, not down. Keep toes inside the walker. Do not pull on the walker to stand. Push up from the chair arms instead. A cane goes in the hand opposite the weaker leg. If you see someone using a device in an unsafe way, tell your nurse or therapist.
In reach
Their own device
CMS says a device the person cannot reach can cause a fall. People get up without it. Keep the walker or wheelchair next to the person, not across the room. Each person uses their own device. NIA says borrowed equipment should be checked for the right size and safety. So never hand someone another person's walker.
On your shift
Before he stands
Mr. Adams needs the bathroom. He is in socks. His walker is by the door, and his glasses are on the table. You say, 'Let's get you ready first.' You put on his nonskid shoes and hand him his glasses. You bring his walker close and check the brakes on his chair. Then you walk with him, as his care plan says.
Quick review
Ready to walk
Let's review. Nonskid, low-heeled shoes that fit. No socks or smooth slippers on the floor. Clothes that fit and do not drag. Clean glasses on, and hearing aids in and working. A walker or cane that fits, is in good shape, and is in reach. Report broken devices and unsafe use.
Lesson 5: Helping Someone Walk and Transfer Safely
In this lesson you will:
Check the care plan before every transfer.
Get the space and the person ready.
Know when to stop, get help, or use a lift.
Care plan first
How much help
CMS says each person's assessment decides the safe way to move them. That includes whether one or more staff, or a lift, is needed. The care plan tells you. Check it before you help someone move. In home health and hospice, the RN writes care instructions for the aide. If the plan says two people or a lift, do not do it alone.
Don't lift by hand
Use the lift
OSHA says lifting residents by hand should be kept as low as possible, and stopped when it can be. MedlinePlus says if a person cannot use at least one leg, use a lift. If they cannot stand, take small steps, and hold up their own weight, get help. Use only lifts you have been trained on. OSHA says the lift must be rated for the person's weight.
Get ready
Brakes, shoes, path
MedlinePlus lists steps to get ready. Explain each step to the person. Move loose rugs out of the way. Put nonskid socks or shoes on their feet. Place the wheelchair next to the bed. Put the brakes on, and move the footrests out of the way. Lower the bed so their feet touch the floor.
Sit first
Wait a moment
MedlinePlus says the person must be sitting before the transfer. Let them sit for a few moments, in case they feel dizzy. NIA says getting up too fast can drop blood pressure and make a person wobbly. Ask, 'How do you feel?' If they are dizzy or weak, wait, and tell your nurse.
Show the answer
Wait, or find another trained staff member to help. Follow the care plan for the number of staff and the device.
Gait belt
Only if planned
Use a gait belt only if your policy and the care plan say to, and you are trained. OSHA says a gait belt is for people who can bear some weight and can help. Fasten it snugly over clothing, so the person cannot undo it. OSHA says it is not for lifting, and it may not be safe after recent belly or back surgery. Check with your nurse if you are not sure.
Your body
Close and low
MedlinePlus says stand close to the person. Bend your knees and keep your back straight. Count out loud to three, so you both move together. The person pushes up from the bed with their hands. They can reach for the wheelchair arm. They should not hold your neck. Pivot by moving your feet. OSHA says to move toward the person's strong side.
Walking together
Stay close
When you help someone walk, stay close, as the care plan says. Go at their pace. MedlinePlus says to look ahead and keep all walker tips on the ground. CMS says falls are more likely when a person has a new device, or just got weaker, and does not get enough supervision. Watch for tiredness, and let them rest.
Starting to fall
Ease them down
If a person starts to fall, do not try to hold them up. You could both get hurt. MedlinePlus says to lower them to the nearest flat surface: a bed, a chair, or the floor. Use your body to slow the fall. Keep your feet wide apart and your knees bent. Protect their head. Then stay with them, call for help, and do not get them up on your own.
Stop and ask
When in doubt
Sometimes a person is weaker than the plan expects. They cannot hold their weight, or they are scared. CMS says a person who is frightened in a lift may resist, so talk with them and ease their fear. If the plan does not match what you see, stop. Keep the person safe, and call your nurse. CMS says plans should change when a person changes.
Quick review
Plan, prepare, protect
Let's review. Check the care plan for how much help and which device. Do not lift people by hand. Use a lift if the plan says so. Brakes on, shoes on, path clear, bed low. Sit first and wait for dizziness to pass. Use a gait belt only if the plan says. Stay close and bend your knees. If they start to fall, ease them down and get help.
Your facility's policy (ask your supervisor):
Your transfer-status system (signs or codes for 1-person, 2-person, lift)
Your gait belt policy and who may use one
Which lifts you use, their weight limits, and how staff are trained and checked
Home health/hospice: where to find the RN's written aide care instructions
Know that rushing to the toilet is a common reason people fall.
Meet needs before people try to get up alone.
Answer call lights and alarms fast.
Rushing to the toilet
A big trigger
Many falls happen on the way to the bathroom. NIA says conditions that make people rush to the bathroom, like incontinence, raise the chance of falling. CMS lists bladder control problems, and trouble getting on and off the toilet, as fall risks. MedlinePlus says the bathroom is where falls most often happen at home.
What were they doing?
Find the need
When a person tries to get up alone, there is usually a reason. CMS says to find out what the person was trying to do. CMS gives examples: they had been in one spot too long, or they were reaching for something. Often it is the bathroom, a drink, pain, or something out of reach. Meet the need, and the risky trip may not happen.
Check in often
Before they ask
CMS says some nursing homes cut falls by using regular, planned check-ins to meet residents' needs before they ask. They also put more staff on at the times of day when most falls happen. Follow the toileting times in the care plan. A simple way to check in: ask about pain, the toilet, comfort, and whether needed things are in reach.
Show the answer
Ask her, 'Do you need to use the bathroom?' Toileting is a common reason people get up. Find the need behind it.
Call lights
Answer fast
CMS says the call system only works if calls are answered. There must be a call system at each toilet and bath, and it should be reachable from the floor. Answer call lights quickly, even if the person is not on your assignment. If you cannot help, find someone who can. In a home, help the patient keep a phone within reach.
Bathroom safety
Bars, mats, dry
MedlinePlus gives bathroom tips. Use grab bars and non-slip mats. Keep the floor dry. Do not use towel racks as grab bars. They cannot hold a person's weight. A raised toilet seat or a commode chair can help. MedlinePlus says not to get up suddenly after using the toilet. If the plan says to stay with the person, stay close.
At night
Light the way
Nighttime bathroom trips are risky. It is dark, and the person may be sleepy. CMS says extra light near the bed can help people who get up at night. CDC suggests a nightlight on the path from the bed to the bathroom. MedlinePlus says a commode near the bed can save a long trip. Ask your nurse if a person needs one.
Alarms
Not enough alone
Some nursing homes use bed or chair alarms. CMS says these alarms have not been proven to prevent falls. They may only tell staff a fall has already happened. False alarms can lead staff to stop responding. CMS says alarms should not be the main or only way to prevent falls, and they do not replace supervision. If a care plan uses an alarm, check it is on, and go right away when it sounds.
On your shift
The 2 a.m. alarm
Mrs. Bell's bed alarm goes off at 2 a.m. A coworker says, 'She does that all the time. Just turn it off.' You go to her room right away. She is sitting on the edge of the bed. She says, 'I need the bathroom.' You help her, as her care plan says. Then you tell your nurse she keeps getting up at night to use the toilet, so the team can plan for it.
Quick review
Meet needs early
Let's review. Rushing to the toilet is a common reason people fall. When someone tries to get up, find the need behind it. Check in often, and follow toileting times in the care plan. Answer call lights fast. Keep the bathroom dry and use grab bars, not towel racks. Light the path at night. Alarms do not replace you. Answer them right away.
Know that bed rails carry risks, including getting trapped.
Know the steps the facility must take before using a bed rail.
Know that restraints do not prevent falls, and never restrain anyone on your own.
Bed rails
Real risks
Many people think bed rails keep residents safe. But CMS says bed rails can be a hazard, even when they are used the right way. This is most true for people with dementia or sudden confusion. A person may try to climb over the rail, and fall from a greater height. Part of their body can get caught between the rail and the mattress, or in the rail itself.
Entrapment
Caught in a gap
Entrapment means a person is caught, trapped, or tangled in the space in or around the bed rail. CMS says those most at risk are frail or elderly, or have confusion, pain, or restless movement. Not getting help to the bathroom in time can add to the risk. An air mattress can squeeze down on one side and make a gap wider.
The rule
Try other ways first
A federal rule says a nursing home must try other options before using a bed rail. If a rail is used, the facility must check the person's risk of entrapment first. It must explain the risks and benefits, and get the resident's or representative's informed consent. The bed must fit the person's size and weight, and rails must be put on the way the maker says. CMS lists other options, like a lower bed, foam bumpers, and roll guards.
Show the answer
Other options, like a lower bed or foam bumpers. The rule says to try appropriate alternatives before installing a bed rail.
Your part
Follow the plan
Your job is to follow the care plan for each bed. If the plan says no rails, keep them down. CMS says raising a rail, even for a short time during care, is not allowed unless all the bed rail steps were done first. So do not raise a rail 'just for a minute.' If you need help with care, ask a coworker.
Check the bed
Report gaps
CMS says bed rails and mattresses should be checked often for gaps. There should be no gap wide enough to trap a person's head or body. Rails can shift or get loose over time. Tell your nurse right away if you see a loose rail, a gap, or a mattress that does not fit. When rails are used, the plan should say how the person's needs, like the bathroom and drinks, will be met.
Restraints
Not for convenience
Residents have the right to be free from restraints used for discipline or staff convenience, when they are not needed to treat a medical symptom. If a restraint is ever needed, the rule says to use the least restrictive kind for the shortest time. CMS says a physical restraint is anything attached or next to the body that the person cannot easily remove, and that limits their movement. A bed rail can be a restraint if it keeps a person from getting out of bed.
Restraints harm
Never on your own
Restraints do not make falls safer. CMS says serious injuries and deaths have happened from restraints. People can be hurt trying to get out of them, or trying to walk while restrained. CMS says restraints cause more harm than good. Never restrain anyone on your own. Do not tie, tuck sheets tight, or push a chair against a table to keep someone still. If someone keeps trying to get up, tell your nurse.
On your shift
A worried daughter
Mr. Green's daughter asks you to put both rails up so he will not fall. His care plan says rails down, a low bed, and a mat on the floor. You say kindly, 'I understand you want him safe. Rails can also cause injuries. I need to follow his care plan. I'll ask the nurse to talk with you.' Then you tell your nurse about her concern.
Quick review
Plan first
Let's review. Bed rails can trap people or lead to worse falls. The facility must try other options first, check the risk, and get informed consent. Follow the care plan, and never raise a rail 'just for a minute.' Report loose rails and gaps right away. Restraints do not prevent falls, and you never restrain anyone on your own.
Your facility's policy (ask your supervisor):
Your bed rail policy and how to see which residents have approved rails
Who to tell about loose rails, gaps or a mattress change
Your emergency steps if a resident is trapped in a bed rail
Stay with the person, keep them still, and get the nurse.
Never lift a fallen person on your own.
Report the facts and help the team learn from the fall.
Falling now
Protect the head
If you are with someone when they start to fall, do not try to hold them up. MedlinePlus says to use your body to break the fall. Keep your feet wide apart and your knees bent, to protect your back. Make sure their head does not hit the floor or anything else. Ease them down to the nearest flat surface, like a bed, a chair, or the floor.
Stay and call
Get the nurse
MedlinePlus says falls need attention right away. Stay with the person and call for help. Do not leave them alone on the floor. Use the call light, or call out to a coworker to get the nurse. CMS says the call system should be reachable from the floor, so the person can call for help too. Speak calmly. Tell the person help is coming.
Emergency signs
Call the code
Check if the person is awake and breathing. MedlinePlus says if a person is not awake, not breathing, or has no pulse, call an emergency code and start CPR. In your workplace, call your emergency code right away. Follow your CPR policy and the person's wishes. Do not wait to see if they wake up.
Keep them still
Don't lift them
MedlinePlus says if the person is confused, shaking, weak, in pain, or dizzy, stay with them. Cover them with a blanket to keep them warm. Do not raise their head if they could have a neck or back injury. OSHA says to always check for injury before moving a person who fell. NIA says getting up too fast, or the wrong way, can make an injury worse.
Show the answer
Stay with him, call the nurse, and keep him still. Check for injury before moving. The nurse decides how to move him.
Nurse decides
Then the right lift
The nurse checks the person and decides if they can be moved. MedlinePlus says do not help a fallen person up on your own. If they are not hurt, two staff can help them into bed or a chair. If they cannot hold up most of their own weight, use a lift. OSHA says a person who cannot stand with a little help should be moved with a lift, not by hand.
What happened
Facts only
MedlinePlus says if you did not see the fall, ask the person or anyone who saw it what happened. CMS says the team needs to know what the person was trying to do when they fell. Tell the nurse the facts: the time, the place, and what you saw and heard. Say what they were wearing on their feet, the lighting, and the floor. Do not guess the cause. An injury no one can explain may need to be reported under the abuse rules.
Watch closely
In the hours after
Some injuries show up later. MedlinePlus says to watch the person closely after a fall. CDC says an older person who hits their head should see a doctor right away, especially if they take blood thinners. Tell your nurse about any new pain, new confusion, sleepiness, or any change. Follow any extra checks your nurse asks for.
Learn from it
Change the plan
CMS says after a fall, the team should find what caused it, deal with the risk factors, and change the care plan if needed. Write down what happened, as your policy says. If your workplace holds a short team talk after a fall, often called a huddle, share what you know. CMS says a safe workplace lets staff report without blame. Honest facts prevent the next fall.
On your shift
Found on the floor
You find Mr. Patel on the bathroom floor. He is awake. He says, 'My hip hurts. Just help me up.' You press the call light and call out for the nurse. You stay with him. You say, 'Let's keep you still until the nurse checks you.' You cover him with a blanket. When the nurse comes, you tell her when you found him and what he said.
Quick review
Stay, call, wait
Let's review. If someone starts to fall, ease them down and protect their head. Stay with them and call for help. Call the code if they are not awake or not breathing. Keep them still and warm. Do not lift them on your own. The nurse decides how to move them. Report the facts, watch for changes, and help the team learn from it.
Your facility's policy (ask your supervisor):
Your emergency code and how to call it
Your CPR policy and where code status is found
Your post-fall steps, incident report form, and who must be told
CDC says most falls happen at home. NIA says that at home, people often move around without thinking about safety. Home health and hospice aide training must cover keeping a clean, safe, and healthy place. You are in the home often. You may see hazards that no one else sees.
Their home
Their choice
Remember, it is the patient's home. Aide training includes respect for the patient, their privacy, and their property. Ask before you move things. Explain why: 'This rug could trip you. May I move it?' If the patient says no, respect that, and tell your RN. Home health and hospice aides must report changes to the RN. The RN can plan with the patient.
Floors
Rugs, cords, clutter
CDC's home checklist starts with floors. Remove throw rugs, or use double-sided tape or a non-slip backing so they won't slip. Pick up papers, shoes, and books from the floor. Coil or tape cords next to the wall. Move furniture so the path is clear. NIA also says to know where pets are, so they do not trip the person.
Stairs
Rails and light
CDC says to keep things off the stairs, and to fix loose or uneven steps. There should be a light and a light switch at the top and bottom of the stairs. Burned-out bulbs should be changed. Handrails should be on both sides of the stairs, tight, and as long as the stairs. NIA says to hold the rail, and not to carry things that block your view of the steps.
Show the answer
Remove it, or secure it with double-sided tape or a non-slip backing. CDC's checklist says to remove throw rugs or keep them from slipping.
Bathroom
Bars, mats, dry
MedlinePlus says the bathroom is where falls most often happen at home. CDC suggests grab bars next to and inside the tub, and next to the toilet. Use a non-slip mat or strips in the tub or shower. Keep the floor outside the tub dry. MedlinePlus says towel racks are not grab bars. A shower chair and a raised toilet seat can help. It also says the water heater should be set no higher than 120 degrees, to prevent burns.
Bedroom, kitchen
Light and reach
In the bedroom, CDC suggests a lamp close to the bed and a nightlight on the path to the bathroom. NIA suggests a phone and a flashlight near the bed. In the kitchen, keep things used often on lower shelves, about waist high. CDC says if a step stool is needed, use one with a bar to hold. Never use a chair as a step stool. NIA says to clean up spills right away.
Outside
Steps and ice
NIA says to check outdoor steps for broken or uneven spots, and to add non-slip material. Keep porches and walks clear of leaves and branches. Turn on the porch light at night. In winter, use ice melt or sand on walkways. NIA says to take extra care on wet or icy ground.
Report it
Tell your RN
Tell your RN about hazards you see, and anything the patient or family cannot or will not fix. NIA and MedlinePlus say a nurse, physical therapist, or occupational therapist can check a home and suggest changes. CDC says to tell a health care provider right away if the person has fallen, is worried about falling, or seems unsteady. Your report can lead to grab bars, a shower chair, or a home safety visit.
On your shift
A dark hallway
Mrs. Owens is a hospice patient. She is weak, but she still walks to the bathroom at night. Her hallway rug curls at the edge, and there is no nightlight. You ask, 'This rug could catch your foot. May I roll it up for now?' She agrees. You tell your RN about the dark hallway. MedlinePlus says a commode near the bed can also help, so you mention that too.
Quick review
Look, ask, report
Let's review. Most falls happen at home. Look for rugs, clutter, cords, dark stairs, loose rails, wet bathroom floors, and high shelves. It is the patient's home, so ask before you change anything. Make simple fixes with their OK. Report hazards and any fall or unsteadiness to your RN.
Your facility's policy (ask your supervisor):
How aides report home hazards to the RN (call, app, visit note)
Whether aides may make small changes in the home (moving rugs or cords) with the patient's OK
Know what to do if a patient falls while you are there.
Know what to do if you find a patient who has fallen.
Report every fall to your RN right away, even with no injury.
Starting to fall
Ease them down
If a patient starts to fall while you are helping, do not try to hold them up. MedlinePlus says to use your body to break the fall. Keep your feet wide and your knees bent. Make sure their head does not hit the floor or anything else. Lower them to the nearest flat surface, like a bed, a chair, or the floor.
Stay calm
Stay with them
Stay with the patient. Speak calmly. NIA tells people who fall to take a few deep breaths and stay still for a moment, to get over the shock. Then they need to find out if they are hurt. NIA says getting up too fast, or the wrong way, can make an injury worse. So ask, 'Where does it hurt?' and look for cuts, swelling, or a leg that looks out of place.
Emergency
Know your rule
Aide training must cover how to spot an emergency and what to do. NIA says to call 911 if a person is hurt or cannot get up. MedlinePlus says a person who is not awake or not breathing needs emergency help and CPR. In home health, call 911 for those emergencies, then call your agency. In hospice, follow your hospice's rule and the plan of care for when to call 911 and when to call the hospice nurse first. Learn your rule before you need it.
Don't lift
Keep them still
MedlinePlus says to stay with the person and keep them warm with a blanket. Do not raise their head if they could have a neck or back injury. Do not help them up on your own. OSHA says to always check for injury before moving a person who fell. Lifting someone by yourself can hurt them, and it can hurt you.
Show the answer
Keep her still and call your RN for direction before she is moved. Check for injury first, and report the fall. Do not lift her on your own.
Call your RN
Right away
Call your RN right away, even if the patient says they are fine. Home health and hospice aides must report changes in a patient's condition to the RN. CDC says to tell a health care provider right away when a person has fallen. Your RN will tell you what to do next, and whether and how the person can be helped up. Follow those directions.
Hidden falls
Ask every visit
Many falls are never reported. CDC says less than half of older people who fall tell their doctor. Look for clues, like new bruises, a new limp, or things knocked over. A good habit: ask, 'Have you fallen or nearly fallen since my last visit?' MedlinePlus says if you did not see the fall, ask the person or anyone who saw it what happened. CDC says a person who hit their head should see a doctor right away, especially if they take blood thinners.
Write it down
Facts only
Aide training covers observing, reporting, and writing down a patient's condition. Aides must complete records the way the agency says. Write the facts: the time, the place, and what the patient was doing. Note what you saw, what they said, what you did, and who you told. Note any hazards, like a wet floor or a loose rug. Do not guess or blame.
Be ready
Phone in reach
NIA says people at risk of falling should keep a charged phone with them as they move around the house. An emergency button worn on a necklace or bracelet is another option. NIA also suggests a large-print list of emergency numbers near the phone. Before you leave, make sure the patient's phone is charged and within reach.
On your shift
Since last night
You arrive for a home health visit. Mr. Bishop is on the kitchen floor. He is awake. He says he fell last night and could not get up. His hip hurts. He is hurt and cannot get up, so you call 911. You stay with him, cover him with a blanket, and keep him still. Then you call your agency RN and tell her what you found.
Quick review
Stay, call, report
Let's review. If a patient starts to fall, ease them down and protect their head. Stay with them and keep them still and warm. Do not lift them on your own. Call 911 for an emergency, following your agency's rule. Call your RN right away about every fall, even with no injury. Ask about falls each visit, write down the facts, and keep the phone in reach.
Your facility's policy (ask your supervisor):
Your agency's 24/7 RN phone number
Home health: when aides call 911 and when they call the agency first
Hospice: when aides call 911 and when they call the hospice nurse first, based on the plan of care
Answer every question. You need 80% to pass. You can try again as many times as you like.
Your quiz covers the lessons for: Nursing home ( questions). Change your setting
Please read
This free course gives you a certificate of completion from Pact Compliance. It is not continuing education (CE) credit and is not approved by any state.
Your employer decides whether it counts toward required in-service hours. Home health and hospice aide training must be given or supervised by the agency's registered nurse.
California: it does not count toward CNA or HHA renewal hours.
Your name and quiz answers stay in your browser and are never sent to Pact.
Pact Compliance LLC, Cordova, TN
Certificate of Completion
This certifies that
completed the online in-service course
Fall Prevention and Resident Safety
Setting
Completed
Seat time
Quiz score
Certificate ID
This free course gives you a certificate of completion from Pact Compliance. It is not continuing education (CE) credit and is not approved by any state. Your employer decides whether it counts toward required in-service hours. Home health and hospice aide training must be given or supervised by the agency's registered nurse. California: it does not count toward CNA or HHA renewal hours.
Part of this topic needs a hands-on check with your supervisor; this online course does not cover that part.
Pact does not keep a record of this certificate. Print it or save it as a PDF and give a copy to your supervisor. pactcompliance.com/free-training/fall-prevention/
For owners, administrators and staff development coordinators
Track every staff member's training and licenses in one place. Try the 30-day demo.