FALL RISK

Beyond the Checklist

Building a strong fall prevention strategy in homecare

By Ryan Sharrow

Each September, homecare organizations across the country recognize Falls Prevention Awareness Month, a national effort to raise awareness of one of the most significant threats to the health, safety, and independence of older adults. The observance serves as an important reminder that while falls remain common, they are not an inevitable part of aging. In fact, many falls can be prevented through proactive assessment, education and collaboration.

For homecare providers, fall prevention is uniquely important. Unlike facility-based settings, clinicians and caregivers can see patients in their everyday environments, identify hazards firsthand and implement practical solutions where people live. Research has also shown that the majority of falls occur within a person’s own home. This places homecare teams in a strong position to reduce fall risk, prevent injuries and support aging in place.

Turning Awareness Into Community Action

Falls Prevention Awareness Month provides more than just an opportunity to educate current clients—it also creates a platform for community outreach. Homecare agencies are often viewed as trusted resources within their service areas, making them well-positioned to lead local conversations about fall prevention.

Consider partnering with senior centers, community organizations, physician practices, rehabilitation providers and local health departments to offer educational seminars, balance screenings, home safety demonstrations or caregiver workshops. Community engagement not only helps raise awareness but also strengthens relationships with referral sources and stakeholders while positioning the agency as a leader in preventative care.

Establishing a Consistent Process for Fall Risk Screening

One of the most effective ways homecare agencies can strengthen their fall prevention efforts is by implementing a standardized process for identifying individuals at risk.

The Centers for Disease Control and Prevention's STEADI program (Stopping Elderly Accidents, Deaths and Injuries) offers an excellent framework for organizations looking to improve fall risk management. STEADI is built around these three straightforward steps:

Screen
Assess
Intervene

For homecare clinicians, the STEADI toolkit provides practical resources, including fall risk screening questionnaires, clinical algorithms for risk stratification, timed up-and-go testing, 30-second chair stand assessments, four-stage balance testing, medication review resources, patient education materials and referral tools for community-based prevention programs.

A structured screening process helps move organizations beyond subjective observations and toward a more consistent, evidence-based approach. More importantly, screening should never be viewed as a one-time event. Fall risk is dynamic and can change quickly due to illness, medication changes, hospitalization, functional decline or environmental factors.

Moving from Risk Identification to Meaningful Intervention

Identifying patients who are at increased risk of falling is only the beginning. The real impact comes from developing individualized interventions that address the specific factors contributing to a person's risk.

The 2022 World Guidelines for Falls Prevention and Management for Older Adults emphasize the importance of personalized, multifactorial interventions that target modifiable risks. Several evidence-based prevention strategies stand out as particularly relevant in the homecare setting.

Promote regular exercise and balance training. Physical activity remains one of the most effective interventions for reducing falls. Strength, mobility and balance training can improve confidence and reduce fall risk over time.
Evaluate sensory and cognitive deficits. Evaluation and management directed at visual, hearing, dizziness and cognitive impairments help tailor interventions to the needs of the patient.
Address environmental hazards. Common hazards include throw rugs, cluttered walkways, poor lighting, uneven flooring, loose electrical cords and lack of grab bars or handrails. Simple modifications can often make a meaningful difference.
Conduct medication reviews. Polypharmacy, medication interactions and certain drug classes can contribute to dizziness, sedation, orthostatic hypotension and impaired balance. Collaboration with physicians and pharmacists is often a critical component of a prevention plan.
Support safe footwear and vision management. Footwear should provide stability and support, while individuals should use appropriate corrective eyewear and address vision-related concerns.

Fall Prevention Is a Team Effort

In organizations with multidisciplinary care models, successful fall prevention depends on every discipline understanding its role.

Nurses can identify clinical risk factors, monitor changes in condition, conduct medication reviews, reinforce education and coordinate provider communication.
Physical therapists evaluate strength, balance, gait and mobility while designing individualized exercise programs.
Occupational therapists assess functional performance and home safety, recommending environmental modifications and adaptive equipment.
Speech therapists assess cognitive communication deficits that can impair a patient’s ability to follow safety recommendations.
Home health aides and caregivers often recognize emerging safety concerns first.
Medical social workers can connect individuals with community resources and supportive services to support fall risk mitigation interventions.

When all team members understand how their observations contribute to fall prevention, risk factors are more likely to be identified early and addressed proactively.

Creating a Culture of Fall Prevention

The strongest fall prevention programs are built on culture rather than compliance. Agencies that consistently achieve positive outcomes create an environment where fall risk management is integrated into every patient interaction.

During Falls Prevention Awareness Month, homecare organizations have an opportunity to reaffirm their commitment to keeping patients safe and independent at home. By combining community education, standardized screening practices, evidence-based interventions and multidisciplinary collaboration, agencies can move beyond reacting to falls and begin preventing them before they occur.

Ultimately, successful fall prevention is about helping older adults maintain mobility, confidence and quality of life while safely aging in the place they most want to be—their homes.

Ryan Sharrow is a physical therapist who holds an MBA in healthcare administration and is board certified in geriatric physical therapy, wound care and healthcare quality. He has over two decades of experience in home health and rehabilitation and is currently the associate vice president of therapy care and research at CenterWell Home Health, where he focuses on transforming care models, empowering interdisciplinary teams and improving the lives of older adults. Visit centerwell.com.