Setting up the environment to prevent falls: practical guide Nursing home and home
📋 Table of contents
- The environment: a powerful and often underutilized lever
- The bedroom: area to prioritize securing
- The bathroom and toilets: very high-risk area
- Hallways and common areas
- Lighting: a priority often neglected
- Floors: identify and correct hazards
- Footwear: protection at the end of the feet
- Bed height: an important adjustment
- At home: what families can do
- Environmental audit: methodical walkthrough
If we had to isolate the most accessible, least expensive, and quickest to achieve fall prevention lever — it would be the environment. Unlike medical factors or exercise programs that require time, coordination, and resident compliance, the environment can be modified quickly, without the active consent of the person, and with immediate effects on their risk level.
Yet, environmental audits regularly reveal risky situations in establishments that believe they are compliant. A rug in a hallway. A missing bathroom grab bar. Insufficient night light. Slippers that are too soft. Details that seem minimal — and are enough to create the conditions for a fall.
1. The environment: a powerful and often underutilized lever
The environment contributes to about 30 to 50% of falls in elderly people — either alone or in combination with personal factors. This proportion means that a significant share of falls could be avoided by simple modifications to the living space.
The difficulty is that environmental risks are often invisible to the accustomed eye — caregivers who have worked in the same space for months or years no longer see the dangers it presents. Hence the importance of regular external oversight, a structured audit method, and a culture that values reporting observed risks rather than minimizing them.
2. The bedroom: area to prioritize securing
The bedroom — security checklist
- Bed adjusted to the right height — feet flat on the floor when the resident is sitting on the edge of the bed (see dedicated section)
- Call bell accessible without the resident having to get up or stretch dangerously
- Clear path between the bed and the bathroom — no obstacles, even at night
- Night light sufficiently bright on the path bed → bathroom, automatic if possible (motion detector)
- Chair or armchair with firm armrests to facilitate standing up
- Phone or call device easily accessible from the bed
- No rugs, cables, or objects on the floor that could create an obstacle
- Hip protectors available and worn if residents are at high risk and have documented osteoporosis
3. The bathroom and toilets: very high-risk area
The bathroom concentrates several major risk factors: often wet floor, smooth surfaces, repeated sit-to-stand transitions, and dressing/undressing that temporarily shifts the center of gravity. It is the room where the highest number of falls occur in nursing homes as well as at home.
Bathroom and toilets — security checklist
- Grab bars installed on the dominant side — at the shower, toilet, sink
- Non-slip mat in the shower AND at the shower exit
- Shower seat available and systematically used for at-risk residents
- Flush-mounted floor drain (no shower tray edge to step over)
- Toilet at appropriate height — toilet riser if the toilet is too low (high risk when standing up)
- Non-slip floor or anti-slip treatment of existing floor
- Call bell accessible from the shower and toilets — while seated
- Sufficient lighting — no shadow areas in the bathroom
“ We installed a grab bar at the toilet for Mrs. R. It seems simple. But it changed her autonomy dramatically — she could get up alone again, without calling the caregiver. And her fall risk score dropped by 15 points on the next Morse. ”
4. Hallways and common areas
Hallways and common areas — points of vigilance
- Continuous handrails on both sides of the hallways — at the right height (90–95 cm)
- Absence of rugs, raised thresholds, cables crossing pathways
- Visual contrasts on the floor at direction changes and thresholds (colored strips)
- Stable and heavy furniture in the hallways — no lightweight furniture on wheels
- Dining room: stable chairs with armrests, tables at appropriate height, non-slip floor
- Living spaces: armchairs and sofas at appropriate seat height (not too low), firm, with armrests
- Care trolley passage organized to avoid obstructing hallways during walking hours
5. Lighting: a priority often neglected
Insufficient lighting is involved in a significant proportion of nighttime falls — which are among the most serious falls, as the person is often alone, in a state of drowsiness, and experiencing orthostatic hypotension after a long period lying down.
✦ Good anti-fall lighting practices
- Night light on the path bed → bathroom, automatic (presence detector) or permanently on at night
- Switch within reach from the bed — without having to get up
- Progressive lighting — avoid sudden transitions from total darkness to bright light that cause slow visual adaptation in elderly people
- Sufficient lighting in risk areas — thresholds, stairs, areas of flooring change
- Bedside lamps easily accessible — with a button or remote control in bed
- Regular bulb checks — a bulb that has gradually dimmed is often not noticed by accustomed caregivers
6. Floors: identify and correct hazards
The flooring is one of the first elements to evaluate during an environmental audit. A slippery floor (waxed parquet, smooth tiles, shiny vinyl) is a major risk factor — particularly when combined with inappropriate footwear.
What can be done to secure floors without major work: Application of anti-slip products on tiles and parquet (chemical treatment, renewable, without altering appearance). Installation of anti-slip strips at stair edges and thresholds. Systematic removal of all unsecured rugs. Replacement of existing rugs with models that have non-slip backing and beveled edges. Ground marking (contrasting strips) at flooring changes and risk areas. Rigorous maintenance — wet floor reported and dried immediately.
7. Footwear: protection at the end of the feet
Footwear is a fall risk factor often underestimated — while it is one of the easiest to modify. Inappropriate footwear significantly increases the risk of falling.
The ideal shoe for an elderly person at risk of falling: non-slip sole, low and wide heel, velcro closure (no laces or elastic that come undone), support for the foot and ankle, appropriate size (neither too tight nor too loose). Lightweight slippers and socks without grip on smooth floors are among the top modifiable causes of falls.
Report to the family if the resident regularly wears inappropriate shoes. Refuse to let a resident walk in socks on smooth floors. Ensure that the resident has appropriate shoes in their room and that they are actually wearing them during movements.
8. Bed height: an important adjustment
Bed height is a modifiable risk factor often overlooked. A bed that is too high forces the person to jump to touch the ground — unstable and dangerous. A bed that is too low forces them to get up with more effort and imbalance. The ideal height is one that allows the feet to be flat on the ground when the person is sitting on the edge of the bed, with hips slightly above the knees.
In nursing homes, medical beds allow for this adjustment. But someone needs to do it — and check it regularly, as the weight and physical condition of the resident can change. The optimal height for care (high) is different from the optimal height for independent standing (low) — and this management must be conscious and documented in the care plan.
9. At home: what families can do
For families supporting an elderly relative at home, evaluating and modifying the environment are concrete and often very effective actions they can initiate themselves — with the help of an occupational therapist if needed, who can visit the home for a safety assessment.
✦ Home setup priorities
- Remove all non-essential rugs — especially in walkways and at the foot of the bed
- Install a grab bar at the toilet and in the shower (simple intervention, achievable in a few hours)
- Install an automatic night light on the path bedroom → bathroom
- Ensure the phone is accessible from the bed and that the relative knows how to use it
- Clear pathways — move furniture, tidy cables, pick up objects on the floor
- Check and adapt footwear — suggest velcro shoes and non-slip soles
- Request a visit from an occupational therapist for a complete assessment (coverage possible by health insurance)
10. Environmental audit: methodical walkthrough
The environmental audit is a systematic and structured visit of a living space to identify fall risk factors. It can be carried out by the occupational therapist, coordinating nurse, physiotherapist, or any caregiver trained for this purpose. Ideally, it is conducted upon admission for each new resident and renewed annually or after any fall.
A well-conducted audit takes 20 to 30 minutes per room. It uses a standardized checklist that covers all spaces used by the resident — bedroom, bathroom, hallways, common areas. It results in a concrete action plan, with priorities, responsibilities, and deadlines — not just an observation.
🎓 Train your team in fall prevention setup
The DYNSEO training “Preventing falls” trains your teams to conduct environmental audits and implement modifications that effectively reduce risk. Qualiopi certified.
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