Training teams and involving families : building a true culture of fall prevention

Nine articles, nine levers for action. Understanding falls, assessing risk, adapting the environment, prescribing exercises, reviewing medications, adjusting technical aids, preventing nighttime falls, managing residents with dementia, providing care after a fall — all of this is possible, proven, effective. And yet, in many nursing homes, falls continue to occur at the same rate despite the available knowledge. Why?

Because knowledge alone is not enough. What makes the difference between a nursing home where fall prevention is a daily reality and one where it remains a document in a binder is a culture — a collective way of thinking, observing, transmitting, and acting around the safety of residents. And this culture cannot be decreed. It is built through training, by example, through team rituals, and through collaboration with families.

1. The prevention culture: what really makes the difference

A fall prevention culture is a set of values and practices shared by the entire team — from the director to the service agent — that ensures the question “ is it safe for this resident? ” is present in every gesture, every decision, every transmission. It is not a list of procedures. It is a way of being together in service of the residents.

Establishments that achieve the best results in fall prevention share several characteristics : frontline caregivers feel legitimate in reporting a risk, even minor; managers value this reporting rather than minimizing it; a resident's fall is always analyzed collectively; prevention is seen as skilled work, not just common sense; and families are integrated as active partners, not informed afterward.

2. Why training changes practices — and not just knowledge

A study published in the Journal of the American Geriatrics Society showed that caregivers trained in fall prevention report 40% more environmental risk factors than their untrained colleagues — even in the same environment. Training does not change the environment. It changes what we see within it.

This is the first effect of training : making visible what was invisible. A trained caregiver entering a room sees the absent nightlight, the poorly secured rug, the oversized slippers — where the same untrained caregiver saw only an ordinary room. This change in perspective is the condition for any preventive action.

But training has a second effect, less often mentioned : it legitimizes action. A nursing assistant who knows that rugs are a documented risk factor for falls will feel empowered to report it and suggest removing it — where, without this training, they might hesitate to “ interfere in what doesn't concern them ”. Training empowers action.

3. Who to train? The whole team, without exception

Fall prevention is not just the responsibility of the physiotherapist or the coordinating nurse. It is the responsibility of everyone who interacts with residents — which includes often overlooked profiles in training plans.

4. How to train effectively: formats that work

Classroom training, lectures, theoretical — the mandatory annual training day — has limited value in fall prevention. Knowledge quickly fades if not anchored in practice. The most effective formats are those that combine short theoretical inputs with concrete situational practice and are repeated regularly.

5. The role of management in the prevention culture

The nursing supervisor, the director of care, management — their behavior shapes the culture of the facility more than any institutional policy document. If management mobilizes after every serious fall and demands an analysis, the team understands that prevention is taken seriously. If they minimize, classify without follow-up, or never provide feedback on reports, the message is the opposite.

6. Transmissions: the often forgotten link

The transmission between teams — between day and night, between weekend and week — is the link where information about risks is most often lost. A caregiver who observed that a resident “has been walking strangely since yesterday morning” and did not report it missed an opportunity for prevention. A night nurse who does not know that a resident has a new medication that can cause dizziness cannot monitor accordingly.

7. Families: partners, not spectators

Families are present in the lives of residents in a way that caregivers cannot replicate — they know the person's history, fears, habits, and abilities before the Nursing home. And they are there during visits, often several times a week, with a fresh perspective on developments that the team no longer perceives due to continuity.

Too often, families are treated as recipients of information (they are told what happened) rather than as actors in prevention (they are explained what they can observe and do). This change in posture — from information to participation — is one of the most underutilized levers for fall prevention.

8. Informing and training families: how and when

Families do not always know what they can do — because no one has told them. Organizing information sessions specifically dedicated to fall prevention — during family meetings, during admission interviews, via educational sheets handed out during visits — is a high-return investment.

9. Measuring and managing prevention: useful indicators

What cannot be measured cannot be improved. Fall prevention must be managed with indicators that are regularly monitored and shared with the team. Not to blame, but to see progress, identify problems, and adjust actions.

10. Summary of the series: the 10 levers of prevention

This series of 10 articles has explored all the levers for fall prevention available to caregivers and families. Here they are gathered again — because no single lever is sufficient, and it is their combination that produces sustainable results.

These ten levers are not a checklist. They are dimensions of the same approach: to view each resident as a person with their own risk factors, their own resources, their own history, and to build with them, their surroundings, and the team an environment and support that allow them to stay upright — and free.

Falling is not a fatality. It is a risk, like others, that can be managed. And every fall avoided is, behind the statistics, a person who has been able to continue walking to the dining room, go to the bathroom alone at night, go out into the garden on Wednesday afternoons. Small freedoms. Great dignities.