Home Safety & Falls Prevention Checklist

Why falls are worth taking seriously

Falls are the leading cause of injury-related hospitalisation among older Canadians, and the strongest single predictor of a fall is having had one already. A near miss counts. The good news is that a large share of falls happen in a small number of predictable places, doing a small number of predictable things — which makes them unusually preventable.

Work through this list with the person who lives there, not for them. A safety change made over someone's objection tends to be quietly undone.

Everywhere in the house

• Loose rugs and mats removed, or fixed down with double-sided tape or non-slip backing. Loose rugs are the single most common hazard in this list.
• Clear walking paths — no cables, magazines, laundry baskets, shoes or pet bowls in walkways.
• Cables run along the wall, never across a floor.
• Lighting bright enough to see edges and level changes. Replace dim bulbs; brighter is better as vision changes.
• Night lights on the route between bed and bathroom.
• Light switches reachable at both ends of every hallway and at the top and bottom of stairs.
• Frequently used items stored between hip and shoulder height — no step stools, no reaching to the back of a high shelf.
• A phone reachable from the floor, or a charged mobile carried in a pocket. Consider a personal alarm.
• Pets: a bell on the collar, and a feeding spot out of the walkway.

Stairs

• A handrail on at least one side — ideally both. It should be firmly fixed, and it should run the full length including the top and bottom step.
• Steps clear of anything stored on them.
• Good light at the top and the bottom, with a switch at both ends.
• Non-slip strips or well-fixed carpet; no worn or loose edges.
• Contrasting tape or paint on the edge of the top and bottom step, where misjudged depth causes most stair falls.

Bathroom

The highest-risk room in most homes: hard surfaces, water, and movements that require balance while partly undressed.

• A non-slip mat inside the bath or shower, and a non-slip mat outside it.
• Grab rails properly fixed into the studs or wall structure — never suction cups for weight-bearing.
• A shower chair or bath board if standing for a whole shower is tiring or unsteady.
• A raised toilet seat and/or a toilet frame if getting up is a struggle.
• Towel rails are not grab rails. Neither is a sink, a soap dish or a shower curtain rail.
• Toiletries within reach from a seated position.
• Water temperature set to avoid scalds.

Bedroom

• Bed at a height where feet reach the floor with hips and knees at roughly ninety degrees.
• A clear, lit path to the door and to the bathroom.
• Lamp, phone, glasses and water reachable from the bed without getting up.
• Firm surface beside the bed to push up from — not a wheeled bedside table.
• Slippers with a back and a non-slip sole, or bare feet. Backless slippers cause falls.

Kitchen

• Everyday items between hip and shoulder height.
• Spills wiped immediately.
• A stable chair or perching stool for tasks that take a while.
• A trolley for carrying things, so hands stay free and nothing is carried while walking.
• Kettle, cooker and taps easy to operate with reduced grip — jug kettles with a tipper, lever taps, jar openers.

Outside

• Steps and paths even, well lit and clear of moss and leaves.
• A handrail at the front and back steps.
• A winter plan — who clears the walk and salts the steps, arranged in advance rather than in January.
• Ice grippers for footwear, kept by the door where they will actually be used.

The person, not just the house

• Footwear. Enclosed, firm sole, low heel, fits properly. Worn socks, slippers with no back and shoes with worn soles are hazards.
• Eyesight. Checked in the last year; bifocals and varifocals make stairs harder — many people do better with a single-vision pair for going out.
• Medication. Ask a pharmacist for a review. Dizziness, drowsiness and blood pressure drops are common contributors, especially where several medicines interact.
• Blood pressure on standing. Feeling faint when getting up is a treatable falls cause — mention it.
• Strength and balance. The single most effective long-term measure. Any regular activity that challenges balance helps; a physiotherapist or a falls-prevention class can set a specific program.
• Walking aids. Only useful if the right height, in good repair, and used every time — including for the short trip to the bathroom at night, which is when a great many falls happen.

Signs it is time for an occupational therapy assessment

• A fall or near miss in the last year.
• Furniture-walking — holding on to furniture to move around the house.
• Avoiding stairs, the bath, or going out.
• Difficulty getting off the toilet or out of a chair.
• A recent hospital stay, a new diagnosis, or a change in mobility.
• Family noticing changes in how the house is being managed.

A home safety assessment looks at the person doing the task in the actual room, which is why it finds things a checklist cannot. Recommendations come at three levels — free, low-cost and structural — so nobody is pushed into a renovation to solve a problem that a grab rail would fix.