A room-by-room home safety checklist to lower the risk of falls

Why is a home safety check worth doing?

Because most falls happen at home, in places we walk through without thinking. The Centers for Disease Control and Prevention reports that more than one in four older adults falls each year, that one fall doubles the chance of another, and that falls are the most common cause of head injuries in older adults.

The CDC's fall prevention program, called STEADI, publishes a home checklist, and the National Institute on Aging publishes a room-by-room list. This guide brings both together, adds what we see in Central Pennsylvania homes, and suggests which fixes to tackle first.

A safer house is one part of the picture. The doctor, the medicine cabinet, the eye doctor and exercise matter too, and we cover those at the end.

How should you use this checklist?

Walk the house twice: once in daylight and once after dark, following the route your parent takes from bed to bathroom. Bring a notepad and mark each item fix now, fix this month, or ask someone (an electrician, a contractor, the doctor).

Involve your parent. People are much more likely to keep a change they chose themselves. And do not try to fix everything at once. The NIA notes that not every suggestion fits every home, and that it is worth checking again as needs change.

What should you check on the stairs?

Stairs are where the most serious falls happen, so check them first, inside and out.

• Handrails on both sides, solid, and running the full length of the stairs. Tighten loose ones.
• A light with a switch at the top and the bottom. If there is only one switch, an electrician can add another; plug-in motion lights help in the meantime.
• No burned-out bulbs over the stairs. Change them for your parent rather than leaving it to them on a ladder.
• Carpet firmly attached to every step, or replaced with non-slip treads.
• Nothing stored on the steps: no shoes, mail, laundry baskets or "things to take up later."
• Step edges that are easy to see. Bright tape on each edge helps, especially for someone with low vision or dementia.
• Outside steps solid and even, with a rail, and ice melt or sand on hand for winter.

Many older homes in Harrisburg, Reading, Lancaster and the river towns have steep, narrow stairs with a single rail. If climbing them every day has become a struggle, setting up a first-floor bedroom and bathroom is often the biggest single change a family can make.

What should you check in the bathroom?

The bathroom combines wet floors, hard surfaces, and a lot of standing up and sitting down, so it deserves the closest look.

• Grab bars next to the toilet and both inside and outside the tub or shower, anchored into studs or with proper anchors. A towel bar is not a grab bar.
• Non-slip mats or strips in the tub or shower, and a non-slip mat on the floor beside it.
• A shower chair or tub bench and a hand-held shower head if standing is tiring.
• A raised toilet seat or toilet frame if getting up is hard.
• A night light that comes on by itself, or a light left on.
• Soap and shampoo within reach from a seat, so no one has to bend or stretch in the shower.

If bathing has started to feel risky, a caregiver who helps with the shower is often the change that matters most. Our Bathing Assistance page describes how we set up the room and help only as much as your parent wants.

What should you check in the bedroom?

The bedroom check is mostly about the trip to the bathroom at night.

• A lamp or switch your parent can reach without getting out of bed.
• Night lights along the whole path from bed to toilet. Motion-activated plug-in lights work well.
• A clear, straight path with no rugs, cords, laundry or furniture to steer around.
• A bed height where feet rest flat on the floor when sitting on the edge.
• A phone within reach of the bed, plus a flashlight in case the power goes out.
• Slippers or shoes with backs and non-slip soles, kept beside the bed.

The CDC notes that rushing to the toilet, especially at night, raises the chance of falling. If night-time bathroom trips are frequent, mention it to the doctor, and think about whether overnight care would give the household some peace of mind.

What should you check in the kitchen and living room?

Here you are looking for reaching, climbing and tripping.

• Everyday dishes, pots and food on lower shelves, about waist high.
• No chairs used as step stools. If a step stool is needed, it should be steady with a bar to hold.
• Spills wiped up right away, and no walking on freshly washed floors.
• Throw rugs removed or secured with double-sided tape or non-slip backing.
• Electrical cords along the walls, not across walkways.
• Furniture, especially low coffee tables, out of the walking path.
• Chairs that are easy to get in and out of. A firm chair with arms is easier than a deep recliner.
• Pets: know where the dog or cat is, and keep pet bowls out of the path.

What should you check outside?

Check the routes your parent uses every day: to the car, the mailbox and the trash cans.

• Front and back steps in good repair, with non-slip surfaces and a rail.
• A porch light, ideally on a timer or motion sensor.
• Walkways clear of leaves, branches, hoses and uneven pavers.
• A plan for snow and ice: who shovels, who salts, and an agreement that your parent does not do it alone.
• A grab bar near the door for balance while unlocking it, as the NIA suggests.

In rural parts of Perry, Juniata, Huntingdon and Fulton counties, the walk to a roadside mailbox or a detached garage can be the riskiest trip of the day in winter. Moving the mail to a porch box, or having someone else make that walk, is a small change that takes a daily hazard off the list.

What about shoes, clothing and walkers?

Even the safest house still has to be walked through, so check what your parent wears and how they use a cane or walker. Look for slippers without backs, socks on hard floors, worn soles, and long robes or pant legs that catch on the stairs.

Make sure a walker or cane is the right height and actually used, not parked in a corner. If a therapist or doctor recommended a walking aid, ask them to check the fit, and keep a second cane or walker upstairs if the house has two floors.

How can your parent get help after a fall?

Plan for the fall you could not prevent. The NIA suggests keeping a charged phone within reach at all times, putting emergency numbers in large print near each phone and in the cell phone's favorites, and considering a medical alert button or a smartwatch that can call for help.

Agree on a daily check-in call. If your parent lives alone and has fallen before, talk honestly together about who would find them and how quickly.

What should you ask the doctor about falls?

Tell the doctor about every fall, even one without an injury, and ask for a fall-risk review. The CDC's advice for family caregivers includes:

• Tell a health care provider right away if your parent has fallen, is worried about falling, or seems unsteady.
• Bring an up-to-date list of all medications, including over-the-counter medicines and supplements, and ask about side effects such as dizziness or sleepiness.
• Have their eyes checked at least once a year and update glasses as needed.
• Have their feet checked and ask about the right shoes.
• Ask what kind of exercise is right for them.

After a fall, the doctor may suggest a therapist or nurse visit to look at the home. That visit comes from a home health agency on a doctor's order. Our page for families whose parent just fell covers the first 48 hours.

Are there fall prevention programs in Pennsylvania?

Yes. The Pennsylvania Department of Aging offers Healthy Steps for Older Adults, a workshop on fall risk that covers home safety, exercise, nutrition, foot health, vision and hearing, and medication side effects. It also offers Healthy Steps in Motion, a strength and balance class.

Healthy Steps for Older Adults is open to people 60 and older and offered through local Area Agencies on Aging. Call your county office to find a session; our Area Agency on Aging guide lists the phone number for each county we serve. The NIA also notes that some state and local programs help older adults with home changes, and the Area Agency on Aging is the place to ask.

How can a home caregiver help?

A caregiver is there at the moments when falls tend to start: getting out of bed, bathing, dressing, the bathroom at night, and getting in and out of the car. No one can promise a fall will never happen, but a steady arm at those moments can make a real difference to how confident your parent feels.

At It's Your Home Care, caregivers are trained in safe transfers and walking assistance before they are assigned. They keep walkers and canes within reach, take over chores that involve ladders and heavy laundry baskets, and tell the family when they notice new unsteadiness, dizziness, or a change after a new medication. We are a non-medical agency. Therapy and nursing come from home health providers, and our caregivers can encourage the exercises a therapist leaves behind.

During our in-home consultation, we walk the house with you using a list much like this one. If you would like a second set of eyes, call us at (717) 695-2704 or request a consultation.