Falls in care homes: prevention and what to ask

By CareFinder Team · Published 2026-09-18 · Last reviewed 2026-09-18

Care homes cannot prevent every fall, but a good one reduces them by assessing each resident's own risks, reviewing medicines, keeping people active and making the building safe. NICE guidance says everyone living in residential care should be offered a comprehensive falls assessment. Ask how the home assesses risk, what staff do after a fall and how quickly they will tell you.

No care home can promise that your relative will never fall, and a home that tries to stop every fall usually does it by stopping people moving, which causes more harm than it prevents. What a good home can do is work out why this particular person might fall, deal with the causes it can change, and respond properly and honestly when a fall happens.

Why do falls still happen in care homes?

People who move into a care home are usually frailer than others of the same age. Many have dementia, poor balance, weak muscles, continence problems that mean hurried trips to the toilet, or several medicines that cause drowsiness or a drop in blood pressure. A new building is also unfamiliar.

A fall is often a sign that something else has changed. An infection, dehydration, a new medicine, poor sleep, pain, or delirium (sudden confusion) can all show up first as a fall. A good home therefore treats a fall as a reason to look for a cause.

Walking keeps muscles and balance working, and sitting all day makes the next fall more likely. Keeping someone safe by keeping them in a chair is not good care.

What should a care home do to reduce the risk?

The main national guidance is the NICE guideline on falls assessment and prevention, updated in 2025. NICE guidance is written for health and care services in England. Scotland, Wales and Northern Ireland decide for themselves how to use it, but the same principles are widely followed across the UK.

NICE says that people living in residential care settings, meaning both residential and nursing homes, should be offered a comprehensive falls assessment and a plan to manage what it finds. The plan should be tailored to the person, not a standard form that looks the same for every resident.

What the assessment should look at

According to NICE, a comprehensive falls assessment covers, where relevant:

• walking, balance, mobility and muscle strength
• a review of medicines
• blood pressure taken lying down and then standing, to check for a drop on standing
• eyesight and hearing
• footwear and the condition of the feet
• continence
• memory, mood and any signs of delirium
• eating, drinking and weight loss
• dizziness
• alcohol use
• long-term conditions such as dementia, Parkinson's disease, arthritis or diabetes
• the risk of osteoporosis (fragile bones), which affects how serious a fall is likely to be
• the person's own worries about falling

Much of this needs the GP, a pharmacist or a therapist as well as the home's own staff, so ask who is involved.

What the home should then do

For people in care homes, NICE recommends:

• A structured medication review to find medicines that may raise the risk of falls, and to consider changing them. Medicines that act on the brain, such as antipsychotics, antidepressants, sedatives and some epilepsy medicines, are linked with a higher risk of falls. NICE says these should be reviewed, the risk discussed, and withdrawal planned where appropriate. Never stop a medicine without the prescriber's advice.
• Staying active. Staff should reassure residents that they should not avoid getting up and moving around, and build regular chances to stand and walk into the daily routine.
• Exercise for those who can manage it, aimed at balance, coordination and strength, suited to the person's abilities and preferences, one to one or in a group.
• Vitamin D. NICE found too little evidence that vitamin D supplements prevent falls in themselves, but says people should be encouraged to follow NHS advice for bone and muscle health. The NHS advice on vitamin D is that people who are rarely outdoors or who live in a care home should take a daily supplement all year round. Check with the GP or pharmacist before starting one, as it is not suitable for everyone.

NICE also says staff should talk to residents, involving family where appropriate, about moving around safely, using equipment such as call bells and movement sensors, and how visitors can tell staff about hazards they notice.

Are bed rails, sensors and alarms a good idea?

Bed rails are the clearest example. The medicines and devices regulator, the MHRA, publishes UK guidance on the safe use of bed rails. It says rails are meant to reduce the risk of someone falling out of bed. They are not designed to stop a person who wants to get up from leaving the bed, and using them that way can increase the risk, because the person may try to climb over and fall from a greater height. The MHRA continues to receive reports of serious injuries and deaths, mainly from people becoming trapped. It expects a risk assessment of the person, the bed, the mattress and the rail together, which is repeated as needs change.

Alternatives include a bed that lowers close to the floor or a sensor that alerts staff when someone gets up. A sensor only helps if staff can respond quickly, so ask how it works at night.

Anything that restricts a person's movement or monitors them raises a legal question if they cannot agree to it themselves. In England and Wales such decisions must be made in the person's best interests under the Mental Capacity Act 2005, using the least restrictive option. Scotland and Northern Ireland have their own incapacity laws built on similar principles. The home should be able to explain how the decision was made and who was consulted.

What questions should you ask about falls when visiting?

These questions are specific to falls. The way they are answered tells you as much as the answers.

About assessment

• When is a new resident assessed for falls risk, and how often is it repeated?
• Who carries out medication reviews, and how often?
• Can residents see a physiotherapist or occupational therapist, and how is that arranged?

About daily life

• How do you help residents stay active? Is there any strength and balance exercise?
• How quickly are call bells answered, by day and at night? Do you check this?
• How many staff are on at night, and how do they keep an eye on people who get up?
• How do you make sure glasses, hearing aids, walking aids and well-fitting shoes are actually in use each day?

About equipment

• What is your approach to bed rails, low beds and sensors? Who decides, and is the family involved?

About what happens after a fall

• What do staff do straight away when someone falls?
• When would you call 999 or 111, and when the GP?
• How soon would you tell me, including at night?
• Do you look at falls across the home to spot patterns, such as a time of day or a particular corridor?

A confident manager will answer these without defensiveness and may show you an anonymised care plan. Be wary of "our residents don't fall".

What to look for as you walk round

• good, even lighting, including in corridors and bathrooms
• handrails, and grab rails by toilets and showers
• floors that are clear, dry and free of trailing wires
• call bells within reach of the bed and the chair
• residents wearing proper shoes or slippers that fit

What should happen if your relative does fall?

Staff should check for injury before trying to move the person. The NHS advice on falls is to call 999 if someone has fallen and may have injured their head, back, neck or hip, or cannot get up, and not to try to lift them yourself. For other falls where the person may be in pain, injured or unwell, NHS 111 can advise. Staff should keep a close eye on the person afterwards.

After that, a good home will:

1. record what happened, including where, when and what the person was doing
2. tell the family, in line with what you agreed when your relative moved in
3. look for a cause, which may mean asking the GP to check for infection, review medicines or check blood pressure
4. update the falls assessment and the care plan
5. arrange a referral, for example to physiotherapy or a local falls service, if needed

Ask what has changed in the care plan as a result. "We will keep a closer eye on them" is not a plan.

Does the home have to tell you and the regulator?

England. Care homes must notify the Care Quality Commission (CQC) without delay of certain serious injuries to a resident. These include injuries that change the structure of the body, which covers a broken bone, and injuries causing prolonged pain. Separately, the duty of candour requires providers to be open when something unexpected goes wrong and causes significant harm. They must tell the person or their representative, give a truthful account, and apologise. CQC's guidance is clear that an apology is not an admission of liability.

Scotland. Care homes are regulated by the Care Inspectorate. An organisational duty of candour has applied to care services since 1 April 2018. It requires the provider to tell those affected, apologise, offer a meeting and review what happened.

Wales. Care homes are regulated by Care Inspectorate Wales. The regulations for care services require providers to act in an open and transparent way with residents and their representatives, and to notify the regulator of a serious accident or injury.

Northern Ireland. Care homes are regulated by the Regulation and Quality Improvement Authority (RQIA). The rules are set out differently there, so ask the home how and when it would tell you about a fall.

Not every fall triggers these duties. A fall with no injury will not normally be reported to the regulator, but it should still be recorded and you can still expect to be told.

What if falls keep happening?

Repeated falls do not prove poor care, particularly in someone with advancing dementia or Parkinson's disease. They do call for a fresh look. Ask for a meeting with the manager and ask:

• Has the falls assessment been redone, and what did it find?
• Has the GP reviewed the medicines and looked for a medical cause?
• Has a physiotherapist or falls service been involved?
• Does your relative now need more help than this home can give, for example nursing care?

If you are not satisfied, use the home's complaints procedure, and tell the council or the NHS if either arranges or pays for the placement. You can also share your experience with the regulator for your nation. If you believe your relative is being neglected or is at risk of harm, contact the adult safeguarding team at the local council, or the health and social care trust in Northern Ireland.

This article is general information, not medical or legal advice. For decisions about medicines, injuries or equipment, speak to the GP, pharmacist or therapist involved in your relative's care.

Frequently asked questions

Can a care home prevent all falls?

No. Anyone who walks can fall, and frail older people fall more easily. The only way to remove the risk entirely is to stop someone moving, which leads to weaker muscles, pressure sores and a poorer life. A good home aims to reduce falls and the harm they cause while keeping people as active as possible.

Should my relative have bed rails?

Only if an individual risk assessment shows they are safer with them than without. MHRA guidance says bed rails are for people at risk of falling out of bed, not for stopping someone who wants to get up. For a person who is confused and likely to climb over, a low bed or a sensor may be safer.

Will the home ring me every time there is a fall?

There is no single rule on timing for every fall. Most homes will phone the next of kin after any fall, and you can agree in advance whether you want a call at night for a fall with no injury. Where a fall causes significant harm, providers in England, Scotland and Wales have legal duties to be open about what happened.

Does a fall mean my relative needs a nursing home?

Not necessarily. Many falls have a cause that can be treated, such as an infection or a medicine that needs changing. If falls continue alongside growing health needs, ask for a review of whether the current home can still meet those needs.

Key takeaways

• No home can prevent every fall. Judge a home by how well it understands each resident's risks and how it responds when someone falls.
• NICE says everyone living in a care home should be offered a comprehensive falls assessment and a plan tailored to them.
• Medication review, staying active and suitable exercise matter more than gadgets.
• Bed rails and sensors need an individual risk assessment and, where the person cannot consent, a best interests decision.
• After a fall, expect a check for injury, a call to you, a search for the cause and an updated care plan.
• Serious injuries must be reported to the regulator, and providers in England, Scotland and Wales have legal duties to be open with you.
• Repeated falls are a reason to ask for a full review.