Quality statement 9: Home hazard assessment and interventions

Quality statement

Older people who are admitted to hospital after having a fall are offered a home hazard assessment and safety interventions. [2015]

Rationale

Adapting or modifying the home environment is an effective way of reducing the risk of falls for older people living in the community. Home hazard assessment undertaken in the person's home, and intervention if needed, has been identified as a component in successful multifactorial intervention programmes. It is important that a home hazard assessment is undertaken after a multifactorial falls risk assessment has been completed.

Quality measures

Structure

a) Evidence of local arrangements to ensure that older people who are admitted to hospital after having a fall are offered a home hazard assessment.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that older people who are admitted to hospital after having a fall are offered safety interventions if these are identified by a home hazard assessment.

Data source: Local data collection. The Royal College of Physicians (2011) Falling standards, broken promises: report of the national audit of falls and bone health Clinical audit results, section 3: Multifactorial risk assessment and intervention contains the following question: Were appropriate home hazard interventions offered?

Process

a) Proportion of older people admitted to hospital after a fall who are offered a home hazard assessment.

Numerator – the number in the denominator offered a home hazard assessment.

Denominator – the number of older people admitted to hospital after having a fall.

Data source: Local data collection.

b) Proportion of older people admitted to hospital after having a fall who have a home hazard assessment that is performed in their home.

Numerator – the number in the denominator who have a home hazard assessment performed in their home.

Denominator – the number of older people admitted to hospital after having a fall.

Data source: Local data collection. The Royal College of Physicians (2011) Falling standards, broken promises: report of the national audit of falls and bone health Clinical audit results, section 3: Multifactorial risk assessment and intervention contains the following question: Was an access or home visit/assessment performed in the patient's own environment?

c) Proportion of older people whose home hazard assessment identified a need for safety interventions who are offered those interventions.

Numerator – the number in the denominator who are offered safety interventions.

Denominator – the number of older people whose home hazard assessment identified a need for safety interventions.

Data source: Local data collection. The Royal College of Physicians (2011) Falling standards, broken promises: report of the national audit of falls and bone health Clinical audit results, section 3: Multifactorial risk assessment and intervention contains the following question: Were appropriate home hazard interventions offered?

d) Proportion of older people who accepted the offer of safety interventions who received those interventions.

Numerator – the number in the denominator who received safety interventions.

Denominator – the number of older people who accepted the offer of safety interventions.

Data source: Local data collection.

Outcome

Falls rates in the home for older people.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as community health trusts, independent sector providers and district general hospital trusts) ensure that they employ staff with the expertise to perform home hazard assessments for older people who are admitted to hospital after having a fall and, if appropriate, the assessment is followed up with the offer of safety interventions and/or modifications.

Healthcare professionals (in particular occupational therapists) ensure that they perform home hazard assessments for older people who are admitted to hospital after having a fall, and offer safety interventions and modifications as appropriate. This should happen in the person's home and within a timescale that is agreed with the person or their carer.

Commissioners (clinical commissioning groups and local authorities) ensure that they commission services that have the capacity and employ staff with the expertise to perform home hazard assessments for older people who are admitted to hospital after having a fall, and in which the assessment is followed up with the offer of safety interventions and/or modifications as appropriate.

Older people who are admitted to hospital after having a fall are visited in their home after they are discharged by a trained healthcare professional (usually an occupational therapist) who will check for anything that might put them at risk of falling again. If the healthcare professional thinks that making changes in the person's home (for example, changing the layout of furniture) or having special equipment might lower the chances of another fall, they will offer help with this.

Source guidance

Definitions of terms used in this quality statement

Fall

A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground, or an object below knee level.

[NICE's clinical knowledge summary on falls – risk assessment]

Home hazard assessment

Home hazard assessment should be undertaken in the person's home and should be more than a 'checklist' of hazards. It is essential that the assessment explores how the actual use of the environment affects the person's risk of falling.

[Adapted from the College of Occupational Therapists' practice guideline Occupational therapy in the prevention and management of falls in adults (2015)]

Equality and diversity considerations

Healthcare professionals undertaking home hazard assessments and offering safety interventions should be aware that age, socioeconomic status, family origin and culture may influence the willingness of people to accept help with home hazards.