Home Safety Assessment — Home Health Training

You assess the home at start of care and you keep assessing it every visit, because homes change — a grandchild moves in, the oxygen arrives, someone brings a rug back.

The thing to hold onto: you do not control this environment. You are making recommendations in someone's home, and the ones that get acted on are the ones that respect that.

Walk the route the patient walks

The most useful five minutes is following the patient's actual daily path: bed to bathroom at 3am, chair to kitchen, front door to car. Hazards live on that route, not in the rooms nobody uses.

Bedroom to bathroom, at night

This is where falls happen.

Is there a light they can reach before standing? Night lights along the route?
Clear path — no cords, no pets' bowls, no boxes
Bed at a height they can transfer from safely
Walker or cane within reach from the bed, not across the room
Phone or call device reachable from the floor if they fall

Bathroom

Grab bars — properly anchored, not towel rails and not suction cups
Non-slip surface in the tub or shower
Toilet height, and whether a raised seat or frame would help
Shower chair or tub bench where transfers are difficult
Water heater temperature — scald risk, especially with neuropathy
Door that opens outward, or can be opened from outside if someone falls against it

Floors and walkways throughout

Throw rugs — the single most common removable hazard
Cords crossing walkways
Clutter, especially in hallways
Uneven thresholds and transitions between floor types
Pets that weave around feet

Stairs

Handrail, and whether it runs the full length
Lighting at top and bottom
Even step height; no worn or loose treads
Nothing stored on the steps
Can the patient actually do them? If not, what is the plan for the ones at the front door?

Kitchen

Frequently used items within reach without a step stool
Stove safety — can they manage it, and do they leave it on
Working smoke detector
Food storage and spoilage, which tells you about function and about resources

Medications

Stored safely, and away from children and anyone at risk
Not decanted into unlabelled containers
Expired and discontinued medications removed
Organised in a way this patient can actually use

Fire, oxygen, and emergency exit

Working smoke detectors, and carbon monoxide detectors where appropriate
Two ways out, and can the patient use either
Space heaters clear of anything flammable
Oxygen: no smoking in the home, no open flame, tubing not run under rugs or through doorways, cylinders secured and not stored in closets
Emergency numbers visible — not stored only in a mobile phone

The oxygen conversation is worth having properly. Smoking with oxygen in the house is the highest-consequence hazard in home health, and telling someone to stop smoking does not work. Talk about where and how, involve the family, and document what you advised.

Getting recommendations acted on

Most safety recommendations fail because they were delivered as instructions.

What does not work: "You need to get rid of these rugs."

What works better:

Ask first — "what's the trickiest part of getting to the bathroom at night?"
Explain the mechanism — "that rug edge is exactly where a walker catches"
Offer a trade — "could we move it to the bedroom where you don't use the walker?"
Start with the one that matters most, not all fourteen
Involve the person who will actually do it, usually family
Come back to it next visit

A patient who agrees to one change and does it is ahead of a patient who nods at ten and does none.

When they say no

They are allowed to. It is their home.

Document what you recommended and what the response was
Document the education you gave about the risk
Keep it on the plan of care and revisit it
Consider whether OT could solve it another way — often they can
Escalate to your Field Supervisor when the risk is serious

Refusal is not a reason to stop assessing. Note it, work around it, and try again.

What goes on the plan of care

Safety measures have to be specific to this home. "Fall precautions" is not a plan. See The Plan of Care, Field by Field.

Remove throw rug in hallway; night light between bedroom and bathroom; rolling walker within reach at bedside; grab bar installed by son at tub — pending; phone kept on bedside table within reach from floor.