Positive Risk-Taking for Falls, Mobility and Safe Movement in Older People’s Services
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Falls prevention is a core safety priority in older people’s services, but it can unintentionally drive over-restriction. If people are discouraged from walking, practising stairs, or accessing everyday environments, their strength and confidence reduce, dependency increases, and risk can actually rise over time. Positive risk-taking focuses on enabling safe movement through planning, coaching, environmental design, and proportionate safeguards. This article sits within positive risk-taking and links directly to person-centred planning, because mobility enablement only works when it is personalised, reviewed, and consistently delivered.
Why “risk elimination” increases long-term harm
Falls risk is often managed through blanket rules: “always use a wheelchair,” “no independent transfers,” or “only walk with two staff.” These approaches can be appropriate short-term (e.g., acute deterioration), but when they become routine they reduce muscle strength, balance, confidence, and motivation. People stop practising movement and start avoiding it. Over time, this can create a higher-risk profile: frailty increases, transfers become less safe, and minor illness leads to rapid functional decline.
Positive risk-taking reframes the goal: not “no falls,” but “safe movement with the least restrictive controls.” The service uses structured assessment, graded enablement, and clear documentation to show that decisions are reasonable, proportionate, and regularly reviewed.
What good looks like in day-to-day delivery
Effective mobility enablement is visible in daily routines, not just in care plans. It includes:
- Clear transfer plans (bed, chair, toilet) with consistent cues and equipment positioning.
- Agreed “walking windows” (short distances at set times) to build confidence and strength.
- Environmental controls (lighting, clutter removal, footwear checks) completed as routine, not “when remembered.”
- Staff coaching techniques: slow pace, step-by-step prompts, and respectful encouragement rather than rushing.
- Rapid review triggers: near-misses, changes in medication, infection, reduced appetite, or increased confusion.
These controls support a defensible balance between enablement and safety, and they reduce variation between staff shifts.
Operational example 1: Graded walking plan after a fall
Context: A resident experienced a fall at night when attempting to walk to the bathroom. Family asked for “no more walking alone,” and staff confidence reduced.
Support approach: The service completed a falls review, including environment, footwear, continence routines, and possible medication contributors. A graded enablement plan was agreed with the person and family, focusing on safe daytime mobility and supported night-time routines.
Day-to-day delivery detail: Staff introduced a consistent prompt sequence for transfers and walking (“feet flat, pause, stand, balance, step”). A walking aid was positioned within reach, lighting checks were added to the night checklist, and the person practised a short corridor route twice daily with one staff member. Overnight, staff offered proactive toileting support at agreed times to reduce rushed unplanned walking.
How effectiveness is evidenced: The service tracked walking frequency, confidence scores (simple 1–5 rating), and near-misses. Within four weeks, mobility increased, the person resumed walking to meals, and unplanned night walking reduced. Falls monitoring showed fewer instability incidents because movement was planned and rehearsed.
Operational example 2: Safe transfers and “dignity of risk” for toileting
Context: A person wanted privacy when using the toilet but had variable balance. Staff responded by insisting on continuous assistance, leading to distress, refusal, and occasional unsafe attempts alone.
Support approach: The service held a risk discussion focusing on privacy, dignity, and predictable routines. A compromise was agreed: staff would assist the transfer and then step away, remaining within call range, unless specific risk triggers were present.
Day-to-day delivery detail: The care plan defined when staff must remain (e.g., acute confusion, dizziness, new medication, illness). The bathroom environment was adapted: clear route, stable grab rails, non-slip flooring, and the call system tested each shift. Staff used the same transfer technique and checked footwear before walking. A short “safety script” was used to avoid mixed messages (“I’ll help you stand and sit safely, then I’ll wait just outside.”).
How effectiveness is evidenced: Incident records showed fewer distressed episodes and fewer unsafe unassisted attempts. Supervision notes evidenced staff confidence and consistent adherence. The person reported improved dignity and reduced anxiety.
Operational example 3: Enabling outdoor access despite mobility risk
Context: A resident valued daily outdoor time but had a history of unsteadiness. Staff stopped outdoor access during busy periods, which increased low mood and agitation.
Support approach: The service created an outdoor enablement plan with clear boundaries: time, route, weather conditions, and staffing model. The plan focused on predictable, supported outdoor access rather than “only if we have time.”
Day-to-day delivery detail: Outdoor access was scheduled into the rota at agreed times, with a specific staff role responsible for preparation (coat, footwear, walking aid check). The route was standardised to reduce hazards, and a seated rest point was used to prevent fatigue. Staff recorded the person’s energy level and any balance issues after each outing, using this to adjust future support.
How effectiveness is evidenced: Mood and engagement improved, documented through daily notes and activity participation. The person’s gait stability improved due to regular practice, and the service could evidence a structured enablement approach rather than ad hoc decisions.
Commissioner expectation
Commissioners expect providers to demonstrate outcomes that reduce avoidable dependency, including maintained mobility and independence. They also expect evidence that falls management is proactive (reviewed, personalised, and risk-assured), not simply restrictive.
Regulator / Inspector expectation (CQC)
CQC expects risk to be managed through person-centred, least restrictive practice. Inspectors will look for clear documentation of decisions, regular review, consistent staff practice, and evidence that people are supported to live the life they choose while remaining as safe as reasonably possible.
Governance and assurance mechanisms that make enablement defensible
Providers strengthen auditability when they can show: (1) a clear falls review process after any incident; (2) routine environmental checks; (3) staff competence sign-off for transfers and mobility support; (4) trend monitoring (falls time, location, trigger patterns); and (5) learning loops (what changed, when, and why). Supervision should test whether staff can explain the “reasoned balance” behind an enablement plan, not just repeat instructions. Regular file audits should confirm that outcomes are tracked, reviews occur on time, and restrictive steps are time-limited with clear exit criteria.
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