Fall Prevention

The comprehensive assessment should include a standardized, validated, multi-factor fall risk tool. Common choices in home health are the MAHC-10 from the Missouri Alliance for Home Care, the Timed Up and Go (TUG), and the 30-second chair stand. Whatever the tool, the assessment should capture the major risk factors: prior falls, polypharmacy and psychoactive medications, orthostatic hypotension, impaired vision, lower extremity weakness, neuropathy, cognitive impairment, incontinence or urgency, and environmental hazards. A score alone is not a plan. The value comes from converting each identified factor into a specific intervention on the plan of care.

The strongest evidence supports a bundle rather than any single fix:

• Physical therapy for progressive strength and balance training, the best-supported single intervention
• Medication review to reduce sedatives, hypnotics, and other psychoactive load
• Home hazard remediation guided by an occupational therapy home safety evaluation
• Properly fitted footwear and assistive devices, with training in their use
• Vision assessment and referral
• A toileting plan, since rushing to the bathroom at night is a classic fall scenario

Document patient and caregiver teaching for each element, and revisit the plan when status changes.

OASIS-E captures fall history and risk at admission, and discharge items J1800 and J1900 report whether the patient fell since the start or resumption of care and the level of injury. Falls with major injury are treated as serious adverse events, and injurious falls frequently become emergency department visits or hospitalizations, which flow into the claims-based utilization measures that carry 40% of the HHVBP Total Performance Score in CY2026. Accurate, honest fall reporting also feeds your internal QAPI program, and surveyors expect to see incident data connected to corrective action.

Make fall screening an every-visit habit for every discipline, not a start-of-care ritual. After any fall, run a brief huddle or root cause review: what changed, what was missed, what gets fixed today. Track falls per 1,000 patient days by team and by branch so trends are visible, and feed the data into QAPI with a named owner. The most common program failure is a risk score documented at admission followed by silence until the discharge OASIS asks whether the patient fell.