Why Waiting Until Someone Falls Is Costs Thousands

A client doesn’t have to fall before they become a falls risk.

Yet many Occupational Therapy referrals are still made after a hospital admission, fractured hip, or a significant decline in function. By this stage, the person has often lost confidence, independence and mobility, while providers are managing increased care needs, urgent equipment requests, and pressure from families.

We know falls are one of the leading reasons older Victorians are admitted to hospital, and many of these incidents occur in and around the home.

According to the Victorian Department of Health, falls account for around 72% of injury-related hospital admissions and 53% of injury-related emergency department presentations in Victoria

Under the Support at Home program, the focus is shifting from reacting to crises to preventing them through re enablement. Early Occupational Therapy intervention is one of the most effective ways to reduce falls, support independence, and help older people remain safely at home.

Falls rarely happen “out of nowhere”

Falls are usually the result of several small changes occurring over time rather than one isolated event.

These changes may include:

• Reduced balance or lower limb strength.
• Fatigue or shortness of breath during everyday tasks.
• Medication side effects such as dizziness or urinary urgency.
• Changes in vision.
• Cognitive impairment or dementia.
• Arthritis or chronic pain.
• Difficulty transferring on and off chairs or the toilet.
• Hazards within the home environment.

Many older people adapt gradually. They begin holding onto furniture, avoiding certain rooms, limiting outings, or relying more heavily on family members. These compensatory strategies often mask declining function until a fall occurs.

By recognising these early warning signs, providers have an opportunity to intervene before a crisis develops.

The hidden falls risks that are often overlooked

Not all falls risks are obvious.

Some of the most significant contributors include:

Furniture walking

Clients who regularly use walls, benches or furniture for support are often demonstrating declining balance and mobility or a need to offload their body weight from painful joints onto another stable surface.

Difficulty standing from chairs

Needing multiple attempts to stand, pushing heavily through armrests or requiring assistance may indicate reduced strength and increased falls risk.

Urinary urgency

Rushing to the bathroom, particularly overnight, significantly increases the likelihood of falls.

Fatigue

Clients living with cardiac, respiratory or neurological conditions may become increasingly unstable later in the day as fatigue develops.

Dementia

Changes in judgement, insight, visuospatial awareness and problem-solving can increase environmental risks, even when physical mobility appears relatively good.

Environmental hazards

Poor lighting, loose mats, uneven pathways, clutter, inappropriate furniture heights and inaccessible bathrooms all contribute to falls.

Small interventions can make a significant difference

Preventing falls doesn’t always require major equipment or expensive home modifications.

Often, small, timely interventions can have a significant impact.

These may include:

• A comprehensive home safety assessment that includes screening and educations about falls risk- and risk-taking behaviours
• Adjusting chair or bed heights
• Installing strategically positioned grab rails.
• Recommending appropriate mobility aids.
• Rearranging furniture to improve access.
• Improving lighting and reducing trip hazards.
• Introducing simple Assistive Technology.
• Educating older people, carers on safe transfer techniques and mobility habits.

The key is ensuring these interventions are based on a comprehensive Occupational Therapy assessment rather than a one-size-fits-all approach.

The real cost of waiting

A fall can have consequences well beyond the immediate injury.

For the older person:

• Fractures and hospital admission.
• Loss of confidence.
• Reduced independence.
• Increased fear of movement.
• Earlier transition into residential aged care.

For providers:

• Increased care hours.
• Urgent equipment and home modification requests.
• More complex case management.
• Increased coordination with hospitals and health professionals.
• Family complaints and distress.
• Greater pressure on care teams.

Many of these outcomes are preventable through earlier assessment and intervention.

When should you refer to an Occupational Therapist?

Consider referring when a client:

• Is beginning to “furniture walk.”
• Reports feeling unsteady or “nearly falling”
• Requires increasing assistance with transfers.
• Has recently been discharged from hospital.
• Has experienced changes in mobility or balance.
• Is living with dementia and becoming less safe at home.
• Has carers expressing concerns about safety.
• Is avoiding activities they previously completed independently.
• Is beginning to struggle with stairs, showers or toileting
• Has experienced one or more falls in the past 12 months.

The best referral is often made before the first serious fall occurs.

Case study: Early intervention prevented a hospital admission

Recently a Care Partner referred an 84-year-old gentleman to BBOT after noticing he had begun holding onto furniture when walking through his home. Although he had not yet fallen, his daughter reported increasing fatigue and several “near misses.”

Our Occupational Therapist completed a comprehensive home safety assessment and identified multiple contributing factors, including an unsuitable lounge chair, poor lighting between the bedroom and bathroom, urinary urgency, and reduced lower limb strength.

Recommendations included:

• A more appropriate lift chair.
• Minor home modifications.
• Night lighting.
• Falls prevention education.
• Referral and collaboration with his physiotherapist regarding mobility and best use of mobility aids.

Six months later, he had experienced no falls, remained living independently at home, was able to attend the Physio outpatient clinic providing a regular outing, and had not required any increase in formal support services.

Early intervention reduced risk while preserving both independence and quality of life.

Prevention aligns with Support at Home

The Support at Home program places greater emphasis on helping older people remain safe, independent and engaged in their own homes.

Occupational Therapy plays an important role in achieving these outcomes by:

• Identifying risks before they become crises.
• Supporting reablement and independence.
• Recommending appropriate Assistive Technology.
• Prescribing effective Home Modifications.
• Educating clients, families and care teams to identify opportunities for reablement.

Rather than responding after a fall, providers have an opportunity to prevent one.

Free Falls Referral Checklist

Not every client who is at risk of falling has already had a fall.

Our Falls Referral Checklist has been developed for Care Partners to help identify clients who may benefit from an Occupational Therapy assessment before an incident occurs.

The checklist includes:

• Early warning signs.
• Common environmental risks.
• Indicators for referral.
• Practical questions to ask during routine visits.
• A simple decision guide to support timely referrals.

Download your free Falls Referral Checklist and help identify risks earlier—before a preventable fall changes everything.

Need advice about a client?

If you’re supporting an older person who is becoming less steady, has experienced a near miss, or whose family has expressed concerns about safety, our team can help.

Better Balance Occupational Therapy provides comprehensive home safety assessments, falls prevention strategies, Assistive Technology prescriptions and Home Modification recommendations across Melbourne, Geelong and the Bellarine Peninsula working alongside care providers to help older people remain safe, independent and living well at home.