A guide on home safety for older adults, with a printable checklist to help assess your home for risks.
Written by: Miranda M. Riva, Esq Medical Reviewer: Christopher Norman, MSN, APRN, APHN-BC, GNP-BC Reviewed by: Kathleen Cameron BSPharm, MPH, Senior Director, NCOA Center for Healthy AgingAs we age, our homes should continue to be a place where we feel safe, secure, and comfortable. But research shows the exact opposite is sometimes true. A 2014 study conducted by the Centers for Disease Control and Prevention (CDC) found 28.7% of adults over the age of 65 reported falling at least once in the last 12 months. 1 Another study by the Hospital for Special Surgery found 60% of falls happen in the home. 2 To help prevent falls and other accidents, you can make safety modifications to your environment and eliminate common hazards.
Our Reviews Team assembled this guide and checklist highlighting home safety tips and helpful devices to ensure your home, or your loved one’s home, continues to be a safe environment for aging in place.
Having tools and processes in place to get help in an emergency and minimize damage from falls, accidents, or other dangers is vital. The systems and processes below can help ensure you get the help you need when you need it—with no time wasted.
The first emergency tool you can use is a general home security system. A special report released by the U.S. Department of Justice showed about 93% of all crime experienced by adults 65 and older was property crime, which includes general theft, burglary, and car theft. 3 Using even a small system that alerts you when certain home barriers are breached or if someone is near an entryway of the home can help you be more alert and reach out for help if it’s needed.
Choosing a system with a camera and speaker system can allow you to preview people at the door from wherever you are in the home, so you can speak to them if necessary. This can help you determine whether it’s even necessary to answer the door, as well as allow you to inform visitors it will take you a few minutes to get to the door. You can take your time instead, so you don’t increase your fall risk by rushing.
Useful for getting help in an emergency, medical alert devices often include a wearable help button, which, in the event of a fall or another emergency, the wearer can push to connect with a 24/7 monitoring center. Research shows a medical alert device can help give users a stronger sense of security and independence and can bring peace of mind, even for people not at high risk of falling. 4
You’ll want to establish a process for alerting family members and caregivers if there’s an accident or if help is needed. An emergency phone tree, which specifies which caregivers and family/friends to contact in an emergency and in what order, can help alert others of an emergency and get the help you need quickly.
With some medical alert systems, you can set friends and family as emergency contacts. For example, when you push the button you can customize the alert to summon the operator as well as your first emergency contact. This can streamline your emergency phone tree and ensure your caregivers are the first people aware of an emergency.
When assessing the safety of the inside of the home, it might be easiest to go through each room, taking notes as you go, to spot potential hazards and make changes as needed. Be sure to use the tips below and our printable checklist.
First, we will discuss general safety considerations that should be applied throughout the home and then move through measures that are room-specific.
As a general rule, keep a list of emergency phone numbers in an accessible place, preferably near a phone or stored in your cellphone. Consider prioritizing contacts who live close to you, so if there’s an emergency, they can reach you promptly.
Increasing the lighting in your home doesn’t need to be an expensive fix requiring an electrician or rewiring your home.
First, consider replacing current bulbs with LED lightbulbs with higher brightness in areas or rooms that need more lighting. These bulbs will also last longer, so you won’t need to change them as often. If you’re easily bothered by bright lights, you may want to install dimmer light switches, so you can adjust the brightness according to your needs. “Dimmer switches are an excellent suggestion for folks that have cataracts, too,” noted Christopher Norman, a geriatric nurse practitioner in New York State. “While fluorescent lighting is often the worst for people with cataracts, bright LED lighting can sometimes create discomfort, too.”
If you’re looking to add lighting in places not currently wired for traditional light bulbs, consider purchasing LED light strips to plug into existing outlets. They can easily illuminate walkways and give extra lighting under cabinets in the kitchen or bathroom. Our Reviews Team found LED light strips for as little as $15 from Home Depot.
You might also want to consider adding motion-detection lights. These lights are great for interior and exterior use and are perfect if you don’t want to worry about using switches or remotes to light up the room. Using motion-detection night lights in hallways can make trips to the bathroom easier at night, so you won’t stumble looking for the light switch. “Light-sensor nightlights that can plug into outlets are helpful, too—they come on automatically when light dims below a certain point, illuminating hallways better,” added Norman. We also found motion-detection lights at Home Depot starting at $14.
One of the easiest ways to prevent a slip or fall is to wear nonslip footwear, like slippers, that are comfortable and easy to walk in. Look for footwear with a closed heel to prevent the shoe from coming off your foot, as well as a rubberized or textured sole to create traction when walking. Norman noted that having a hard sole is often helpful. “Slippers can still be comfy and have a hard sole. A hard sole contributes to more sensation being transmitted from the bottoms of the feet, which in turn provides a greater sense of stability and balance—thus falls prevention,” he said. This is especially important for people with diabetes, he added. “Excess sugar in the blood over a long period of time decreases nerve function and sensation. This is why some people talk about a tingly sensation in their hands and feet when diabetes is ‘uncontrolled.’”
When conducting your home assessment, pay special attention to the floor. Something as simple as a throw rug can bunch up under a walker, a cane, or your feet and easily turn into a fall hazard. Even traditional nonslip mats can become a hazard if the mat creates the slightest elevation rise between steps.
Consider removing all rugs, especially from high-traffic walkways, or at least replacing them with vinyl rugs. Vinyl rugs are low-profile, so they don’t create an elevation change, and are made of slip-resistant material that won’t bunch up under your feet or other walking aids. Any area rugs (larger rugs used in a sitting area) should be fixed to the floor to keep them from moving. “Another caveat to this is in bathrooms that have porcelain or tile floors: Having something nonskid that’s appropriately tacked down can be, not only aesthetically pleasing, but falling onto a carpet rather than directly onto a tile floor can sometimes make a difference in the extent of fall-related injuries,” added Norman.
Also, note any thresholds transitioning between flooring types and rooms. Ideally, they should be completely flat to make sure they aren’t a trip hazard. If a threshold presents a drastic change in elevation, and you can’t replace it with a flat one, you can install a small threshold ramp on either side of the threshold to make it less of a tripping hazard.
It can be difficult to grip certain handles or turn knobs, particularly if you have reduced dexterity or arthritis, so to keep day-to-day life more comfortable, consider replacing commonly used handles, doorknobs, and other pulls with more comfortable ones. “D” handles are known for being the easiest to use because you don’t need to grip them to open them. Rather, you can simply loop your hand around the handle and pull.
If it’s not in your budget to replace all handles throughout your home, prioritize replacing the ones getting daily use, like in the primary bathroom and on kitchen cabinets.
As you’re walking through your home, ask questions and take notes about what items are used every day and where they’re stored. This includes large and small items. For example, if you or your loved one takes daily medication, consider using an easy-to-open pill container with clear labeling. Make sure larger items are in an accessible location, as well as in a location where you won’t have to perform any overhead lifting and bending. Of course, it’s impossible to put every item in a place that’s easy to access. Ask for assistance from family and friends when needing to reach items that are not within reach.
As we age, our skin becomes more likely to be hurt by heat because of changes in skin composition, noted Norman. If you’ll be taking hot showers or using hot water in the kitchen, consider reducing the temperature setting on your hot water heater to prevent burns. Also, be mindful when boiling water, and when possible, use an electric kettle with an easy-pour spout rather than a pan over the stove.
The living area is a space in the home where the majority of your day is spent. Arrange the furniture to keep a clear walkway and pay close attention to coffee or other low-level tables, which can be tripping hazards. Consider removing coffee tables and replacing them with tables placed adjacent to the most frequently used couches and chairs. The most frequently used chairs should be high enough, so it’s easy to get in and out of. If you use a landline as your primary phone, consider putting it close to the sitting area to make answering calls easier. If you use a cordless phone or cellphone, make a charging station nearby to keep devices at full power.
Also, consider pets, especially cats and dogs. According to a report released by the CDC, an estimated average of 86,629 fall injuries each year were associated with cats and dogs.5 While they make great companions, our pets can also get underfoot. You can try putting a bell or other noise-making device on your pet’s collar so you’ll know where they are at all times. But you might not hear a bell if you’re experiencing hearing loss. Other ways to avoid tripping over pets include training them, knowing their habits so you’re not taken off guard, knowing your surroundings, and making sure they get enough attention and exercise.
When assessing hallways, look for potential trip hazards, like throw rugs and thresholds, and consider adding handrails along the walls. Even if you or your loved one are fully mobile, installing a handrail is good for fall prevention. Adding bright contrast tape to uneven parts of the floor can help you be more aware when walking. If electrical cords or other lines or cables are crossing the path, relocate the device to another plug more out of the way to reduce the possibility of tripping over the cables.
If you or your loved one uses a walking aid and has a multi-story home, you may want to invest in a stair lift for the stairway. This can reduce the time it takes to move up the steps and remove the risk of falling up or down the stairs. If a stair lift isn’t in your budget, adding nonslip treads or carpeting to steps with a smooth surface can also help reduce the risk of falling. Make sure there is adequate lighting at the top and bottom of the stairs and light switches in both places. If you are using the stairs at night, think about adding motion detection lights along the steps to keep the stairs illuminated. Adding a strip of reflective tape at the end of each step can also be helpful, noted Norman.
The bedroom can harbor risks that disproportionately affect older adults, and awareness and proactive measures can help prevent potential accidents associated with bed and room falls, bedding hygiene, circulation issues, mattress safety, and fires.
Falling out of bed is a significant concern for older adults, as it can lead to severe injuries and a decline in overall quality of life. Bed falls may be caused by mobility issues resulting from reduced strength and balance, along with chronic health conditions. Medications, including benzodiazepines, antidepressants, sleep aids, and antihistamines, are associated with dizziness or imbalance, increasing the risk of falls. And, if an older adult has impaired vision, wakes frequently throughout the night, or the room is poorly lit or cluttered, these individuals are also at an increased risk of bed falls.
To lower the likelihood of a fall, we suggest making adjustments to the bed, such as placing it next to a wall, lowering the height, or switching to an adjustable base bed. Adding bed rails, keeping walkers close by, and adding foam bumpers as barriers are additional safety steps to prevent bed falls. Removing clutter and cords around the bed as well as using a bed alarm to alert caregivers when you are getting out of bed are added steps you can take to increase bed safety.
A softer mattress tends to contour to the body, allowing the sleeper to sink into the bed. While this can be comfortable for some, these beds are often difficult to rise from. Make sure the mattress is comfortable but firm, and avoid a soft or saggy mattress altogether.
As we age, what we need from a mattress may change. If you find you are looking for a new mattress to meet those needs, take a look at mattresses for back pain or specific chronic pain conditions.
Circulatory problems and heart disease go hand-in-hand since your heart is in charge of circulating your blood, and these circulation issues can lead to discomfort, numbness, and pain, making it challenging to find a comfortable sleeping position. In some cases, older adults may find relief only in specific sleep positions or with their feet hanging off the end of the bed, which may pose a safety hazard for falls or other injuries. Improving circulation can alleviate these issues and contribute to a safer, more comfortable sleep environment.
There are many strategies aimed at reducing circulation problems, including using pillows or an adjustable base to elevate the feet, getting regular exercise, and taking a warm bath before bed. Compression stockings, a healthy diet, and drinking plenty of water are additional steps that can be taken to improve problems with circulation.
Maintaining good bedding hygiene is crucial for both comfort and health. Unclean bedding can breed bacteria, which can lead to a host of issues like skin irritations and infections. Regularly washing sheets in hot water kills bacteria and germs. Wash at least once a week, more often if incontinence is an issue, and use a mattress protector to prevent moisture from seeping into the mattress.
Scented laundry detergents can irritate the skin, so we suggest opting for hypoallergenic, fragrance-free options to minimize reactions. Additionally, by practicing good skin hygiene, changing sleep positions often, and checking for pressure sores, you can help prevent skin issues that could result in an infection.
The first step of kitchen safety is making sure your appliances, smoke detectors, and carbon monoxide detectors are working correctly. Check appliances for frayed cords or malfunction when completing your kitchen safety assessment. Smoke and gas detectors should be installed according to National Fire Protection Association guidelines and should be tested at least once per month, and batteries should be replaced at least once per year.6 If you don’t want the hassle of replacing batteries regularly, you may prefer smoke alarms with non-replaceable batteries, which last up to 10 years, and will alert you with a chirp when the battery is low.
According to the American Burn Association, adults 65 and older are at much higher risk of injury and death from a kitchen fire due to physical, visual, hearing, or mental impairments, which may slow the quick action necessary in a fire emergency.7 If you have a hard time hearing, choose a detector that will alert you by sound and strobe lights. If you ever have a fire emergency or a detector goes off, call 911 immediately. You should not try to put out the fire yourself. Another helpful fire safety tip is to be aware of the flame height on burners when cooking with a gas stove and avoid wearing long sleeves that could easily catch fire.
If using knives, purchase pierce-resistant safety gloves to protect from cuts, and use a rubberized cutting board to prevent the knife from slipping while chopping. Vegetable choppers are a safe alternative to using knives to cut or dice foods.
A study published in the Injury Epidemiology Journal reported that falls occurring in the bathroom are more than twice as likely to result in an injury compared to falls occurring in the living room.8 This makes bathroom safety one of the top concerns for older adults who choose to age in place. Investing in a walk-in tub can be an effective way to prevent falls while getting into and out of the shower or tub. If a walk-in-tub renovation isn’t in your budget, there are other more affordable options to provide additional safety and comfort.
This includes adding nonslip gripping material to the shower or tub floor and installing grab bars near the toilet and in the shower or tub to help you remain stable. Rugs are great for catching water around the bathing area, but make sure you’re using nonslip mats, so they won’t bunch up when you walk on them.
Depending on how often you or your loved one leaves the home, making appropriate exterior modifications may be a good idea to keep your environment safe and comfortable. This starts with keeping entryways accessible by installing handrails and ramps, if needed, to get in and out of the home. Also make sure that lighting is working and is adequate by fully lighting up the space when it is dark.
Using bright solar lights or motion detection lights around steps and walkways will help you see where you’re going and prevent falls, and since they aren’t constantly on, they will need to be replaced less frequently than traditional overhead lights.
During the winter months, take extra precautions when using steps or walking on icy concrete. If you’re unable to do it yourself, see whether a neighbor or family member can help salt your steps and walkways to reduce ice build-up, and always use assistance (handrailing or another person) when using steps. If it’s in the budget, there are snow removal services you can hire to keep your driveway and walkways clear.
Also, consider the impact of the elements on steps and walkways, which can degrade over time, causing these areas to break down and become uneven. Maintaining these high-traffic spaces is important for keeping your home free of fall hazards. If you start to notice bricks crumbling or the walkway becoming uneven, consult a concrete repair specialist.
Fire prevention and preparedness is of utmost importance in your bedroom as in other rooms of your home. Certain renovations, such as installing a sprinkler system, and keeping items like fire blankets or extinguishers easily accessible can help you if an emergency situation should arise. It’s also a good idea to plan your fire evacuation by ensuring your fire alarm is working properly and practicing fire drills every so often.
Since electrical fires most commonly start in the bedroom, take care and avoid trapping electrical cords under bedding or against walls where heat can build up. Keep bedding, clothes, curtains, and other combustible items away from space heaters, and only use lab-approved electric blankets and warmers.
Check cords regularly to make sure they are not frayed, and make sure the fuse box in your home is properly labeled for clear and safe use.
It is important to take all medications exactly as they are prescribed by your healthcare provider, educating yourself on potential side effects that could pose safety risks.
Adopting a few simple habits can go a long way when it comes to medication safety, including checking expiration dates regularly and keeping a list of medications up-to-date to show your healthcare provider if they’re considering prescribing a new medication. Lastly, store medications in a cool, dry place, and avoid exposing them to extreme heat or moisture.
Properly fitting nonslip footwear, easy-to-open pill dispensers, and appropriate eyewear are just a few everyday items you can purchase to make independent living safer and more comfortable. Additionally, there are certain devices and products specifically created to help older adults age in place.
A medical alert system is a device that allows you to connect with a 24/7 monitoring center at the push of a button. With some medical alert systems, like HandsFree Health, you can customize it, so your caregiver receives your emergency alerts when you push the button for help. Other systems can give you the benefit of automatic fall detection, so if you fall, the system will automatically contact a monitoring center staff member who can call for help. A variety of systems are available for in-home or on-the-go lifestyles, so you can find one to fit your needs.
GPS trackers are small devices that can help track someone’s location. These work using a Global Position System (GPS), so a connection to the internet or other wireless service isn’t required. You can purchase GPS trackers separately, like as a watch, or many medical alert systems come with GPS already installed and a corresponding caregiver app, which allows you to track someone when they’re on the move. The Alzheimer’s Association reported six in 10 people living with dementia will wander at least once. 10 A GPS can help locate a lost person and reduce their exposure to danger. These devices are generally discreet and can easily be tucked away in a bag.
It’s important to be aware of your surroundings when living independently. If you or someone in your care has been having trouble hearing, consider taking an online hearing test or seeing an audiologist for a more in-depth hearing test to discuss hearing aids.
If you don’t already own a cellphone and regularly leave the home, consider getting a cellphone, so you can easily reach someone in the event of an emergency. Some mobile phones, like Jitterbug, also double as a medical alert system and come with access to a monitoring system, so all you need to do is press a button to summon help if you fall or are in an accident.
Walk-in tubs offer a safe, comfortable, and convenient way to bathe, especially if you experience mobility issues. The door on a walk-in tub swings either out or in and has a low threshold, making it easier to step over. Plus, walk-in tubs often come with jet features, which can help ease sore joints. Walk-in tubs come in many models, with some including a shower combination. The cost to install a walk-in tub ranges from $5,000–$20,000, depending on the size, features, and renovation required to install.
If you want extra guidance when making a home safer, consider using a home safety specialist. These professionals will perform an in-home consultation, make suggestions about how to make the environment safer, and will even install equipment or make modifications based on their suggestions. This can help take the pressure off of you to find all potential hazards and leave it to a person who specializes in home safety. These professionals include occupational and physical therapists and certified aging in place specialists.
Use our room-by-room checklist below as you walk through your home and note potential safety hazards and modifications you should make.
Click here for the PDF printable checklist.
If you need financial assistance for home safety modifications, there are several options available, including home improvement grants, long-term material loans, and certain Medicare plans.
Home improvement grants are generally offered on a one-time basis for a single specific home modification project. They do not need to be repaid.
Some organizations offer long-term loans for certain kinds of home modification materials, such as portable wheelchair ramps. These may be borrowed until they are no longer needed.
While original Medicare usually does not cover the cost of home modifications, there are several exceptions. Medicare might pay for assistive technology devices, which can be part of a home modification project, if they’re considered medically necessary and prescribed by a doctor. Medicare may also offer assistance in determining which home modifications can be considered a medical requirement. Medicare Part B will cover the costs of a home evaluation from an occupational therapist to determine necessary changes. In certain instances, Medicare will also pay for bathroom modifications, including walk-in tubs, although this is rare. Generally, Medicare assistance is limited to any hardware associated with a home modification but not for construction costs.
If you have a Medicare Advantage plan, you may have more coverage for home modifications. These plans tend to offer additional benefits, which may include home modifications that are considered medically necessary. Keep in mind that Medicare Advantage plans vary from one state to another, so you should check the supplemental benefits offered where you live.
Home safety should be at the top of the list when choosing to age in place. If you want to assess the overall safety of your home, print out our Reviews Team’s home safety checklist and walk through each room of your house and take notes. This will make you more aware of potential hazards and how they can be removed or modified.
You can make your home safer by using our safety checklist to complete a room-by-room walk-through of your home. Take notes of all potential hazards and review our suggestions for minimizing risks and enacting prevention protocols.
How can I monitor my older adult parents at home?If you want to receive alerts of potential health or safety concerns, there are several monitoring systems you can invest in. Medical alert systems can help you keep tabs on someone when they’re on the move, as well as medication use, eating habits, and sleep patterns.
What are the hazards in an older person’s home?A large majority of injury-causing accidents occur in the bathroom, making it one of the most hazardous rooms in the house. Some of the easiest modifications you can make to your home are adding grab bars and gripping mats to the bottom of your tub or shower. Adding a walk-in tub can help minimize the risk of a fall, though this is a pricy investment.
What are five recommendations to maintain a safe and healthy environment for an older adult?First, perform a safety walk-through of the home yourself or hire a professional service. “These can often be covered by insurance when ordered (‘getting a script’) by a health care provider. Nurses and occupational therapists are trained to do these kinds of assessments, for example,” noted Norman. Also occupational therapist home assessments are covered by Medicare.
Second, make suggested modifications based on the results of the home safety assessment. Third, invest in devices that will alert you or a medical term if an accident occurs. Fourth, if the home is not your own, make frequent visits to ensure no hazards have developed in your absence. Fifth, make sure you or your loved one regularly attends screenings and appointments with a health care provider to stay on top of your health.
Have questions about this review? Email us at reviewsteam@ncoa.org.
Miranda Riva is a writer and licensed Tennessee attorney who has written and edited legal content covering the topics of family law, business law, criminal law, environmental law, and estate law.
Christopher Norman is a Board-Certified Geriatric Nurse Practitioner and Holistic Nurse. As a nurse’s aide, registered nurse and now nurse practitioner, he has loved working with older adults since 2004.
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© 2024 National Council on Aging, Inc.
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© 2024 National Council on Aging, Inc.
