Homecare Excellence – Assisting a Fallen Client Safely Off the Floor

At BrightStar Care of Sacramento, Carmichael and Roseville we pride ourselves of ongoing, in-person training for our homecare caregivers.  While all caregivers are hired with at least one year of experience or Certified Nurse Assistance training, ongoing training is important to refresh their minds, especially in the case of specific clients that have fallen or are at high risk of falling.   Our care is supervised by home health RNs which also conduct training.  We assist clients with activities of daily living, which includes ambulation support.  Many of our clients are at risk of falling.  We prepare our caregivers for those incidents.

Helping a client get up safely off the floor after a fall is a critical skill for home care aides and all caregivers. While the concepts of training can be obtained on the internet and by watching videos, there is no substitute for in-person training and live practice of these homecare skills.

Here is a step-by-step guide to assist when a client has fallen:

1. Assess the Situation:

• Approach the client calmly and assess for any injuries or signs of distress.
• Ask the client if they are experiencing pain or discomfort, and if they can communicate, inquire about specific areas of pain.

2. Ensure Personal Safety:

• Ensure your safety first. If the client is heavy or you're concerned about your ability to lift them, wait for additional help or use assistive devices if available.

3. Communicate with the Client:

• Explain your plan to the client and reassure them that you are there to help.
• Ask the client to move slowly and follow your instructions.

4. Call for Additional Assistance:

• If the client is unable to stand or if there are any concerns about their well-being, call for additional help. This might include family members, emergency services, other caregivers or the homecare agency.

5. Help the Client to a Seated Position:

• If the client is able to sit up, assist them into a seated position. Place a chair or other sturdy object nearby for support.  More details are provided below.

6. Assess for Injuries:

• Check for any visible injuries, swelling, or signs of distress.
• If there are signs of serious injury or if the client is in pain, do not attempt to lift them. Wait for professional medical assistance.

7. Encourage Movement:

• If the client feels capable and there are no signs of serious injury, encourage them to move their limbs slowly to assess for any pain or limitations.

8. Use Proper Lifting Techniques:

• If the client is willing and able to stand, help them into a standing position using proper lifting techniques. Bend at the knees, keep your back straight, and lift with your legs.

9. Provide Support:

• Once the client is standing, provide support as they regain their balance. Encourage them to take small steps.

10. Assist to a Safe Location:

• Assist the client to a nearby chair or stable surface where they can sit and rest.
• If needed, offer additional support to help them back to their bed or another safe location.

11. Report and Document:

• Report the incident to the appropriate individuals, such as a supervisor or healthcare professional.
• Document the details of the fall, the actions taken, and any observations about the client's condition.

Remember, your safety and the safety and well-being of the client are the top priorities. If there is any doubt about your ability to safely assist the client, seek help immediately. Additionally, communication and reassurance throughout the process are essential to minimize anxiety and ensure the client's comfort.

• Additional instructions on how to assist a client off the floor using a chair
• Assist the client off the floor with either a total mechanical lift or a stand-by assist with the client using a sturdy surface to get up. 
• Use a total mechanical lift if the client does not have the strength, weight-bearing ability or cognitive ability to stand with the chair technique.  Or seek assistance of another individual or from the BrightStar agency.
• Never leave the client alone. 
• Comfort the client. There is no rush to get them up, they can’t fall any further. 
• Place the chair directly in front of the client. The chair is to help provide balance and support for the client. 
• Log roll the client to their side. From their side, the client should be instructed to come to a four-point stance (caregiver should not lift them to a four-point stance – support only). If the client is unable to come to a four-point stance, stop the transfer and seek further help or use a mechanical lift if available. 
• With the resident holding the chair for support, they should be instructed to bring one foot forward. From this position, they should be able to come to a standing position. 

Key Points to Remember:

• If, at any time, the client is unable to proceed, the transfer should be stopped, the client should be lowered to the floor and a total mechanical lift should be used.  If a mechanical lift is not available, develop a plan with other caregivers and seek support from your homecare agency.
• At no time should the caregiver be required to lift the client. That effort is not safe and goes beyond the scope of a caregiver or home health aide’s job.  If they are required to do so, the transfer should be stopped and a total mechanical lift should be used.