Fall Safety at Home
By Dolly Garcia-Willix
Senior Licensed Social Worker
VNS Health
Bronx Voice
September 24, 2024
NEW YORK - As a home care occupational therapist, my colleague Stacey Mislavasky often cares for patients recovering from a fall in their homes.
Nationwide, one in four adults over 65 will experience a fall, and that risk increases with age. When Stacey recently reached out to schedule a patient visit, she was surprised when her patient informed her that the front door would be open and that she could walk right in.
Coming up to the house, Stacey knocked and announced herself, but no one came to the door. Walking in, she quickly realized why not. She was met with a hallway packed to the ceiling with possessions, random trash, clutter, and food. Weaving through the house, it became evident to Stacey why the fall had likely occurred—the whole home was a safety risk to the patient.
For many home care clinicians, encountering clients who have excessive clutter is not uncommon. Nationwide, 2% of Americans suffer from a hoarding disorder, but that number grows higher as we age, with 6% of older adults experiencing severe hoarding tendencies.
While many of us can relate to the difficulty of keeping homes clutter-free, a pathological hoarding disorder is a diagnosed mental health condition, when an individual has extreme difficulty getting rid of items or possessions in their home, and the thought of parting with objects causes distress. It can also coincide with other neuropsychiatric disorders such as dementia, schizophrenia, obsessive-compulsive disorder and autism.
One serious consequence for older adults with a hoarding disorder is that disorganization and overcrowded spaces make the chances of a fall much more likely. With September being Falls Prevention Month, it’s a good time to take stock around the home to see the impact house clutter can have on a loved-one’s physical and mental well-being—and how it can put them at risk for serious injuries from a fall.
It’s important to remember that for older individuals a fall can be much more problematic than a moment of temporary instability or embarrassment. According to the CDC, falls are the number one cause of injury for older adults, and 37% result in medical treatment or restricted activity. More broadly, fall-related injuries can have an outsized impact on one’s ability to live independently and safely at home.
As my VNS Health colleagues and I have found, the reasons that move someone’s house from “messy” to “dangerous” can vary greatly. Progressive physical mobility issues might make it difficult to rearrange or de-clutter a home. A social worker, like myself, often collaborates with rehabilitation therapists and other home care team members, and the family—to create a home safety plan that addresses these issues.
Stacey advises that even little changes can make a big difference, from securing or getting rid of loose rugs, to removing stray electrical cords from walking areas, to fixing loosely tucked in sheets and bedding. Patty Vieira, a physical therapist on our team, also notes that preventative measures—from getting sturdier and getting shoes that fit properly, to learning how to safely use mobility devices—can all go a long way in preventing a dangerous fall.
Education is a big part of home health care. For our teams, falls prevention is also about setting healthy habits and educating clients and families, because fall risks need to be addressed early on. Patty notes that common factors that make a fall more likely include: medications that cause dizziness, vestibular issues, not having the correct eyeglass prescription, and nerve issues (peripheral neuropathy) in the feet, which is a common side effect of diabetes.
For clients experiencing a severe hoarding disorder, especially when the hoarding is tied to mental illness, the solution may require more than a few lifestyle changes. It’s important to ease into these conversations with your loved one, since speaking about the issue can understandably provoke strong emotions. I encourage starting off with nonjudgemental or helpful questions, such as asking gently if they would like some help putting things away or trying to get more organized.
Stacey also notes that it’s important to acknowledge the person’s feelings and put yourself in their shoes, recognizing that removing belongings might be difficult for them. “I don’t go in telling people to ‘just move this” or ‘get rid of that,’” she says. “I want them to understand that none of us have a crystal ball as to what could cause a fall—but it’s better to be safe ahead of time and ensure they can continue to live where they are most comfortable.”
We connect with families and caregivers in these situations as well since they may live far away or not be aware of a loved one’s home environment. We also work to find the root causes behind a client’s hoarding—it could be tied to a traumatic life event such as a divorce or death in the family, or in some instances it can be related to an undiagnosed mental illness. We’ve seen cases where the hoarding is generational. In other cases, as a caregiver becomes overwhelmed with all that goes into caring for a loved one, it simply becomes hard for them to keep up with organization and cleaning.
In any of these situations, hoarding can cause embarrassment and uncertainty. But no one should be ashamed to ask for help. Once we have an idea of what the problem is, home care clinicians spend a lot of time listening and then working with our clients to find the right solution for them so we can connect them with the resources they need.
Whether you’re recovering from a fall yourself, or simply at risk, addressing the causes of falls is no easy task. That’s why we encourage caregivers and their loved ones to reach out for help. It’s never too late to “put your best foot forward” and make meaningful changes in how you care for yourself!
Dolly Garcia-Willix is a Senior Licensed Social Worker at home- and community-based health nonprofit VNS Health. Learn more about VNS Health’s Falls Prevention Program here.
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