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What can be done to prevent injuries in care homes?

The number of serious injuries reported by care homes in England has almost doubled since 2011. Almost 290,000 reports of serious injuries in non-NHS care homes have been reported to the Care Quality Commission (CQC) since October 2010.

Charities, and former ministers described the figures as "deeply disturbing" and "intolerable in a civilised society".

Serious injuries, which include deaths, have risen rapidly year on year, reaching a record high of 43,594 in 2018, almost twice the number recorded in 2011, when there were 23,709. There have already been more than 14,600 reported injuries this year up to the start of April.

This report raises issues about the care and protection of services users. It begs the question about the reasons for the rise. Is the increase in serious injuries caused by:

  1. An increase in the level of frailty suffered by service users now admitted to care homes at an older age or dementia.

  2. Poor care practice.

  3. Poorly trained staff.

  4. Shortage of staff.

There are other reasons why service users suffer of injuries in care homes, but in my view serious injuries can be prevented or at least reduced by paying more attention to environmental hazards, incorrect use of lifting equipment and wheelchairs, trips and falls and the prevention of abuse.

Prevention of serious injuries

Firstly, on admission to the care home service users must have a comprehensive assessment to determine if they going to be susceptible to trips and falls along with the assessment of risks. The details of the assessments must be recorded as part of the service users care plan and regularly checked and acted upon by care staff.

Environmental Hazards

The manager should ensure that senior staff carry out regular routine inspections of the home to identify and prevent any hazards that may result in a service user suffering a trip or fall. Where a hazard is identified it should be reported to the manager who should carry out remedial action as soon as possible to rectify the problem.


Auditing of lifting equipment and wheelchairs should be carried out to ensure they are safe for service users to use. Manufacture’s instructions on the use of hoists and other lifting equipment must be followed by staff and there should be up to date records in place that details when the equipment was last maintained. Faulty equipment must not be used and removed from service.

Ensuring care plans are followed

The reduction in the availability of local authority funding means that people are older and can be frailer on admission to care homes. Service users will therefore need more assistance and support with their mobility. It is important that risk assessments and care plans are followed.

I recently had experience of a relative with dementia in a care home who suffered a serious injury because care staff failed to check the persons care plan. The person was strapped into her wheelchair, because of the risk that she would fall out. One lunch time the strap holding her in was removed and this resulted in a fall and a broken leg. All because the member of care staff did not check the care plan.

Staff training

The importance of staff training cannot be over emphasised. Training should include the use of equipment, awareness of hazards, health and safety issues and ensuring care plans and risk assessments are followed.


The increase in the number of service users who suffer from serious injury is a national disgrace. It is bound to encourage even more criticism of care homes. The cause of the rise in serious injuries cannot be laid solely at the door of increase in service users’ level of frailty or shortage of staff. If care home staff are trained to make proper use of the tools of assessment, care planning and auditing, we may then see an improvement in care practice and a reduction in serious injuries suffered by service users.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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