Falls remain a significant concern across Australia’s aged care sector, with individuals aged 85 and over experiencing hospitalisation from falls at a rate of over 10,000 per 100,000 people, according to the AIHW. Despite clear national standards and growing awareness, it’s time to ask a nuanced question: how well are we really doing in preventing falls — and what might be standing in the way?
The Intent Behind the Standard
The Aged Care Quality and Safety Commission’s focus on falls prevention is both timely and necessary. Under the Comprehensive Care Standard (Standard 10), providers are expected to take proactive steps to minimise falls risk, from individual assessments to tailored interventions and environmental safety improvements.
On paper, many providers are compliant. Policies are in place, falls risk tools are regularly completed, and passive prevention technologies like sensor mats and call bells are widespread.
But what happens in practice?
Current Data: Progress or Plateau?
The Aged Care Quality Indicator Program provides regular data on falls resulting in major injury. In the July–September 2023 quarter, the rate of falls with major injury in residential aged care remained relatively stable. However, variability between facilities is stark — some report very low rates, while others show persistently high numbers.
Meanwhile, Stewart Brown’s benchmarking reports continue to highlight operational and financial pressure points: rising wage costs, regulatory burden, and staffing shortfalls across the board. Many providers are operating in deficit, which inevitably affects the resources they can devote to proactive care measures like allied health-led mobility programs or the rollout of cutting-edge technology.
The Human Element: A Care Workforce Under Strain
One of the most pressing challenges is workforce availability. In many facilities, the ratio of residents to staff — particularly at night or during high-risk times like early mornings — makes constant supervision nearly impossible. Personal care workers and nurses are stretched thin, often prioritising immediate care tasks and compliance documentation over preventative work.
There’s also growing anecdotal evidence that alert fatigue may be a factor. With sensor mats, wearable alerts, and call bell systems going off frequently — many of them false alarms — staff may become desensitised. In some settings, falls are seen as an inevitable part of ageing, especially in residents with cognitive impairment or high frailty levels.
It’s worth asking: are we creating a culture of acceptance around falls when more can be done?
When Passive Systems Aren’t Enough
While most facilities have passive monitoring systems in place, such tools are not failsafe. A mat that alerts after a fall may help with response time but does not prevent the fall in the first place. Similarly, checklists and documentation meet regulatory requirements but don’t necessarily translate into real-time prevention.
What’s missing is the space, time, and investment in proactive, dynamic care — especially interventions led by allied health professionals who can tailor mobility plans, build strength, and train staff in practical risk reduction strategies.
Is Innovation the Missing Link?
There are promising technologies on the horizon that could reshape how we approach falls. AI-driven systems like motion-sensing cameras and gait analysis tools are already being trialled in parts of the UK and US. These platforms don’t just alert when someone has fallen — they predict when someone might fall, allowing for timely intervention.
Yet in Australia, uptake is slow. High implementation costs, funding uncertainty, and workforce training needs are barriers to adoption. Furthermore, without robust clinical integration and cultural change, even the best tech risks becoming another passive layer rather than a transformative tool.
A Way Forward: Balancing Compliance, Culture and Care
Meeting the falls prevention standard shouldn’t be about ticking boxes — it should be about empowering aged care staff to truly engage with risk, prevention, and person-centred support.
To move forward, we may need to:
- Reframe falls as a system issue rather than an individual or staff failing.
- Invest in allied health-led programs that focus on mobility, strength and balance.
- Support staff with training and manageable workloads, so they can respond meaningfully to alerts.
- Shift organisational culture, challenging the notion that high falls rates are “just part of aged care.”
- Embrace innovation thoughtfully, integrating AI and smart systems where they enhance — not replace — human care.
I’ll Leave You Ponder
Falls prevention in aged care is a complex, ongoing journey. While compliance is important, we must also be honest about the pressures on staff, the limits of current systems, and the cultural beliefs that may be holding us back. If we want to truly honour older Australians, we need to move beyond compliance — and toward innovation, investment, and a deep commitment to care.
