Definition/Introduction

An individual's surrounding environment, particularly his or her home environment, can significantly impact one's overall health and well-being. Furthermore, an individual's home's condition can dramatically influence one's risk for domestic accidents and subsequent suffering.[1] Home safety must be evaluated, discussed with patients and caregivers, and considered continuously when making decisions about the future of the patient's care in order to maximize their health outcomes.  

Home safety is significant for people of all ages. Young children may be at risk for injury or suffering from unintentional poisoning, falls from heights, drowning, or scalds and burns.[2][3] Older adults are commonly at risk for falls because of decreases in eyesight or mobility.[1] At any stage of life, people may be at risk from faulty or improperly used appliances like smoke detectors or improperly installed electrical circuits.[1][2][3] Because there are a broad range of potential hazards within the home, home safety evaluations and assessments can be critical in identifying and removing potential home hazards.

Some home safety assessments include:[2][3][4][5][6][7]

• Safety Assessment of Function and the Environment for Rehabilitation—Health Outcome Measurement and Evaluation (SAFER-HOME v3)
  • This pre-discharge assessment is an interview and observation-based assessment that evaluates an individual's ability to engage in functional activities safely. 
• In-Home Occupational Performance Evaluation for Providing Assistance (I-HOPE Assist)
  • This tool assesses changes in performance and safety in the home before home modifications and after home modifications. 
• Home Falls and Accidents Screening Tool (Home FAST)
  • A short, 25-item assessment for identifying fall hazards in the homes of older adults
• Westmead Home Safety Assessment (WeHSA)
  • This tool has a long-form and a short-form and targets potential fall risks in older adults. 
• Home Safety Self-Assessment Tool (HSSAT)
  • Patients and patient caregivers can use this self-assessment tool to self-identify and correct potential fall hazards. 
• Informal practitioner-created checklists.
  • Some practitioners create their own checklists for home safety evaluation. These checklists can help to identify hazards to child/infant safety, hazards for individuals with differing levels of physical or cognitive disability, adults who are aging in place, or any general area of home safety. 

Techniques and interventions for home safety are as varied as the potential hazards. Some strategies are as simple as removing the potential risk.[2][3] For example, eliminating small hard objects that may be choking hazards from a home with a young child or lowering the temperature of the hot water heater to reduce the risk of burns in the home of an older adult. Other strategies may involve adding or routinely checking safety measures such as fire extinguishers, smoke detectors, and carbon monoxide detectors.[2][7] Home modification techniques work to reduce environmental barriers to safe, functional performance through the use of activity modifications, the addition of assistive devices, or even changes to the architecture of the house.[7] Finally, patient and caregiver centered education about home safety techniques can lead to long-term reduction of risk of suffering from home hazards.[8][9]

Issues of Concern

Common injuries due to hazards in the home include falls, ingestion accidents, and heat accidents.[1][2][7]

Falls can lead to serious injury and complications in individuals of all ages. Hazards that may increase the risk of falls include wires or loose rugs in walkways, steep steps or steps without a hand railing, and even cluttered floor space.[1][7] To prevent falls and injuries from falls in young children, some home safety strategies may include home modification by installing gates at the top and bottom of staircases or modifying sharp corners of counters or fireplaces.[1] For older adults, home safety interventions may include patient or caregiver education on safe ambulation techniques and how to identify fall hazards and home modifications, including removing clutter and freeing up walk spaces, installing grab bars in showers and bathrooms, and removing or securing loose rugs and wires.[8][1][6][7]

Ingestion accidents are also a serious risk across the lifespan.[1] Children may be at risk for poisoning through ingestion of toxic substances, suffocation through ingestion of choking hazards, or even drowning in a bath or whenever there is water.[1] Older adults are also at risk for injury through accidental ingestion, especially adults who are cognitively impaired or whose cognition is declining. Accidental poisoning may occur through medication mismanagement, even ingestion of spoiled or rotten foods. Additionally, living alone increases an adult's risk of serious injury or death through choking.[1][10] Interventions to prevent ingestion accidents may include the use of child-proof seals and barriers on cleaners, medication bottles, and cabinets or drawers. It is also essential to ensure that adults are cognitively able to be safe in their homes[10] The Kohlman Evaluation of Living Skills (KELS) assessment is one example of a tool used to evaluate an individual's ability to safely perform instrumental activities of daily living and basic activities of daily living.[11] 

Heat accidents are primarily characterized by scalding or burning of the skin. Burns may come from improperly protected cooking equipment or heating appliances, and lack of proper supervision for children and adults with declining cognition can lead to increased risk for such injuries.[1][2] Patient and caregiver education and home modification can reduce the risk of injury from heat accidents. One example of a home modification may be installing knob covers on stoves and ovens.[1] Carbon monoxide poisoning is also under the category of heat accidents. Stove knob covers and carbon monoxide detectors may reduce the risk of carbon monoxide poisoning.[2] Carbon monoxide detectors and smoke detectors require routine checking to ensure their effectiveness in the prevention of heat-related injuries.[1][8][2][9]

These are just a few examples of potential hazards and techniques for home safety.

Clinical Significance

Home modifications play an important role in the recovery and prevention of serious injury, as well as the promotion of functional and independent living. Proper evaluation, assessment, and implementation of home safety techniques can lead to better overall health and quality of life for all patients.[12]

Nursing, Allied Health, and Interprofessional Team Interventions

Interprofessional collaboration is essential to consider all the different facets of home safety for patients and clients. Additionally, coordination and communication between the caregiver team and the patient or patient caregiver are essential for long-term risk reduction in the home. Caregivers can help evaluate patients' home environments and track any changes with the patient or in the home. Evaluation and reevaluation can prevent delays in reducing risk, particularly for adults with declining cognition.[12] [Level V]