Quality Occupational Therapy - Reducing Risk, Improving Independence

Case Study - Back to case studies

Reason for referral: Risk assessment for safety in and around the care home.

Mrs T was residing within a residential home specialising in dementia. She was independently mobile in and around the home with no walking aid. Her room was situated on the 2nd floor. Access to this floor was via a stair lift with steps in-between as the stair lift was not available on all floors. Mrs T was able to follow basic instructions however she was not orientated to time and place and had been known to wander during the night.

There were no specialist pieces of equipment in her room and there was access to a communal bathroom just outside her bedroom. Mrs T required prompting for personal care but managed this very well.

As Occupational Therapists we were asked to complete a risk assessment for Mrs T regarding her safety in and around the home environment.

Assessment and Treatment plan:

This involved observations of Mrs T during the day, discussions with the care staff and communication with Mrs T.

Mrs T was able to demonstrate how she managed to get up to her room however did ask for help in finding her room as she could not remember where it was. Once in her room she was able to point out some of her personal belongings and demonstrated how she slept at night. These were not prompted questions; they were automatic responses from Mrs T when she was asked to 'show us around' Mrs T then demonstrated how she was able to go back down the stairs into the communal lounge area.


Mrs T required prompts to orientate herself around the home, if not prompted Mrs T would hesitate mid walk causing a loss of balance on occasions. She also became quite agitated when she could not remember where she was going. When accessing the room on the second floor Mrs T did not use the stair lift and managed to negotiate 2 flights of stairs, again this proved difficult as she hesitated half way up the stairs causing her to become unsteady and unbalanced, unless prompted.

The risk assessment identified that Mrs T was at high risk of falling when wandering around the home alone, although she was very steady on her feet her lack or orientation and short term memory impacted on her safety.

It was therefore recommended that Mrs T was found a room on the ground floor to reduce the risk of her falling on the stairs and to reduce the risk of her going up and down the stairs regularly throughout the day. Although this move may disorientate Mrs T further, the risk of her falling was greater than the risk of disorientation on the ground floor. It was also recommended that Mrs T was issued with a sensor pad for use at night so that the care staff were alerted immediately if Mrs T wandered during the night. The care staff would then be able to respond to Mrs T quickly and monitor Mrs T and encourage her back to her room safely.

The risk rating was then changed to 'mild' once these recommendations were made and the care staff and Mrs T remained safer in the home environment.


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British Associations of Occupational Therapists Dementia Friends