University of Akron College of Nursing 370-Care of Older Adult Home Safety Checklist Patient: 1. 2. 3. 4. Living Room/- Family Room Yes No Can you turn on a light without having to walk into a dark room? Are lamp, extension or phone cords out of the flow of foot traffic in this room? Are passageways in this room free from objects and clutter (papers, furniture)? Are curtains and furniture at least 12 inches from baseboard or portable heaters? 5. Do your carpets lie flat? Do your small rugs and runners stay put (don t slide or 6. roll up) when you push them with your foot? 7. Is furniture arranged to prevent tripping? 8. Kitchen Yes No Are you able to prepare meals or do you have a system to access meals or snacks? 9. Are you able to get a drink of fluids? 10. Are your stove controls easy to see and use? Do you keep loose fitting clothing, towels, and curtains that may catch fire away from the burners 11. and oven? Can you reach regularly used items without climbing 12. to reach them? Do you have a step stool that is sturdy and in good 13. repair?
Bedrooms Yes No 14. Is your bed at a proper height for safe entrance/exit? 15. Is furniture arranged to prevent tripping? Can you turn on a light without having to walk into a 16. darkroom? 17. Is a phone within easy reach of your bed? Do you have a lamp or light switch within easy reach 18. of your bed? Is a light left on at night between your bed and the 19. toilet? Are the curtains and furniture at least 12 inches from 20. your baseboard or portable heater? Do you have a working smoke detector on the ceiling 21. outside your bedroom door? 22. 23. Bathroom Yes No Does your shower or tub have a non-skid surface: mat, decals, or abrasive strips? Does the tub/shower have a sturdy grab-bar (not towel rack)? 24. Is your hot water temperature 120 or lower? Does your floor have a non-slip surface or does the 25. rug have a non-skid backing? 26. Are you able to get off and on the toilet easily?
27. 28. Stairways Yes No Is there a light switch at both the top and bottom of inside stairs? With the light on, can you clearly see the outline of each step as you go down the stairs? 29. Do all stairways have sturdy handrails on both sides? Do handrails run the full length of the stalls, slightly 30. beyond the steps? Are all steps in good repair (not loose, broken, 31. missing or worn in places)? Are stair coverings (rugs, treads) in good repair, 32. without holes and not loose, torn or worn? 33. Are items stored on steps, even temporarily? 34. Is laundry accessed via stairs? 35. Hallways and Passageways Yes No Do all small rugs or runners stay put (don t slide or roll up) when you push them with your foot? 36. Do your carpets lie flat? Are all lamp, extension and/or phone cords out of the 37. flow of foot traffic? 38. Are night lights used?
39. Front and Back Entrances Yes No Do all entrances to your home have outdoor lights and are they working? 40. Are outside stairs are in good condition? 41. Do outside steps have handrails? 42. Is there and outside ramp in good repair? 43. Is an outside ramp needed? 44. Are paths to your entry free from cracks and holes? 45. Are sidewalks and steps free of debris and snow? 46. Are windows and doors air tight (weatherization)? 47. Are clothes lines high enough for pedestrians? Throughout Your House Yes No 48. Are pets/ sleeping pets out of pathways? 49. Do you have an emergency exit plan in case of fire? Do you have a working flashlight in case of a power 50. outage? Do you have emergency phone numbers listed by 51. your phone? 52. Are smoke detectors present? Are smoke detectors checked twice a year using a 53. cane or yardstick or helper? Are you aware of Lifeline/Alert or cell phone options 54. in case of a fall? 55. Are Canes, walkers, wheelchairs in good condition?
56. 57. 58. 59. Medications Yes No Are your medications stored in clearly labeled bottles? Do you use a daily or weekly pill dispenser case to remember to take your medications? Do you have difficulty opening pill bottles or dispensers? Are your medications kept in a cool, dry area? (NOT THE BATHROOM)? 60. Do you take your medication in a brightly lit room? Do you discard your medications after the expiration 61. date by taking them to your local pharmacist?? Do you use only medication that has been prescribed 62. for you? Do you use the same pharmacy for all your 63. medication needs? Do you take any over the counter and/or herbal 64. medications? Do you talk with your pharmacist before purchasing 65. over the counter and herbal medications? Do you understand the purpose for each of the 66. medications you are taking? Do you keep a list of all prescription and over the counter medications you take and keep it with you at all times, include your allergies and medical 67. conditions? Do you review all medications on a regular basis with 68. your physician, pharmacist or RN? Do you have any difficulty swallowing any of your medications? Did you tell your physician, pharmacist 69. or RN? Do you follow directions to avoid alcohol with specific 70. medications?
Are there other hazards or unsafe areas in your home not mentioned in this checklist that you are concerned about? If so, what? Are there home safety changes do you want to make? If so, what? Recommendations: Student: Date: Adapted from Community and Home Injury Prevention Project for Seniors, San Francisco Dept. of Health; Pro-Action Senior Wellness Program of Bath, NY; Are You in Jeopardy? in Central West Senior s Safety Committee, Hamilton, Ontario.