Senior Care Risk: Environmental and Infrastructure Hazards

Susan Lucot, MSN, RN, MLT (ASCP), CPHRM

Environmental safety is of paramount importance in senior care facilities because of the vulnerable nature of resident populations. Advancing age and medical conditions might make individuals more likely to trip, fall, get trapped or entangled in furniture, burn themselves, and so on.

For residents who have behavioral health disorders and/or dementia, these risks are magnified. Staff need to be cognizant of environmental threats associated with wandering, elopement, security, access to items that could be used for self-harm or violence (e.g., maintenance tools), access to harmful substances (e.g., housekeeping chemicals), and ligature risks.

Additionally, many senior care organizations are older structures that need upgrades or renovations. The cleanliness of some centers also is sorely lacking as evidenced by:

• Accumulation of dirt and stains on floors, ceiling tiles, windowsills and tracks
• Damaged moldings, handrails, door jambs, walls, and cabinets
• Ripped and stained furniture upholstery
• Stained and tattered bed curtains and linens
• Grease- and grime-covered air vents
• Rusted and leaking air-conditioning units
• Mold and mildew buildup in bathroom and shower areas
• Peeling paint
• Dead insects and cobwebs
• Dark and outdated interiors
• Lack of proper lighting
• Urine and fecal odors permeating the building
• Broken windowpanes and doorframes
• Outside areas with various perils, such as treacherous walking paths (including sloped drains), landscape debris, and uneven walking surfaces

Living in these conditions can take a toll even on the healthiest residents, but it might be particularly difficult for individuals suffering from behavioral health disorders and/or dementia. A hazardous, rundown, or dirty environment may wreak havoc on their overall outlook and ability to thrive. It also may lead to depression, isolation, anxiety, physical harm, poor care delivery from staff, and a multitude of other negative outcomes.

Thus, providing a clean, safe, and aesthetically welcoming setting is imperative to demonstrate the organization’s commitment to resident safety, well-being, and satisfaction. These strategies can help senior care organizations address environmental and infrastructure risks:

• Make sure staff members conduct routine environmental safety rounds to identify potential dangers and keep track of items that require updating or repairing.
• Ensure a robust environmental cleaning program is in place, and monitor the quality of cleaning and disinfection practices.
• Implement a mechanism for reporting and reviewing potentially dangerous environmental conditions. Educate staff members about reporting procedures.
• Devise a multifaceted approach to fall prevention that considers the unique needs and circumstances of individual residents and incorporates environmental strategies to reduce falls.
• Develop and implement an elopement prevention and response plan, and make sure all staff members receive adequate training on elopement procedures.
• Assess your facility for security risks and environmental factors that could potentially contribute to violence or resident self-harm. Use information gleaned from assessments to improve your violence prevention program and reduce environment-of-care risks for behavioral health patients.
• Reinforce to staff the importance of segregating and securing any toxic substances that residents could accidentally or intentionally consume.

For additional insights on providing care for residents who have behavioral health disorders and/or dementia in senior care settings, click here.

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