Risk Management and Falls Prevention in Irish Designated Centres: A HIQA Guide

This guide covers Ireland. For the UK equivalent, see our guide: Falls Prevention in Care Homes: A CQC Regulation 12 Compliance Guide.

Falls are a constant safety concern in any nursing home, yet the Irish regulations for designated centres for older people do not contain a falls regulation. Falls prevention sits inside the risk management regulation, the care planning regulation and HIQA's National Standards. This guide sets out what those sources say, what they leave to the provider, and how a person in charge can build a defensible approach. It is written for registered providers, persons in charge and their managers.

Staff safety is a separate subject from resident care. If your question is about employees slipping or tripping at work, see our guide to slips, trips and falls and staff safety in care settings. This post is about residents and the HIQA framework.

What the risk management regulation requires

The Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (S.I. 415 of 2013) deal with risk in Regulation 26. The regulation as made is on irishstatutebook.ie; the amendments in S.I. 98 of 2025 (operative 31 March 2025) replaced an earlier amending instrument, S.I. 1 of 2025. Check the current consolidated text before relying on exact wording.

In summary, the registered provider must ensure that the risk management policy (an item in Schedule 5) covers:

• the identification of hazards and the assessment of risks throughout the centre;
• measures and actions to control the risks identified;
• measures and actions to control specific risks: abuse, the unexplained absence of a resident, accidental injury to residents, visitors or staff, aggression and violence, and self-harm. S.I. 98 of 2025 adds infectious diseases to this list;
• arrangements to identify, record and investigate serious incidents or adverse events involving residents;
• a process for carrying out the actions and recommendations that come out of those investigations; and
• a process for auditing, reviewing and learning from events.

Regulation 26 also requires a plan for responding to major incidents likely to cause death or injury, serious disruption to essential services, or damage to property. HIQA's Assessment-judgment framework for designated centres for older people (version 4.1, May 2025) frames its inspection questions around the same elements and links them to National Standard 3.2.

Where falls fit: accidental injury and the absence of a falls rule

Falls are not named in Regulation 26. The closest wording is "accidental injury", and the HIQA framework does not mention falls under Regulation 26, Regulation 5 (individual assessment and care plan) or Regulation 6 (health care). Falls do appear in one place in the Regulations as made: Schedule 3, paragraph 4(l), lists "a record of falls and of treatment provided to the resident" among the records to be kept for each resident. The framework also does not name a risk register. Check the current Regulations, HIQA framework and National Standards for a prescribed falls risk assessment tool, falls rate target or required staff-to-resident ratio for falls prevention; the documents cited in this guide do not set any.

HIQA's framework asks whether the risk management policy covers hazard identification and risk assessment across the centre, control measures for the listed risks, and arrangements to record, investigate and learn from serious incidents and adverse events. Regulation 26 does not name falls, so whether a given fall falls within "accidental injury" or a serious incident or adverse event is a judgment for your own policy; our suggestion is to treat falls that cause harm as adverse events under that policy. Regulation 4(3), as made, also requires policies and procedures to be reviewed at intervals not exceeding three years and updated where necessary in line with best practice, so it is sensible to check whether a risk policy that predates the 2025 amendments reflects them (our suggestion).

What National Standard 3.2 adds

HIQA's National Standards for Residential Care Settings for Older People in Ireland (2016, in effect from 1 July 2016) include Standard 3.2: the residential service has effective arrangements in place to manage risk and protect residents from the risk of harm. The features listed under it include:

• policies that manage risk, with information used proactively to prevent harm (3.2.1);
• risks to residents' safety identified, assessed, mitigated, monitored and reported (3.2.2);
• clinical and non-clinical risks linked to service delivery systematically identified and minimised (3.2.3);
• serious incidents, adverse events and near misses identified, reported, investigated and learned from (3.2.4);
• interim measures taken by the person in charge if safety is compromised (3.2.5);
• contingency plans for major incidents and emergencies (3.2.6); and
• residents informed and supported after an adverse event that affects them (3.2.8).

The introduction to the theme also refers to balancing reasonable risk-taking with residents' autonomy. The introduction does not turn this into a numerical rule, so the balance has to be recorded in the resident's own assessment and care plan.

Falls risk assessment and the care plan

Regulation 5 requires a comprehensive assessment of each resident's health, personal and social care needs, a care plan no later than 48 hours after admission, and a formal care plan review at intervals not exceeding 4 months (also set out in HIQA's framework). A falls risk assessment is not named there, but the care plan is where its results should land.

For clinical content, the HSE has published falls guidance, though the guidance listed here is regional rather than national:

• The Guideline for the Prevention and Management of Falls and Harmful Falls in HSE Inpatient and Residential Services (HSE Mid West Community Healthcare, version 2, February 2022, review date February 2025) applies to HSE Mid West services. It treats everyone aged 65 or over as at risk and describes a nurse-led multifactorial risk assessment within 24 hours of admission, after a fall, every four months for long-stay residents and after significant change. Its risk factors include gait and balance, continence, vision, postural hypotension, medications, cognition and mood.
• The Falls Prevention Framework for Community Services CDLMS (Cavan, Donegal, Leitrim, Monaghan and Sligo, March 2025, version 1.0, revision due February 2027) includes a residential settings section. It recommends a multifactorial falls risk assessment at admission, treats residents in residential aged care as high risk, calls for individualised prevention plans that are regularly reviewed, and recommends staff education in falls prevention.

Neither document is a regulation, and each is written for its own HSE area. They are useful as clinical reference points. They do not bind a private provider and should not be described to inspectors as a legal requirement. Our suggestion: tell the inspector which source you built your falls assessment from, and why it suits your resident group.

Post-fall review and learning from incidents

Regulation 26 requires the risk management policy to cover arrangements to identify, record and investigate serious incidents or adverse events involving residents, a process for carrying out resulting actions and recommendations, and auditing, reviewing and learning from events. Falls are not named, so applying this to falls is our reading. The two HSE documents describe what that can look like clinically. The Mid West guideline sets out a post-fall checklist, assessment for injury before a resident is moved, and reassessment and care plan update after a fall. The CDLMS framework recommends a post-fall protocol and assessment that identifies the mechanism of the fall, any injuries and precipitating factors, then adjusts the plan. The CDLMS framework recommends a pharmacist and/or GP medication review after a fall, and the Mid West guideline's repeat assessment after a fall includes medication as a risk factor.

A practical approach, labelled as ours and not a legal requirement:

• Record every fall, including unwitnessed falls and near misses, in one place. A record of falls and treatment provided is already among the resident records listed in Schedule 3, paragraph 4(l), as made; recording near misses is our suggestion.
• Review each fall within a set time, covering what the resident was doing, the environment, footwear, continence needs, and whether the care plan was being followed.
• Ask for a medication review where medicines may have contributed, and make sure nursing staff are confident about escalating. Our medication management training guide covers the wider topic.
• Trend falls by time of day, location and staff on duty, and put the analysis in front of the person in charge and provider representative.
• Close the loop: record the action taken, who owns it and when it was checked.

Standard 3.2.8 also expects residents to be informed and supported after an adverse event that affects them. Our suggestion: include conversations with the resident and, where appropriate, their family in your review process.

Notifying HIQA about injuries

Notification is a separate step from internal review. Under Regulation 31, as amended, notice goes to the Chief Inspector within 2 working days of the events listed in Schedule 4, item 7, and reports must follow the Chief Inspector's guidance. In the amended Schedule 4, a serious incident or injury to a resident that requires hospital admission or results in death falls in the two-day group, and any restrictive practice and other adverse incidents the Chief Inspector requires are reported quarterly. A fall that causes a hospital admission is therefore likely to be notifiable on the two-day timeline, but the instrument does not name falls or fractures, so confirm any borderline case against the current text and HIQA's notification guidance.

What inspectors look at, and the governance link

HIQA's framework treats Regulation 23 (governance and management) as the place where management systems, the annual review of quality and safety of care and the quality improvement plan sit. Our suggestion: use falls data as an input to that review. For a broader view of how inspections run and what staff should know beforehand, read our guide to HIQA inspections and staff training. Our suggestion: be ready for questions about your risk policy, how falls are recorded and reviewed, and evidence that actions were completed.

What the Irish sources do not set

• No falls-specific regulation, and no named falls assessment tool. The only mention of falls in the Regulations as made is the record-keeping item in Schedule 3, paragraph 4(l).
• No required falls rate, and no stated number of falls that triggers an investigation.
• No risk register requirement by that name in the HIQA framework.
• No falls guidance is named on the HIQA older people's services page.
• The HSE guidance cited here is regional and, in the case of the Mid West guideline, shows a review date that has passed.

Learnsignal's offices are off Baggot Street in Dublin, and we offer in-person training from there. For current details, see our CPD pages.

Frequently asked questions

Is there a specific falls regulation for nursing homes in Ireland?

Not in the Regulations as made. Falls are managed through Regulation 26 (risk management), Regulation 5 (assessment and care plan), Regulation 6 (health care) and National Standard 3.2, none of which names falls.

Does Regulation 26 cover injury to staff and visitors?

Its list of specific risks includes accidental injury to residents, visitors or staff. Employer duties for staff safety are a separate legal area, covered in our staff safety guide linked above.

How often must a falls risk assessment be reviewed?

The Regulations do not name a falls assessment. Regulation 5 requires formal care plan review at intervals not exceeding four months, and the HSE Mid West guideline uses the same four-month interval for long-stay residents, plus reassessment after a fall.

Which falls must be reported to HIQA?

Under the amended Schedule 4, a serious injury to a resident requiring hospital admission, or resulting in death, is a two-day notification. Falls are not listed by name, so check HIQA's notification guidance for other cases.

Which risk assessment tool should we use?

The documents cited in this guide do not require one. Choose an approach suited to your residents, document why you chose it, and review it regularly; this is our suggestion, not a legal requirement.