Missouri Alliance for HOME CARE
2420 Hyde Park, Suite A, Jefferson City, MO 65109-4731 ▪ (573) 634-7772 ▪ (573) 634-4374 Fax
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MAHC 10 - Fall Risk Assessment Tool
Click here to review the Validation Study of the Missouri Alliance for Home Care’s fall risk assessment tool.
Conduct a fall risk assessment on each patient at start of care and re-certification.
(Circle one) SOC or Re-certification Date: ___
Required Core Elements
Assess one point for each core element “yes”.
Information may be gathered from medical record, assessment and if applicable, the patient/caregiver.
Beyond protocols listed below, scoring should be based on your clinical judgment.
Diagnosis (3 or more co-existing)
Includes only documented medical diagnosis
Prior history of falls within 3 months
An unintentional change in position resulting in coming to rest on the ground or at a lower level
Inability to make it to the bathroom or commode in timely manner
Includes frequency, urgency, and/or nocturia.
Includes but not limited to, macular degeneration, diabetic retinopathies, visual field loss, age
related changes, decline in visual acuity, accommodation, glare tolerance, depth perception, and
night vision or not wearing prescribed glasses or having the correct prescription.
Impaired functional mobility
May include patients who need help with IADLS or ADLS or have gait or transfer problems,
arthritis, pain, fear of falling, foot problems, impaired sensation, impaired coordination or improper
use of assistive devices.
May include but not limited to, poor illumination, equipment tubing, inappropriate footwear, pets,
hard to reach items, floor surfaces that are uneven or cluttered, or outdoor entry and exits.
Poly Pharmacy (4 or more prescriptions – any type)
All PRESCRIPTIONS including prescriptions for OTC meds. Drugs highly associated with fall risk
include but not limited to, sedatives, anti-depressants, tranquilizers, narcotics, antihypertensives,
cardiac meds, corticosteroids, anti-anxiety drugs, anticholinergic drugs, and hypoglycemic drugs.
Pain affecting level of function
Pain often affects an individual’s desire or ability to move or pain can be a factor in depression or
compliance with safety recommendations.
Could include patients with dementia, Alzheimer’s or stroke patients or patients who are
confused, use poor judgment, have decreased comprehension, impulsivity, memory deficits.
Consider patients ability to adhere to the plan of care.
A score of 4 or more is considered at risk for falling Total