Falls Prevention in Aged Care: NZ Compliance Guide (Nga Paerewa & ACC)
Falls are the most frequent adverse event in New Zealand aged residential care. Under Nga Paerewa Health and Disability Services Standard (NZS 8134:2021) and ACC’s Falls Prevention in Aged Care programme, providers must have a systematic, resident-centred approach. This guide covers the mandatory requirements, risk tools, post-fall review, and reporting obligations as of May 2026.
1. Nga Paerewa Standard 2.3 – Falls Prevention
Standard 2.3 of Nga Paerewa requires every aged care service to have a documented falls prevention programme. The standard states:
“The service has a falls prevention programme that is based on current evidence and best practice, and includes risk assessment, intervention, monitoring, and evaluation.”
Key elements under 2.3:
- Risk assessment on admission, after a fall, and when a resident’s condition changes.
- Individualised care plans that address identified risks (e.g., mobility, medications, environment).
- Staff education on falls prevention and post-fall management.
- Environmental safety checks (lighting, flooring, handrails, clutter).
- Review and audit of falls data at least quarterly.
Key Rule: Standard 2.3 requires that the falls prevention programme be “based on current evidence”. Use the ACC Falls Prevention Toolkit (2024 update) as your primary reference. Document all changes to the programme.
2. ACC Falls Prevention in Aged Care
ACC’s Falls Prevention in Aged Care programme (part of the Integrated Care for Older People pathway) provides a framework for reducing falls and fall-related injuries. The programme includes:
- Multifactorial risk assessment – covering mobility, balance, vision, medications, continence, and fear of falling.
- Strength and balance exercises – e.g., the Otago Exercise Programme (OEP) or similar.
- Medication review – especially sedatives, antihypertensives, and psychotropics.
- Environmental modifications – grab rails, non-slip flooring, adequate lighting.
- Staff training – ACC provides free online modules (e.g., “Falls Prevention in Aged Care” on the ACC website).
Warning: If a resident falls and sustains a fracture, ACC must be notified within 7 days. Failure to report can result in funding recovery and compliance action. Use the ACC eClaims system or paper form ACC215.
3. STRATIFY Risk Assessment Tool
The STRATIFY (St Thomas’s Risk Assessment Tool in Falling Elderly Inpatients) is the recommended tool for aged care in NZ. It is validated for residential care settings. The tool assesses five factors:
- History of falls (in the last 3 months) – 1 point
- Agitation/confusion – 1 point
- Visual impairment (affecting daily function) – 1 point
- Urinary incontinence/frequency – 1 point
- Transfer and mobility (needs assistance) – 1 point
Scoring: 0–1 = low risk; 2 = moderate risk; 3+ = high risk. All residents with a score of 2 or more require a multifactorial intervention plan.
Key Rule: STRATIFY must be completed within 24 hours of admission, repeated after any fall, and reviewed monthly. Document the score and the care plan response in the resident’s clinical record.
4. Post-Fall Review Requirements
Under Nga Paerewa Standard 2.3 and HealthCERT guidance, every fall must trigger a post-fall review within 72 hours. The review must include:
- Immediate clinical assessment – head injury, fracture, bruising, change in consciousness.
- Root cause analysis – what happened, why, and what can be changed.
- Re-assessment of STRATIFY – update the risk score.
- Care plan update – e.g., increase supervision, change footwear, review medications.
- Environmental check – was there a trip hazard, poor lighting, or equipment failure?
- Communication – inform family/whānau, GP, and (if injury) ACC.
Document the review in the Post-Fall Review Form (template available from HealthCERT or your DHB).
Warning: If a fall results in a serious injury (e.g., fracture, head injury, laceration requiring sutures), you must report it to HealthCERT as a serious adverse event within 24 hours. Use the Serious Adverse Event Notification Form (SAE-1).
5. Reportable Events to HealthCERT
HealthCERT requires notification of certain falls under the Health and Disability Services (Safety) Act 2001. The following are reportable:
- Falls resulting in death – notify within 24 hours.
- Falls resulting in serious injury (fracture, head injury, dislocation, internal injury) – notify within 24 hours.
- Falls requiring hospital transfer – notify within 24 hours.
- Falls that are part of a pattern (e.g., 3+ falls in a month for one resident) – notify as a trend event within 5 working days.
Notifications are made via the HealthCERT Adverse Event Reporting Portal (available on the Ministry of Health website). You must also keep an internal register of all falls, including minor ones.
Key Rule: Even if a fall does not meet the reporting threshold, document it in the resident’s care plan and the facility’s falls log. HealthCERT auditors will review your falls data during certification audits.
6. Staff Training and Competency
All staff (RNs, HCAs, support workers) must complete falls prevention training annually. The ACC e-learning module “Falls Prevention in Aged Care” is free and takes 45 minutes. Additionally:
- RNs must be competent in STRATIFY administration and post-fall review.
- HCAs must know how to assist with mobility, use call bells, and report hazards.
- Managers must review falls data monthly and implement quality improvement.
Warning: If a staff member fails to complete training, and a fall occurs that could have been prevented, the facility may be found non-compliant under Standard 2.3. This can lead to a corrective action plan or, in serious cases, suspension of certification.
7. Documentation and Audit
Your falls prevention programme must be audited at least quarterly. The audit should check:
- Completeness of STRATIFY assessments (100% of residents).
- Timeliness of post-fall reviews (within 72 hours).
- Care plan updates after falls.
- Staff training records.
- Environmental safety checklists.
Use the Falls Prevention Audit Tool (available from the Health Quality & Safety Commission NZ) to standardise your review.
Key Rule: Keep all falls documentation for at least 7 years after the resident’s discharge or death. This includes STRATIFY scores, post-fall reviews, and audit results.
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8. Summary Checklist for Compliance
- ✅ Falls prevention programme documented (Standard 2.3).
- ✅ STRATIFY completed on admission, after falls, and monthly.
- ✅ Multifactorial care plans for all moderate/high-risk residents.
- ✅ Post-fall review within 72 hours (root cause analysis).
- ✅ Reportable events to HealthCERT within 24 hours.
- ✅ ACC notified of fractures within 7 days.
- ✅ Staff training completed annually.
- ✅ Quarterly audit of falls data and documentation.
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Frequently asked questions
What is the STRATIFY risk assessment tool, and how is it used in NZ aged care?
STRATIFY is a validated 5-item risk assessment tool (history of falls, agitation, vision, incontinence, mobility). In NZ aged care, it must be completed within 24 hours of admission, after any fall, and reviewed monthly. A score of 2 or more triggers a multifactorial intervention plan.
What are the reporting requirements for falls to HealthCERT?
Falls resulting in death, serious injury (fracture, head injury), or hospital transfer must be reported within 24 hours via the HealthCERT Adverse Event Reporting Portal. Falls that are part of a pattern (3+ in a month for one resident) must be reported within 5 working days.
How often must staff complete falls prevention training?
All staff (RNs, HCAs, support workers) must complete falls prevention training annually. ACC provides a free 45-minute e-learning module. RNs must also be competent in STRATIFY and post-fall review processes.
What is the ACC’s role in falls prevention in aged care?
ACC provides the Falls Prevention in Aged Care programme, including a multifactorial risk assessment framework, strength and balance exercise programmes (e.g., Otago Exercise Programme), medication review guidance, and free staff training modules. ACC must be notified of fractures within 7 days.
What must be included in a post-fall review under Nga Paerewa?
A post-fall review must include immediate clinical assessment, root cause analysis, re-assessment of STRATIFY, care plan update, environmental check, and communication with family/whānau, GP, and ACC if injured. The review must be completed within 72 hours and documented in the resident’s record.