Step on a crack, break your mother's back.” That childhood superstition serves as a metaphorical warning for those who work in service-related fields such as hospitality and healthcare, including long-term care. If the environmental risks of the job are ignored, it won’t be mom's broken ankle or finger—it will be that of a staff member. According to insurance experts, slips and falls are cited as the number two cause of injuries for employees in service-oriented fields. Daily, these workers are exposed to a laundry list of potential harm ranging from burns, cuts, and contusions to the concomitant injuries caused by slips and falls. Even a simple injury like a twisted ankle creates problems for a facility. If the victim loses time from the job, schedules have to be reworked and other employees may have to work double shifts to compensate for the loss of manpower. Add to this workers’ compensation benefits, medical bills, and any damages, and a simple accident can become a costly proposition. From the kitchen to the bedside, long-term care staff need to be cautious when performing their duties. What can be done to minimize their risk of slips, trips, and falls? Randy Lubart, vice-president of Shoes for Crews, offers insight and advice on how vigilance and proper footwear can keep staff comfortable and safe.

Flooring and Footwear

“The floors in a nursing home can present the same hazards as those in a restaurant kitchen,” says Lubart. Staff who work in the facility kitchen, maintenance, and resident care areas are susceptible to the same conditions. “Tiled floors in facility bathrooms, hallways, and so on can contribute to slips and falls because of construction, improper maintenance, or just the unfortunate spill of liquid, grease, or body fluid,” he adds. Today's savvy floor manufacturers and designers have created and specify reformulated slip- resistant flooring with an eye on safety.

But Lubart cautions that no tile—or shoe—is 100% slip resistant. Tile may be easy to clean, but it is brutally slippery when contaminated. “Tile manufacturers have developed some very aggressive tile that is almost like sandpaper,” says Lubart. The problem, he notes, is that once contaminants hit the floor and solidify, or if spills are not cleaned up properly, the floor becomes a virtual ice rink. This is why investing in slip-resistant footwear is important.

To the naked eye, tile appears as a flat surface. In reality, it is pitted and cratered when looked at through a microscope. “A competent slip-resistant shoe is made of treated rubber that will encapsulate those microscopic imperfections in the walking surface and stop the staff member in his or her tracks,” Lubart says. Some employees wear shoes with intricate tread patterns carved into untreated rubber soles but, according to Lubart, these shoes lack gripping action and will just glide over the flooring.

Finding the Right Shoe for Nursing Staff

The most important feature staff look for in a shoe, says Lubart, is comfort. They want to be comfortable throughout long shifts and during the many hours they spend on their feet. On the other hand, all facility floors (not just tile) are subject to an array of contaminants, including food, liquids, and body fluids—all of which are exceedingly slippery regardless of the floor's composi-tion. To enhance safety and comfort, a slip-resistant athletic shoe offering lateral and ankle support is the best choice in the healthcare setting.

Athletic shoes are the overwhelming choice of caregivers and, Lubart advises, the best athletic shoe design for caregivers is a cross-trainer. This style provides side-to-side foot support that is especially beneficial when nursing staff need to lift or assist in lifting residents. “A running shoe only allows for forward motion, and when you lift your feet can slide. Therefore, the lateral support provided by a cross-trainer is recommended,” says Lubart. Shoes should also provide ankle support. “Most ladies don’t want to wear high-tops but, fortunately, the ankle on women's athletics comes up a bit higher than average. When lifting, an aide has to be sure that her feet have a firm grip on the floor to stabilize herself before she tries to stabilize anyone else,” he notes.

Getting a Great Fit

“Shoes should be comfortable when they are tried on. Don’t count on ‘breaking them in,’” Lubart cautions. Staff should look for a breathable, full-leather shoe that allows air to circulate around the foot. According to Lubart, lace-up shoes are best, followed by those with Velcro closures, for use in the healthcare environment: “Anything with a fastener that can be adjusted by at least a ¼ of an inch is best. Slip-on loafers are not recommended because they can’t support the foot properly through the varied movements a caregiver experiences when performing her duties. Without proper support, the caregiver strains to keep a secure footing, which tires legs and feet.”

The Right Shoe for the Right Activity

Safety precautions are not just for caregivers. Everyone who lives and works in a long-term care facility is at risk for a fall. Office staff are in a peculiar position when it comes to footwear selection. They are usually attired in suits, dresses, skirts, or dress slacks, which dictate a different style of footwear. But safety is still an important issue because they, too, may encounter the same hazards as nursing staff. “Some companies have managed to create fashionable footwear that will help keep the wearer safe and stable on a slippery floor,” notes Lubart.

Residents, too, traverse the facility, and their footwear should be up to the job of ambulation. Lubart suggests shoes for the frail elderly be featherlight and provide the ultimate in support. “The average pair of athletic shoes weighs about two pounds,” says Lubart, “and these are too heavy for the elderly. They will drag their feet, which is dangerous and can lead to a fall.” He notes that many manufacturers have shoes in their lines that weigh as little as seven ounces each. “Shoes for the elderly should also be slip-resistant,” he adds. Slippers should never be worn as footwear. “If the elder walks on tile or carpet, or if they incur an uneven walking surface or a contaminated floor, the slippers are useless,” Lubart says.

Staying Careful

Proper floor and footwear maintenance is paramount to reducing the risk of slips and falls. Any spills or contaminants on floors should be immediately cleaned up according to manufacturer recommendations. Never assume that someone else will clean it up. The same principle applies to footwear. If a staff member steps into a spill, immediately wipe the shoe sole. It is also important to inspect and clean the shoes’ soles regularly with a damp cloth. Be sure to clean between the tread grooves to remove any built-up dirt and grease.

Staying alert, maintaining floors and footwear, and wearing comfortable, supportive, well-fitting shoes can help to reduce the risk of serious injury for all occupants of a facility and help protect the facility's financial well-being.

I Advance Senior Care

I Advance Senior Care is the industry-leading source for practical, in-depth, business-building, and resident care information for owners, executives, administrators, and directors of nursing at assisted living communities, skilled nursing facilities, post-acute facilities, and continuing care retirement communities. The I Advance Senior Care editorial team and industry experts provide market analysis, strategic direction, policy commentary, clinical best-practices, business management, and technology breakthroughs.

I Advance Senior Care is part of the Institute for the Advancement of Senior Care and published by Plain-English Health Care.