Stairs and Ramps

Stairs and ramps are the most physically demanding — and potentially most dangerous — ambulation challenges in home care. A systematic, patient approach protects both the client and you from the most serious falls that occur in and around the home.

Section 01

When to Attempt Stairs — and When Not To

⚠ Stair capability assessment

Before assisting any client with stairs, confirm:

The client's care plan permits stair use — stair restriction is common post-surgery and post-stroke
The staircase has a secure, graspable handrail on at least one side
Adequate lighting at both top and bottom with switches accessible at both ends
Non-slip treads or strips on each step
The client can step up and down from a single step safely with assistance
You have assessed your ability to assist safely — stairs with an unstable client require more caregiver strength and position than flat walking

If any of these conditions are not met, report to the supervising nurse before attempting stairs.

Section 02

Stair Technique — Going Up

💡 "Up with the good, down with the bad"

The cardinal rule of stair navigation with one-sided weakness:

Going up: The stronger (good) leg leads — it steps up first, then the weaker leg follows to the same step.
Going down: The weaker (bad) leg leads down — it steps down first, then the stronger leg follows.

Memory aid: "Up with the good — down with the bad." This ensures the strong leg does the work of lifting the body up and controlling the descent down.

Section 03

Your Position on the Stairs

Going up: Position yourself one step below and behind the client on the weaker side. You can support from below and prevent a backward fall.
Going down: Position yourself one step below and in front of the client on the weaker side. You are the safety net if the client pitches forward.
Gait belt throughout: Gait belt maintained on all stair attempts — never removed mid-staircase.
One step at a time: For clients with limited stair ability, encourage step-to-step walking (bring both feet to the same step before stepping to the next) rather than alternating feet.

Section 04

Ramp Safety

Going up a ramp: Lean slightly forward to maintain center of gravity over the feet as the incline tilts backward. Shorter steps than on flat ground.
Going down a ramp: The higher-risk direction. The client tends to accelerate. Your position: beside or slightly in front on the weaker side to control pace.
Wet ramps: Even slight moisture on a ramp dramatically reduces traction. Do not use ramps in wet conditions without ensuring non-slip surface treatment is in place.
Wheelchair on ramps: Going down: go backward (caregiver first, facing up the ramp, controlling descent). Never allow a wheelchair to roll forward down a ramp uncontrolled.

Section 05

When to Stop Mid-Staircase

🚨 If the client becomes unsteady on the stairs

If a client becomes significantly unsteady, reports dizziness, or you lose confidence in the safety of continuing mid-staircase:

Stay calm — do not alarm the client
Have them grip the handrail firmly
Have them sit on the step they are on if they cannot continue safely standing
Call for help — do not attempt to get an unsafe client up or down stairs alone
Do not leave them alone on the stairs

Sitting on a step to rest is safer than an uncontrolled fall on the stairs.