Fall Risk Assessment at SOC: How to Use the Timed Get Up and Go (TUG) Correctly

The Timed Get Up and Go (TUG) test is one of the most commonly used fall-risk tools in home health — and one of the most commonly misunderstood.

Many nurses treat it like a stopwatch exercise:
Start the timer.
Watch the patient stand.
Record a number.
Move on.

But CMS is not interested in the number alone.

At Start of Care, the TUG is about observed safety, movement quality, and functional risk, not just how fast someone can move when they know they’re being timed.

What the Timed Get Up and Go Is Actually Measuring

The TUG is not simply measuring speed.

It assesses:

Balance
Strength
Coordination
Gait stability
Ability to follow directions
Safety awareness

In other words, it evaluates how safely a patient can perform a basic mobility task in their home environment.

The time matters — but how the patient moves matters just as much.

How to Perform the TUG Correctly at SOC

The standard process:

Patient starts seated in a chair
Patient stands up
Walks approximately 10 feet
Turns around
Walks back
Sits down again

The timer starts when the patient begins to stand and stops when they are seated again.

Assistive devices should be used as the patient normally uses them.

Do not “coach” the patient to perform better than their baseline.

Common Pitfall #1: Focusing Only on the Time

A common mistake is documenting:
“TUG completed in 14 seconds.”

And stopping there.

That number alone tells CMS very little.

Two patients can complete the TUG in the same time but have very different fall risks depending on:

Balance loss
Shuffling gait
Use of furniture for support
Unsteady turns
Hesitation or fear

Observed movement is critical.

What CMS Actually Cares About During the TUG

While performing the TUG, you should be watching for:

Difficulty initiating standing
Use of arms to push off
Staggering or loss of balance
Narrow or wide-based gait
Shuffling steps
Unsafe turning
Improper use of assistive devices

These observations help justify:

Fall risk designation
Therapy referrals
Skilled need
Safety interventions

Interpreting TUG Results in Home Health

General guidance (not rigid rules):

≤10 seconds: Typically low fall risk
11–19 seconds: Increased fall risk
≥20 seconds: High fall risk

But CMS does not require you to memorize cutoffs.

A patient with a “normal” time but unsafe gait or balance loss can still be high risk.

Clinical judgment always comes first.

TUG, Assistive Devices, and Real-World Safety

Patients should perform the TUG:

With their usual walker, cane, or device
Wearing their normal footwear
In their actual home environment

If a patient refuses to use their assistive device during the test, that behavior itself is a fall risk finding and should be documented.

How the TUG Supports Skilled Need

TUG findings often support:

PT evaluation
Balance training
Gait training
Safety education
Ongoing skilled monitoring

Especially when combined with:

Prior falls
Fear of falling
Poor insight into limitations
Unsafe home environment

The TUG is rarely the only reason for skilled services — but it is often a strong piece of the overall picture.

Documentation Tips That Protect You

Strong TUG documentation includes:

Time
Assistive device used
Observed gait and balance
Safety concerns

Examples:

“TUG completed in 18 seconds using front-wheeled walker; observed shuffling gait and unsteady turn, indicating increased fall risk.”
“Patient required use of armrests to stand and demonstrated loss of balance when turning to sit.”
“TUG deferred due to unsafe standing balance; patient identified as high fall risk.”

Specific documentation beats numbers alone.

Common Pitfall #2: Forcing the Test When It’s Unsafe

If a patient cannot safely attempt the TUG:

Do not force it
Document why it was deferred
Document observed risk instead

CMS does not penalize nurses for protecting patient safety.

How the TUG Fits Into the Bigger SOC Picture

The TUG should align with:

Functional mobility scoring
Musculoskeletal findings
Neurological assessment
Living situation
Types and sources of assistance

If the TUG suggests high fall risk, the rest of the SOC should reflect that reality.

Internal consistency matters.

Final Takeaway

The Timed Get Up and Go is not about speed.

It’s about safe movement, balance, and fall risk in the home.

When you perform it intentionally, observe carefully, and document clearly, the TUG becomes a powerful tool to support:

Skilled need
Therapy involvement
Safety planning
Audit-defensible SOCs

A stopwatch alone doesn’t tell the story — your assessment does.

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