A CORONER has warned lives could be put at risk after a 91-year-old man died following a fall down the stairs at his home while waiting for an urgently recommended stairlift.

William George Rice sustained catastrophic injuries in the fall on October 20, 2025, and died two days later at Royal Cornwall Hospital, Treliske, Truro.

Assistant Coroner Guy Davies has raised serious concerns about Cornwall Housing Limited’s adaptations policy, warning its strict rules may fail to take account of wider circumstances, including the potential risk to life when adaptations recommended by social services are refused.

The report, dated August 10, 2026, calls on Cornwall Council and Cornwall Housing to address the concerns, warning that further deaths could occur without action.

The inquest, which concluded on July 15, heard how adult social care therapists assessed Mr Rice on August 7, 2025, and urgently recommended a stairlift because of significant mobility and balance problems.

The application warned of a serious risk that he could fall down the stairs. It also explained that he needed safe access to fulfil his responsibilities as the sole carer for his wife, who has dementia.

The couple had lived at the property for 50 years and had an established support network locally.

However, Cornwall Housing refused the application on September 3, applying its adaptations policy because the three-bedroom council property was considered under-occupied by the couple.

Social services were not informed of the refusal and only discovered the decision on October 16, when an immediate appeal was lodged.

Cornwall Housing authorised the stairlift on October 23 as an exception to its policy, unaware that Mr Rice had already suffered the fatal fall three days earlier.

The inquest concluded Mr Rice died from catastrophic injuries sustained after falling down the stairs at home while awaiting the outcome of an application for a stairlift, urgently requested by social services more than two months earlier.

Mr Davies said a more flexible approach to the original application, taking account of the wider circumstances, could possibly have produced a different outcome.

His report highlights concerns the policy does not consider the risk to life, caring responsibilities or potential additional costs to social services if necessary adaptations are refused. The report states the policy required adaptation applications to be refused in all cases involving under-occupancy or over-occupancy.

Evidence at the inquest revealed stairlifts at Mr Rice’s property had been authorised as exceptions to the policy on two occasions. Cornwall Housing witnesses maintained those decisions were errors because the rules did not permit exceptions.

The report says adult social care and Cornwall Housing have carried out separate reviews, with lessons apparently focused on communication rather than the underlying policy.

Mr Davies said there had been no formal multi-agency review of the potential risks to life arising from strict application of the rules in cases similar to Mr Rice’s.

He has called for action to address the risk of future deaths, with both organisations required to respond by October 5, 2026, setting out measures taken or proposed and a timetable, or explaining why no action is planned.

Cornwall Council and Cornwall Housing Limited have been approached for comment on the coroner’s findings. At the time of publication, neither organisation had provided a response.