Ladder-related injuries are costing Kiwis almost $17 million a year, and those aged 50 to 64 are taking the most tumbles.
During the holiday season, ACC is reminding those planning summer DIY projects to take care on ladders.
The construction industry has already rung in changes. Fletcher Building, the country's largest listed company, has brought in stricter guidelines for ladder use.
Figures from ACC show 9,421 new claims related to ladder use were made in the year to 30 November 2013. They are among 11,739 active claims, for which $16.9 million has been paid in the past year.
A breakdown of claims by age was not available for last year, but in 2012 more than a third of 9,240 new claims were from people aged between 50 and 64. Under-4s accounted for 230 claims, and 157 over-85s were hurt in incidents involving ladders.
ACC spokeswoman Stephanie Melville wasn't surprised over-50s were over-represented. "That age group tends to be more, 'Well, I will give it a go myself, rather than pay somebody'. Whereas with some young people, they've got the money, less time to do it and so might be less inclined to DIY. It's a generational thing. The mind is still strong, but [they're] forgetting the body is not as strong as it once was."
Safety recommendations around ladder use did not target over-50s - the message was aimed at everyone, she said. "Keep three points of contact on the ladder at all times. If you must use two hands when working, then use another part of the body as a third point of contact to brace against the ladder."
People should also never climb higher than the third step from the top of a straight ladder, which should be 1m out at the base for every metre of height. Straight ladders should also extend 1m above the landing place, and at least 4m clear of power lines, Melville said.
Fletcher Construction's building and interiors general manager Greg Pritchard said workers were told ladders were okay for access but mobile scaffolding had to be used in all other circumstances, unless it could be proven a ladder was safer. That had to be signed off by a supervisor.
North Shore Hospital emergency department specialist Dr Andrew Ewens said people should make a plan before climbing the first rung - including understanding the risks and getting others to help.
That was especially important for those over 50. "Muscle mass, balance and co-ordination, as you get older, these things do get impaired. We have to modify our expectations of ourselves."
Grey Power national president Roy Reid said he had had a couple of near misses. "As you get older, you get a bit less nimble and your sense of balance is not as good but you don't want to admit that you can't do it."
Lesson in tough break
As Marianne Hercock reached out on her ladder, she thought she was saving time.
It would have taken less than a minute to climb down, move the ladder and climb up again.
Instead, the Wairarapa business owner spent 10 days in hospital, will wear a moon boot for at least two months and cannot work for at least 10 weeks after breaking her leg.
When the ladder slipped below her, one leg became caught between rungs, crushing her tibia.
She had surgery to insert a rod and screws, but may need a knee replacement. "It would have taken a minute (to move the ladder). I never imagined this happening to me," Hercock said.
The 66-year-old runs The Landing wedding venue in Masterton with her husband, Robin, and the accident puts pressure on the couple during the busy summer wedding season.
Since leaving hospital on November 24 she has either used a wheelchair or a relative's Zimmer frame to get around.
"I feel like I'm about 95. I will never get on a ladder again ... and I don't know how many people have said to me, 'I'm not going to get on a ladder'.
"My advice to people is just be really, really careful."