Before the fall
Before the fall
Falls are the leading cause of fatal and nonfatal injuries of adults aged at least 65 years, according to the Centers for Disease Control and Prevention. They're also a primary concern for senior housing operators and caregivers due to vulnerable residents with diminished cognition, coordination, agility and strength. Twentynine percent of assisted living residents need help with walking, according to the CDC. Those who survive falls often suffer head injuries and hip fractures that can impact quality of life and cost upward of $5,400 per month in treatment costs.
While experts agree not every fall can be prevented, the risks can be significantly reduced. The key to success, they say, lies in the adoption of a comprehensive fall management approach and community-wide participation.
“Successful fall programs in senior living involve an integrated and holistic approach that starts with a strong fall management culture. [That culture must then be supported] with people, processes and technology all focused on keeping residents safe,” explains Lauren Horn, RN, MSN, senior clinical consultant for Stanley Healthcare.
Communities should standardize on the overall fall program for ease of implementation and increased compliance, she adds, while also empowering caregivers to individualize approaches based on each resident's needs.
ASSESS FOR SUCCESS
Today, communities recognize proactive and ongoing fall risk assessments as the first critical step in a comprehensive fall management program. Fall assessments should be conducted upon move-in and on an ongoing and as-needed basis to determine physiological, behavioral or cognitive changes that might affect risk status.
Assessment tools can help identify and score risks by exploring variables such as a resident's fall history, secondary diagnoses, ambulatory status, gait, cognitive status, presence of IV or IV access and use of medications that could increase fall risks. This information is then used to align resident-specific interventions to reduce those risks, whenever possible.
“Implementing an objective fall risk screening test for new residents as a baseline, [followed by] periodic retests, will help staff quickly identify change and give focus to those most vulnerable,” notes Lila Corwin, VP of marketing communications for Biodex Medical Systems. The Biodex Balance SD is a simple two-minute test that can accurately and objectively pinpoint risks. Test results are given numerically, so residents can potentially be graded by risk level, Corwin says. Beyond that, the tool is used for strengthening and retraining balance.
“With improved balance comes increased independence,” she says.
Life Care Center of Waynesville, MO, integrates the screening test into its rehabilitation programs. “After using the system to work on balance, we find residents can walk farther without fear of falling, and [they] demonstrate improved proprioception, stability, agility and mobility,” says Jacquie Bodkin, LPTA, the facility's director of rehabilitation.
Acts Retirement-Life Communities relies on an “all-hands-on-deck approach” to managing high-risk residents. “It's not just our nursing that is responsible. Other departments are made aware and check in on those residents and sometimes sit and talk or take them for a walk, if appropriate,” says Teresa Moore, RN, NHA, corporate director of resident health services.
Silverado communities also make medication management a top priority. “There is a full-time RN director of health services at each community as well as licensed nurses who provide all medications and treatments. At the resident's care conferences, all medications are reviewed to identify any need for adjustments in dosing,” says Silverado's Senior Public Relations and Communications Director David Gill.
Some simple practice shifts also can play an important role in fall risk reduction while improving resident satisfaction and outcomes.
In many Acts communities, dining venues remain open much of the day to allow residents the opportunity to eat on their schedules. This can decrease falls if a resident is hungry during off-hours, Moore says.
Improving balance is another weapon in the fall prevention arsenal. In addition to initial and ongoing fall assessments, residents at Silverado communities have access to the organization's Nexus program, which offers balance and strengthening programming.
Ensuring effective and timely communication and informationsharing across all members of a resident's care circle also is essential; however, meeting that need historically has been challenging as a resident's needs shift and more specialists and care teams enter the picture.
“When a person's [health needs] change, often their care circle will change. The various specialists may not know or communicate with one another, so important information can fall through the cracks,” says Val Ornoy, CEO of LifeAssist Technologies. Sometimes, personal health information is being shared unsecured through email, he warns. “What is needed is information that is centralized and able to be securely shared.”
To help close those gaps, LifeAssist developed a software as a solution (SaaS) care coordination platform that aggregates all data points for monitoring technology being used, such as from gait analysis and fall prevention solutions, blood pressure monitoring and so on, for a particular resident. When a new specialist or clinician needs to access the resident's data, they will be invited to the care circle in the care coordination platform and can gain secure access to appropriate information through a single tab. This allows various care providers to collaborate and coordinate care information and quickly see changes with a resident, such as blood pressure or weight changes, or to see whether a resident is ambulating or sleeping more or less frequently, Ornoy explains.
Increasingly, traditional alarms and stand-alone technologies designed to alert staff when a resident attempts to exit a bed or chair are giving way to more predictive solutions that allow for more proactive response.
More and more fall management solutions also are able to integrate with other resident security and response technologies.
“The time to catch a fall is before it happens,” reminds Tim Fischer, vice president of sales at RF Technologies. “Rather than just a pad on the floor, we've integrated fall management into our Code Alert nurse call system. Caregivers can be notified as the resident starts to get up, so the closest person can immediately go to the resident.
Through use of artificial intelligence and non-intrusive passive monitoring, fall prevention technology can now identify movements and analyze activities that lead to a fall. This affords the ability to monitor specific markers such as gait, walking speed and posture, and to deliver numerous other metrics that can be precursors to a fall, explains Laura Wasson, director of healthcare for Tech Electronics.
“Our systems continuously monitor a resident's movements in gait. By observing only a few initial steps, the system provides an assessment which is translated into a TUG [Time Up and Go] score,” she says.
“While most previous technologies were manual, such as, ‘In case of an emergency, press this button,' the current trend is to allow more automatic observation of habits, so if a change from the norm occurs, staff are alerted and prepared for what the results could be,” says Brad Hyder, marketing manager for TekTone Sound & Signal Manufacturing. TekTone's nurse call systems use wireless motion detectors, door and window monitors and check-in devices for residents, as well as auxiliary inputs on other hardwired systems, for interfacing with door monitoring, wander management and pressure pads for chairs and beside beds.
Still, experts warn that machines alone will not prevent a fall. “Only a human will do that,” says Steve Elder, director of communications for Stanley Healthcare. “Extensive education is needed to ensure caregivers are properly using the data being captured.”