Headshot of Jennifer Burks
Jennifer Burks

Fear and embarrassment are two factors we need to consider when working with home health patients and home care clients to prevent falls. September is National Falls Prevention Month and an excellent opportunity for home-based healthcare professionals to examine their current falls prevention programs. 

Health providers in every specialty should continually be fine-tuning their falls prevention initiatives. However, this is even more true for the interdisciplinary members providing health care inside people’s homes.

Falls impact a patient’s health, and it is our responsibility as healthcare providers to prioritize the importance of prevention. 

Health providers need to pay extra attention to falls.

Falls are preventable. They are not a normal part of aging, despite what the general public may think.

According to the Centers For Disease Control and Prevention (CDC), 25% of Americans age 65 and older fall every year. Falls from this age group cause over 3 million emergency room visits and 32,000 deaths every year. 

With the population of older adults increasing, it is difficult to comprehend how many additional falls there could be in future years. As healthcare practitioners, we have control over those numbers by how we proactively prevent falls. 

Providers of in-home health care may need to dig deeper and uncover potential falls. 

Patients may not want to report a fall out of embarrassment. Start by setting a conversational tone that encourages open discussion and full disclosure about fall risk and fall occurrence.

Falls can seriously impact a patient’s health.

The CDC reports that the most common fall injuries include broken bones, especially the wrist and hip, followed by head trauma. Fall injuries can become lifelong problems for the person and their family. In some cases, people never fully recover.

But there is also a mental aspect of a patient’s health that is negatively impacted. Many patients develop a fear of falling that robs them of their sense of safety. It may cause them to slow down their movements further and socially isolate themselves.

That lack of socialization can progress to complete immobility, which is like a pandemic in itself. In this sense, working with patients to alleviate that fear through fall prevention education is a gift.

Falls impact the bottom line.

Falls cost about $50 billion every year. Medical care for post-fall-related incidents is costly and included in quality measures and compliance records.

For example, the Outcome and Assessment Information Set (OASIS) is used to determine an agency’s Medicare reimbursement and measure quality. The OASIS assessment asks specific questions that directly impact the Centers for Medicare and Medicaid Services (CMS) home health star ratings.

In other words, falls can lead to lower quality scores, thus lower reimbursement.

In addition, Medicare’s Care Compare website reports home health agency performance and patient satisfaction. Fall risk and fall prevention are within those boundaries.

Preventing falls is even more important during the pandemic.

Hospitals are being challenged in ways never seen before by staff burnout. Preventing falls keeps patients out of the hospital and decreases the risk of COVID-19 transmission.  

Identifying risk is the key to avoiding preventable hospitalization or re-hospitalization. We see more medically fragile individuals and complex patient care given in the home than we did ten years ago. But while it is great to care for patients outside of hospital walls, it also comes with fall risk.

Patients deserve to have a safe home, both from a fall risk perspective and an infection control standpoint.

Falls prevention at home is different than in a skilled nursing facility or hospital.

It is an honor and a privilege to work inside a patient’s home. However, there can be various potential fall hazards we need to assess, such as:

  • Stairs
  • Throw rugs
  • Carpets with rolling edges
  • Electrical cords
  • Poor lighting
  • Clutter
  • Pets who create a trip hazard
  • Furniture placement

A home healthcare provider brings a fresh set of eyes to make movement safer in a patient’s home. But explaining this to a patient can be delicate because, as their medical providers, we are also guests.

People live their lives differently than they would in a medical setting. They may have been living in challenging circumstances that they have been navigating for years. They might also perceive any new changes in their homes as having a loss of control over their lives.

Therefore, these conversations require a high level of emotional intelligence and compassion.

Agency owners must ensure their staff understands these three things:

1. How to recognize and assess fall risk hazards in the home 

There are resources to help stop accidents, injuries, and deaths, such as:

2. What your agency’s fall prevention strategy entails 

  • How are you addressing fall risks? 
  • How are you educating staff?
  • What interventions do you have in place?

3. How to report falls if they occur 

Know who should perform the fall risk assessment and what they should do if a fall occurs. Specifically,

  • How to respond and help someone who has fallen
  • How to report a fall
  • How to explain your agency’s fall prevention plan to surveyors

Prioritizing key initiatives in your home health business

Prioritizing key initiatives involves the following:

  • Prioritizing person-centered care first and foremost
  • Creating a robust fall risk and prevention program with a clear system for reporting falls
  • Having an understanding of regulatory requirements that govern your employees’ practice from a state and federal level
  • Providing ongoing staff education about preventing falls and responding to them

Treating patients inside their own homes can be challenging because new regulations such as the Patient-Driven Groupings Model are constantly evolving to adapt to the best recommended practices. Daily attention to your agency’s fall prevention program is essential. 

Every agency needs to have at least one expert who is in charge of maintaining regulatory requirements. Large agencies might want to consider implementing a team of fall experts.

Jennifer Burks, MSN, RN, is a post-acute care curriculum designer for Relias.