More Related Content Similar to Falls are Not Inevitable: Designing and Implementing a Comprehensive, Evidence Based Fall Management Program (20) 1. Falls are Not Inevitable
Designing and Implementing a Comprehensive,
Evidence Based Fall Management Program
MHCA Webinar
Cora Butler, JD,RN,CHC
May 9, 2017
© HCVA 2017
2. THE CONTENT OF THIS PRESENTATION IS INTENDED FOR
EDUCATIONAL PURPOSES ONLY, NOT LEGAL ADVICE
© HCVA 2017
3. Learning Objectives
Describe the individual and residential care setting consequences of falls in the
senior population.
Identify best practices for developing a comprehensive multi-disciplinary
approach to fall prevention and fall management.
Discuss the balance between maintaining resident safety and a resident’s right to
self-determination (right to choose).
Identify the role and application of data driven approaches and emerging
technologies in maintaining quality and resident safety in senior living settings.
Identify ways to sustain performance over time.
© HCVA 2017
5. Any event in which an individual comes to rest on a lower level
BUT
There is no universally accepted definition
SO
Each facility will need to create its own definition to ensure
accurate tracking and trending
Fall Defined
© HCVA 2017
6. Do you define falls in your facility like this?
CMS Definition: “Fall” refers to unintentionally coming to rest on the ground, floor, or other
lower level, but not (except) as a result of an overwhelming external force; an episode where
a resident lost his/her balance and would have fallen, if not for staff intervention, is
considered a fall. A fall without injury is still a fall. Unless evidence suggests otherwise,
when a resident is found on the floor, a fall is considered to have occurred.1
Observed Falls – resident experiences loss of balance while walking or transferring and
comes to rest at lower level (floor, ground, bed, chair, etc.) 2
Unobserved Falls – resident found on floor and no one (including resident) knows how they
got there. 2
Assisted Falls – resident or staff member lowers resident to floor.2
Near Falls – resident experiences sudden loss of balance (slip, stumble or trip) but able to
regain balance. Includes incidents except for those where resident would have fallen but staff
intervened. 2
1 CMS Manual System. (2007). Retrieved from http://www.sorbashock.com/documents/Medicare_Medicaid.pdf
2 Falls in Older People- Prevention and Management- Fourth Edition, Rein Tideiksaar
© HCVA 2017
7. The Burden of Falls
Nursing home residents often fall more than once with the average being 2.6 falls per person per
year.1
Between 50% and 75% of nursing home residents fall each year, which is twice the rate of falls
among older adults living in the community.1
Each year, 2.8 million older people are treated in emergency departments for fall injuries.4
Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a
broken hip or head injury; one out of five falls causes a serious injury such as broken bones or a
head injury.3
Falls are the most common cause of traumatic brain injuries (TBI).4
About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures.1
Each year at least 300,000 older people are hospitalized for hip fractures.2
About 1,800 older adults living in nursing homes die each year from fall-related injuries. 1
1 Falls in Nursing Home CDC 2012. (n.d.). Retrieved from https://www.in.gov/isdh/files/CDC_Falls_in_Nursing_Homes.pdf
2 HCUPnet. Healthcare Cost and Utilization Project (HCUP). 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://hcupnet.ahrq.gov
3 Costs of Falls Among Older Adults. (2016, August 19). Retrieved May 05, 2017, from https://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html
4 Important Facts about Falls. (2017, February 10). Retrieved May 05, 2017, from https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
© HCVA 2017
8. According to the U.S. Centers for Disease Control and Prevention
1.4
3.0
0.0
1.0
2.0
3.0
4.0
2015 2030
Nursing Home Residents Age
65+
Million
Nursing Home Distribution: Resident Age
Below 65
15%
65 to 95
77%
95+
8%
Distribution by Age
Falls Negligence in Nursing Homes: CMS. (n.d.). Retrieved from http://nursinghomeabuseguide.com/negligence/falls-and-fractures/ https://www.cms.gov/Medicare/Provider-
Enrollment-and-Certification/CertificationandComplianc/Downloads/nursinghomedatacompendium_508-2015.pdf
© HCVA 2017
9. Assisted Living Distribution: Resident by Age
National Center for Assisted Living’s study of Long Term Care Providers 2014
Below 75
17%
75 to 85
30%
85 & above
53%
Assisted Living Residents Age:
Nationally
Below 75 75 to 85 85 & above
Total Assisted Living Residents in 2014: 835,200
Below 75
31%
75 to 85
26%
85 &
above
43%
Assisted Living Residents Age:
Missouri
Below 75 75 to 85 85 & above
Residents. (n.d.). Retrieved May 06, 2017, from https://www.ahcancal.org/ncal/facts/Pages/Residents.aspx
© HCVA 2017
10. The Challenge in Assisted Living
National Center for Assisted Living’s study of Long Term Care Providers 2014
40
46
17
23
29
47
20
28
0 10 20 30 40 50
Alzheimer's disease/ Dementia
Cardiovascular disease
Diabetes
Depression
Percentage of residents
Disease burden in Assisted Living
Missouri
National
Nationally:
21%
Missouri:
17%
Percentage of residents
who had a fall in the
last 90 days
Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2014. (2015, November 16). Retrieved May 06, 2017, from
https://www.cdc.gov/nchs/data/databriefs/db223.htm
© HCVA 2017
11. The Economics of Falls
Adjusted for inflation, the direct medical costs for fall injuries are $34 billion
annually. Hospital costs account for two-thirds of the total.2
Medicare pays for about 78% of the costs of falls. 1
The average hospital cost for a fall injury is $35,000.1
Based on a study conducted in 2000,
There were almost 10,300 fatal and 2.6 million medically treated non-fatal fall related
injuries.
Direct medical costs totaled $0.2 billion for fatal and $19 billion for non-fatal fall related
injuries
Fractures accounted for just 35% of the non fatal injuries, but 61% of the costs.2
Long term care general and professional liability costs projected to increase
6% in 2017 to $2,350/bed or $6.44 per patient per day. 3
Note: Direct costs do not account for the long-term effects of these injuries such as disability, dependence on
others, lost time from work and household duties, and reduced quality of life.
1 Costs of Falls Among Older Adults. (2016, August 19). Retrieved May 05, 2017, from https://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html
2 Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006;12:290–5.
3 Report: LTC liability costs to rise in 2017. (2017, January 05). Retrieved May 08, 2017, from http://www.mcknights.com/news/report-ltc-liability-costs-to-rise-in-2017/article/629763/
© HCVA 2017
12. Consequences of Falls in Older Individuals
Psychosocial Trauma
Altered Self-Image
i. Feelings of frailty and incompetence
Increased Anxiety
i. Inability to feel safe in their environment
ii. Heightened sense of vulnerability
iii. Embarrassment
Decreased Mobility
i. Increased isolation and fewer opportunities for social interaction
ii. Concern that family will worry
Depression
i. Loss of autonomy
Family Concerns
Guilt
Blame
Overcompensate
© HCVA 2017
13. Consequences of Falls in Older Individuals
Residential Care Setting Effects
Healthcare Costs
Labor Costs
Equipment Costs
i. Utilization Costs
Litigation Costs
Effects on Staff
i. Staff frustration with balancing increased
care needs of individual resulting from fall
with existing work-load
ii. Family
iii. Stress, guilt, self-doubt about ability to
deliver safe care
© HCVA 2017
17. ‘No shame, no blame’
environment
Falls and injury related hazards
are reported voluntarily
Combined approach by the
clinical, administrative and
support staff
Discussions with residents and
families about occurrences to
promote a fall-free culture
Culture of Safety
© HCVA 2017
18. Use CMS definition of a fall as a
guidance
Observed, unobserved, near and
assisted falls are defined and
measured
Resident bed days are included in
the measurement of the fall rate
Define: Falls & its Measurement
© HCVA 2017
20. Role of Administration
Falls and safety are considered a
priority
Regular updating and
communication of policies and
procedures
Support is provided through
required staff and/or safety devices
Surprise walk-rounds, scheduled
meetings
Annual analysis of potential risk
factors for improvement
© HCVA 2017
21. Care Processes
Fall risk assessment
Multidisciplinary
intervention/referrals are made post
assessment
Communication of individual risk
status
Monitoring of the at-risk residents-
hourly rounding, fall alarms, sitters?
Care planning
Fall investigation report
Regularly scheduled audits
© HCVA 2017
22. Environment & Equipment Safety
Regular inspection of all resident
rooms, bathrooms and hallways
Prompt repairs by maintenance
staff
Inspection of assistive/mobility
devices every 6 months
Documentation of every
inspection and repairs
© HCVA 2017
23. Education
Education on fall management
during employee orientation
Periodic in-service training
sessions for all staff
Regularly updated holistic
educational materials
Residents and families- safety
awareness, individual risk factors
and interventions
© HCVA 2017
24. Quality Assurance & Performance Improvement
Accurate documentation of fall
related information
Monthly analysis of falls
Monthly display of data – Line
graphs/Dashboards
Monthly feedback to the
caregivers
Track trends over six
months/annually
© HCVA 2017
26. Resident
Safety
Resident
Rights
Privacy
Self Determination
Access
Transfer, Discharge &
Grievances
Risk Management
Program (including
falls)
Resident Assessment
& Service Planning
Illness Prevention
Physical Environment
Determine &
Clarify choices*
Discuss
alternatives*
Determine method
to honor choice*
Tailor care plan*
Oversee & adjust
care plan*
Steps to modify care plan based on Residents’
choice while maintaining Resident safety
*Maintain documentation
© HCVA 2017
29. MORSE SCALE1
JHFRAT2
1 Tool 3H: Morse Fall Scale for Identifying Fall Risk Factors. (2013, January 31). Retrieved May 06, 2017, from
https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk-tool3h.html
2 Fall Risk Assessment. (2016, September 02). Retrieved May 06, 2017, from http://www.hopkinsmedicine.org/institute_nursing/models_tools/fall_risk.html
© HCVA 2017
31. INDICATION OF FALL RISK & FRAILTY
Greene, B. (n.d.). ACCURATE AND OBJECTIVE ASSESSMENT OF FALLS RISK. Retrieved May 06, 2017, from http://www.qtug.org/
© HCVA 2017
32. GAIT CAPTURING & ANALYSIS
CRITICAL TO FALL RISK ASSESSMENT
Speed
Stride Length
Cadence
Upper Body Lean
Hip Sway
© HCVA 2017
34. Fall Prevention Intervention Care Plan. (n.d.). Retrieved from
http://www.primaris.org/sites/default/files/resources/Restraints%20and%20Falls/falls_prevention%20intervention%20care%20plan%20final.pdf
© HCVA 2017
37. Fall Risk
Assessment
Fall Prevention
Care Planning
Fall Identification
Fall Prevention Program
• Communication:
Residents/Caregiver
/Support Staff
• Bed Exit,
Virtual Rails and
other sensor
technologies
• Paper tools: MORSE, JHFRAT
• Technology Tools
• Paper tools
• Call light,
Assistive &
Adaptive Devices
© HCVA 2017
38. Safe Wander. (n.d.). Retrieved May 06, 2017, from http://www.safewander.com/
Care View. (n.d.). Retrieved May 06, 2017, from http://www.care-view.com/
http://dracofinancial.com/draco/wp-content/uploads/2013/07/CRVW-Fall_Management.jpg
© HCVA 2017
39. Fall Risk
Assessment
Fall Prevention
Care Planning
Fall Identification
Fall Investigation
Fall Prevention Program
• Communication:
Residents/Caregiver
/Support Staff
• Bed Exit,
Virtual Rails and
other sensor
technologies
• Paper tools: MORSE, JHFRAT
• Technology Tools
• Paper tools
• Call light,
Assistive &
Adaptive Devices
• Communication: Team Huddle,
Investigation meeting
• Paper tools
© HCVA 2017
40. Appendix B2: Tracking Record for Improving Patient Safety (TRIPS). Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/fallspxmanapb2.html
© HCVA 2017
43. Fall Risk
Assessment
Fall Prevention
Care Planning
Fall Identification
Fall Investigation
Fall Prevention Program
• Communication:
Residents/Caregiver
/Support Staff
• Bed Exit,
Virtual Rails and
other sensor
technologies
• Paper tools: MORSE, JHFRAT
• Technology Tools
• Paper tools
• Call light,
Assistive &
Adaptive Devices
• Communication: Team Huddle,
Investigation meeting
• Paper tools
• Sensors, Alerts, Audio, Video
(Rewind & Review)
© HCVA 2017
44. Rewind & Review
Live Audio
Alert System
Bed Sensor Pad & Fall Monitor
https://www.lifeline.philips.com/business/homesafe
http://www.stanleyhealthcare.com/solutions/health-systems/patient-safety/fall-management
© HCVA 2017
45. Fall Risk
Assessment
Fall Prevention
Care Planning
Fall Identification
Fall Investigation
Post- Fall Care
Planning
Fall Prevention Program
• Communication:
Residents/Caregiver
/Support Staff
• Bed Exit,
Virtual Rails and
other sensor
technologies
• Paper tools: MORSE, JHFRAT
• Technology Tools
• Paper tools
• Call light,
Assistive &
Adaptive Devices
• Communication: Team Huddle,
Investigation meeting
• Paper tools
• Sensors, Alerts, Audio, Video
(Rewind & Review)
• Update Fall Risk Status
• Update care plan post fall to
meet additional needs to
prevent further falls
© HCVA 2017
46. Fall Risk
Assessment
Fall Prevention
Care Planning
Fall Identification
Fall Investigation
Post- Fall Care
Planning
Root Cause
Analysis
Fall Prevention Program
• Communication:
Residents/Caregiver
/Support Staff
• Bed Exit,
Virtual Rails and
other sensor
technologies
• Paper tools: MORSE, JHFRAT
• Technology Tools
• Paper tools
• Call light,
Assistive &
Adaptive Devices
• Communication: Team Huddle,
Investigation meeting
• Paper tools
• Sensors, Alerts, Audio, Video
(Rewind & Review)
• Update Fall Risk Status
• Update care plan post fall to
meet additional needs to
prevent further falls
• Conduct Root Cause Analysis to
facilitate performance
improvement
© HCVA 2017
47. Based on assessment ask:
What happened?
Why did it happen?
Continue to ask “Why” questions
until all logical causes identified
Contributing causes may include:
i. Patient related – intrinsic factors
ii. Patient related – activity at time of fall
iii. Environmental – extrinsic factors
iv. Clinical Process Failures – risk assessment plan of care
© HCVA 2017
48. Fall Risk
Assessment
Fall Prevention
Care Planning
Fall Identification
Fall Investigation
Post- Fall Care
Planning
Root Cause
Analysis
Fall Prevention Program
• Communication:
Residents/Caregiver
/Support Staff
• Bed Exit,
Virtual Rails and
other sensor
technologies
• Paper tools: MORSE, JHFRAT
• Technology Tools
• Paper tools
• Call light,
Assistive &
Adaptive Devices
• Communication: Team Huddle,
Investigation meeting
• Paper tools
• Sensors, Alerts, Audio, Video
(Rewind & Review)
• Update Fall Risk Status
• Update care plan post fall to
meet additional needs to
prevent further falls
• Conduct Root Cause Analysis to
facilitate performance
improvement
• Provide feedback to the system
to prevent future falls
© HCVA 2017
50. Baseline Data
Analysis
(Monthly
basis)
• Total number of falls
• Type of fall: Including Near Missed,
Unobserved, Assisted
• Number of residents who fall
• Number of residents with two or more falls
• Number of injuries
• Type of injuries: Fatal or no-fatal
Other
Indicators
• Family and staff satisfaction
• Number of survey tags related to falls
• Number of lawsuits related to falls
• Changes in staff awareness
• Changes in staff organization
Key Data Elements for Data Analysis
Chapter 3. Data Collection and Analysis Using TRIPS. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/fallspxman3.html
© HCVA 2017
51. Basic Data Analysis
• Ideally assessment
should be done after a
year of applying the
changes
• Look for trends over a
period of time following
the rules of trend
analysis
• Caution should be given
to special events where
data shows high or low
rates
5. How do you measure fall rates and fall prevention practices? (2013, January 31). Retrieved May 06, 2017, from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk5.html
© HCVA 2017
52. Predictive Analytics
Oakland Athletics GM Billy Beane upset by his team’s loss to New York Yankees in
2001 postseason
With the impending departure of star players to free agency, Beane needed to
assemble a competitive team for 2002 and simultaneously overcoming Oakland’s
limited payroll
Beane and Paul DePodesta, an Oakland A’s scout, found a system to pick baseball
players using limited funding
Bill James, the writer, creates a system to evaluate baseball players by using
performance statistics called ‘sabermetrics’
Statistics included on-base percentage and slugging percentage which were
combined to form a new statistic called on-base plus slugging.
This was done to determine whether the player can get on the base and can he hit
instead of the traditional theory of decision making based on speed, quickness, arm
strength, hitting ability and mental toughness.
Result: Success in 2002
Academy, U. S. (2015, March 20). An Examination of the Moneyball Theory: A Baseball Statistical Analysis. Retrieved May 06, 2017, from http://thesportjournal.org/article/an-examination-of-the-moneyball-
theory-a-baseball-statistical-analysis/
© HCVA 2017
53. Hospital cuts costly falls by 39% due to predictive analytics. (2017, April 26). Retrieved May 06, 2017, from http://www.healthcareitnews.com/news/hospital-cuts-costly-falls-39-due-predictive-analytics
H. (2015, November 04). Simple Healthcare Predictive Analytics Flag Elderly Fall Risk. May 06, 2017, from http://healthitanalytics.com/news/simple-healthcare-predictive-analytics-flag-elderly-fall-risk
CareSage. (n.d.). Retrieved May 06, 2017, from https://www.lifeline.philips.com/business/caresage.html
© HCVA 2017
57. • Safe Patient Handling: Improving Quality of Care. (n.d.). Retrieved May 04, 2017, from
http://www.arjohuntleigh.com/knowledge/safe-patient-handling/
• Falls in Nursing Home CDC 2012. (n.d.). Retrieved from https://www.in.gov/isdh/files/CDC_Falls_in_Nursing_Homes.pdf
• HCUPnet. Healthcare Cost and Utilization Project (HCUP). 2012. Agency for Healthcare Research and Quality, Rockville, MD.
http://hcupnet.ahrq.gov
• Costs of Falls Among Older Adults. (2016, August 19). Retrieved May 05, 2017, from
https://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html
• Important Facts about Falls. (2017, February 10). Retrieved May 05, 2017, from
https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
• Falls Negligence in Nursing Homes: CMS. (n.d.). Retrieved from http://nursinghomeabuseguide.com/negligence/falls-and-fractures/
https://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/CertificationandComplianc/Downloads/nursinghomedatacompendium_508-2015.pdf
• Residents. (n.d.). Retrieved May 06, 2017, from https://www.ahcancal.org/ncal/facts/Pages/Residents.aspx
• Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2014. (2015, November 16).
Retrieved May 06, 2017, from https://www.cdc.gov/nchs/data/databriefs/db223.htm
• Costs of Falls Among Older Adults. (2016, August 19). Retrieved May 05, 2017, from
https://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html
• Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention
2006;12:290–5.
• Chapter 3. Data Collection and Analysis Using TRIPS. Content last reviewed October 2014. Agency for Healthcare Research and
Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/fallspxman3.html
• 5. How do you measure fall rates and fall prevention practices? (2013, January 31). Retrieved May 06, 2017, from
https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk5.html
• Academy, U. S. (2015, March 20). An Examination of the Moneyball Theory: A Baseball Statistical Analysis. Retrieved May 06, 2017,
from http://thesportjournal.org/article/an-examination-of-the-moneyball-theory-a-baseball-statistical-analysis/
• Hospital cuts costly falls by 39% due to predictive analytics. (2017, April 26). Retrieved May 06, 2017, from
http://www.healthcareitnews.com/news/hospital-cuts-costly-falls-39-due-predictive-analytics
References
© HCVA 2017
58. • H. (2015, November 04). Simple Healthcare Predictive Analytics Flag Elderly Fall Risk. Retrieved May 06, 2017, from
http://healthitanalytics.com/news/simple-healthcare-predictive-analytics-flag-elderly-fall-risk
• CareSage. (n.d.). Retrieved May 06, 2017, from https://www.lifeline.philips.com/business/caresage.html
• Nursing Home Residents’ Rights http://longtermcare.wi.gov/docview.asp?docid=17285
• Rights & protections in a nursing home. (n.d.). Retrieved May 06, 2017, from https://www.medicare.gov/what-medicare-
covers/part-a/rights-in-nursing-home.html
• Residents Have Rights. (n.d.). Retrieved May 06, 2017, from http://www.carewatchers.org/residentshaverights.html
• Church Mutual Safety Resources. (n.d.). Retrieved from
https://www.churchmutual.com/media/safetyResources/files/Self_Inspection_Checklist_SeniorLiving.pdf
• Tool 3H: Morse Fall Scale for Identifying Fall Risk Factors. (2013, January 31). Retrieved May 06, 2017, from
https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk-tool3h.html
• Fall Risk Assessment. (2016, September 02). Retrieved May 06, 2017, from
http://www.hopkinsmedicine.org/institute_nursing/models_tools/fall_risk.html
• Greene, B. (n.d.). ACCURATE AND OBJECTIVE ASSESSMENT OF FALLS RISK. Retrieved May 06, 2017, from
http://www.qtug.org/
• Fall Prevention Intervention Care Plan. (n.d.). Retrieved from
http://www.primaris.org/sites/default/files/resources/Restraints%20and%20Falls/falls_prevention%20intervention%20care
%20plan%20final.pdf
• Safe Wander. (n.d.). Retrieved May 06, 2017, from http://www.safewander.com/
• Care View. (n.d.). Retrieved May 06, 2017, from http://www.care-view.com/
• Appendix B2: Tracking Record for Improving Patient Safety (TRIPS). Content last reviewed October 2014. Agency for
Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-
care/resources/injuries/fallspx/fallspxmanapb2.html
References
© HCVA 2017
59. • www.foresitehealthcare.com
• https://psnet.ahrq.gov/media/cases/images/case6_fig2.jpg
• http://www.rehabmart.com/imagesfromrd/posey-1201.jpg
• http://media.endocrinologyadvisor.com/images/2016/11/17/slide3ts58420401621_1096296.jpg
• http://www.healthcarefacilitiestoday.com/media/graphics/2013/2728.jpg
• http://www.patientsafetyresearch.org/PSLL/images/fall_prevention_blue.jpg
• http://i.dailymail.co.uk/i/pix/2017/03/16/20/3E58416E00000578-4321754-image-a-10_1489697721521.jpg
• https://www.lifeline.philips.com/business/homesafe
• http://www.stanleyhealthcare.com/solutions/health-systems/patient-safety/fall-management
• http://dracofinancial.com/draco/wp-content/uploads/2013/07/CRVW-Fall_Management.jpg
References: Pictures & Graphics
© HCVA 2017
62. Fall Risk Assessment & Prevention Technologies
• www.foresitehealthcare.com
• www.qtug.org
• www.careinnovations.com
• www.rft.com/sensatec-fall-management
• www.stanleyhealthcare.com
• www.earlysense.com
• www.care-view.com
• www.alimed.com/alarms/
© HCVA 2017
Editor's Notes The use of the word facility Age cohorts:- Just over 1.4 million residents were living in US nursing homes on December 31, 2014,
corresponding to 2.6 % of the over-65 population and 9.5 % of the over-85 population. Slightly more than fifteen percent
(15.5%) of the nursing home population is under age 65, while 7.8 % are over 95 years.
83% of the residents nationally within Assisted Living and 69% locally in Missouri belong to the age group 75 and above, with a majority (53% nationally and 43% locally) belonging to the age group 85 and older. The study also indicates that 40% nationally and 29% locally have Alzheimer’s disease or dementia; 46% nationally and 47% locally have cardiovascular disease; 23% both nationally and 28% locally have depression; and 17% nationally and 20% locally have diabetes. Thus, a majority of the residents in assisted living and/or memory care units are older, have complex chronic conditions, mental health issues and/or memory problems, all of which contributes to an increase risk for falls. Moreover, the study also reported 21% of the residents nationally and 17% locally had a fall in the last 90 days. This poses a challenge to the existing care providers to prevent falls, and reflects the need to improve the ability of the staff within the facilities to predict and, to the degree possible, prevent falls.
Claim for fall- Nursing home- 137,000
Liability cost: More than allocation for food
Direct medical costs include fees for hospital and nursing home care, doctors and other professional services, rehabilitation, community-based services, use of medical equipment, prescription drugs, and insurance processing.
Guilt (Not Able to Prevent), Blame (Staff for Allowing Fall), Overcompensate (Insist on activity restriction; use of mechanical restraints, removal of mechanical restraints)
An 89-year-old resident of a nursing home fell when she was left alone in a bathroom. The fall caused a fracture of her left femur, and it required a surgical procedure to correct. Ultimately, the resident died from the complications of the surgery. Surviving family members received a nursing home abuse settlement of $750,000.
Wrongful death of an 87-year-old skilled nursing facility resident/patient who died after the facility’s nursing staff failed to plan care for the patient’s well-documented “high risk” status for falls. Despite notice of previous falls provided by family members, as well as the facility’s own assessment that the patient was at “high risk” for falls, the Southern California facility failed to initiate any fall prevention protocol. Six days after being admitted, the patient fell while unassisted. As a result of the fall, the resident sustained a severe head injury. Despite being transferred to the hospital, he died later that morning.The case settled early in litigation for a total of $475,000.00.
The son of 93-year-old plaintiff contracted with a geriatric in-home care company for his mother to receive assistance with her daily needs in the comfort of her own home. The contract called for the company to provide the services of a specially trained and skilled in-home care provider. On the fourth day of service, defendant sent an untrained, unskilled employee to assist plaintiff. During an attempted transfer, the employee left plaintiff, who was unstable and a known fall risk, standing unattended. Plaintiff fell and sustained a broken hip, subsequently requiring surgery then rehabilitation at a skilled nursing facility. The firm attorneys brought suit on behalf of plaintiff, alleging not only negligence but also that the conduct of defendant in promising, yet failing, to provide a specially trained and skilled in-home care provider was reckless and fraudulent under California’s Elder Abuse Act. After prevailing on an important motion early during litigation which shaped the case as one for Elder Abuse, defendant agreed to settle plaintiff’s claims in the amount of $365,000.00.
Labor Costs (Nursing, physician and rehabilitative), Equipment Costs (Mobility devices and DME), Utilization Costs (Readmission to hospital or facility), Effects on Staff - Staff frustration with balancing needs of individual (Autonomy) and Family (protection and safety)
Litigation Cost- Nursing Home & Care Facility Case Results. (n.d.). Retrieved May 06, 2017, from http://www.bermanlawyers.com/verdicts-settlements/nursing-home-care-facility-case-results/
Payments- In the new CMS reporting for SNFs and Value Based Purchasing- Falls is a priority
Value Based Payments Flowchart- Martial Smoking area by themselves-> high medium fall risk to dining room by themselves; outside by themselves; -> penalties for payments-> care plan? Risk taking is normal part of life, without impeding their life to choose
Fall risk assessment isn’t enough
Updating the forms- Mention POA- Resident Representative Percentage of residents- Total residents: 1,406,220: falls- None: 83.6; 1+ falls no injury- 11.0; 1+ injurious falls-8.3%
Missouri: 39,119; None falls: 78.2%; 1+ fall no injury- 15; 1+ injurious- 6.9%
The MDS assesses whether the resident has experienced any falls since admission or the most recent assessment.
Assessments take place approximately quarterly. If the resident has fallen, it is determined whether s/he had any falls
resulting in injury; injuries can be major (e.g. bone fracture, joint dislocation or head injury with loss of consciousness) or
minor (e.g. lacerations, superficial bruising, sprains).
Sensor pads
Voice alarms
Video stuff
Other predictive
http://www.rft.com/Sensatec-Fall-Management
