Slipping and falling is one of the leading causes of injuries for seniors. Orthopedic Surgeon, Dr. M.E. Hecht, has provided the following best practices for keeping the residents of your community safe.
Fall and injury prevention continues to be a challenge across the senior living care continuum. And with this challenge comes the added burden of the rapid population-growth as baby boomers join the increase in life span to become a part of the slip and fall vulnerable. It is a challenge launched directly at the senior living communities.
The Slip and Fall Facts
Looking at some well-known statistics:
- In 2010, 2.3 million emergency room visits occurred after a recorded slip and fall
- In 2009, 25,000 fatalities were the result of a slip and fall (and this figure has increased every year to the present)
- Resident falls are a source of the greatest medical malpractice exposure
- The greatest risk of falling is during the first week after an admission/move-in to a community
- The most frequent location of falls in a resident’s room occurs while traveling to the bathroom.
- According to the Center for Disease Control, accidents are the fifth leading cause of death for persons over 65, and two-thirds of these deaths are directly related to falls and their consequences
Again, this data clearly shows an inescapable involvement of all concerned with the housing and care of older adults. And not to be forgotten is that the rate of incidence will predictably increase exponentially over the coming years as 43% of the U.S. workforce is eligible for retirement by 2024. These published numbers are clearly requiring senior living care communities to provide more than just shelter.
The purpose of this article is to help senior living communities with some practical suggestions in developing approaches to fall prevention. Fortunately some of these are so patent, that they are already in practice or are in planning by forward-thinking residence providers.
This article then is intended to share with you a program which I think of as S.A.F.E.T.Y., intended to help you review the practice of slip and fall prevention in your community.
The Gift of Safety: The Components of Prevention
The key components of fall prevention are most effective when they address many risk factors. Also note that all of the components are best offered by trained healthcare professionals and include education about falls and risk factors. The main components that should be part of your fall prevention program involve the following: Communication, Assessment, Monitoring, Information, Education and Interaction.
The S.A.F.E.T.Y Fall Precautions initiative is founded on the principle that all residents are at risk for falls, but a core set of fall prevention principles can be applied by all staff to mitigate these hazards. The acronym S.A.F.E.T.Y (Safe environment; Aide in mobility; Fall reduction; Engage resident – communicating risk factors; Take extra measures – monitoring; You make the difference, resident/residence) is utilized to describe the components for these fall precautions.
1. Safe Environment – Fall Assessment
The first step in preventing a fall is to determine a resident’s risk and meet this risk with safety measures. Many falls are predictable, so a fall risk assessment should be completed in all of the following circumstances: within 24 hours of admission, yearly, with any significant resident health change, and of course, after any fall.
A short history of health factors puts a resident at increased risk for slip and fall. These factors can be minimized if known. Therefore, I would suggest this tactful, but pertinent personal history and basic physical exam. Begin recording the following information:
- A history of past falls
- Client cognition and assessment, including fluctuating mental status
- Cardiovascular and severe systemic illnesses
- Vision, and conditions maintaining it
- Ambulation (a short practical demo of same)
- Orthopedic problems identified
- High-risk medications (e.g., anti-hypertensives, diuretics and hypoglycemics)
- Incontinence and needs to control
- Sensory or perceptual deficits (e.g., inability to utilize installed safety devices)
- Ability to communicate and or articulate
These 10 health factors may be solicited as part of the originating rental or ownership papers. Not so much as an applicant health quiz, but as a representation of attention to the individual’s present and future well- being. And there will undoubtedly be some others that are important to your resident.
2. Aide in Mobility
If practical, the use of physical facilities such as a pool, gym, golf course or spa, many of which are currently used by retirement communities as the offer of maximizing well-being, coordination and general health. All have a direct and obvious bearing on slip and fall incidents. Used by the resident, they carry the supplemental aegis of self-help.
Many communities already have one or more of these facilities in place. I would suggest that if not, the cost of installation would be validated by the realized cost prevention factor. In addition, interesting programs to support balance, strength and mobility would be direct aids in slip and fall prevention.
3. Fall Reduction
Careful review of the possible hazards (carpeting, lighting, stairs, grounds, etc.) in individual resident units can be reviewed and modified. The individual residents may be of great assistance, and make suggestions perceived that are not only practical, but encourage the “you make the difference” mode of thought.
To state an obvious theorem – if you can reduce falls, you reduce serious injuries, especially fractures.
4. Engage Resident – Communicating Risk Factors
If the admitting health assessment has been completed and reviewed, many of the individual resident’s risks to fall have been identified. It’s important that their risk status is then communicated to everyone involved (e.g., nurses, nursing assistants, occupational and physical therapists, physicians and other relevant staff members).
However much more may be done. Communication to and with residents is key to preventing many problems. A weekly or monthly newsletter/blog with appropriate articles and interviews concerning the resident population is a good beginning.
I would further suggest a regular “town hall” type meeting or “lunch and learns,” in which subjects of interest and or use to the resident population can be presented and discussed, such as getting residents input of potential hazards in their living quarters and grounds. Again, asking residents to contribute pieces to a monthly newspaper is another way of soliciting “you make the difference.”
Adjunctive to the health assessment can be a suggested schedule of regular medical and dental visits with appropriate written reminders to resident and resident’s family.
There is also an old fashioned communication tool, the suggestion box, soliciting suggestions for amelioration of any part of the senior living and placed in well attended locations throughout the community.
5. Take Extra Measures – Monitoring
Monitoring or follow-up of the resident’s care plan may occur on a regular basis. It’s simply a matter of staff information, education and interaction with families and residents. The purpose of monitoring is:
- To evaluate the effectiveness of the safety strategies in place
- To continue designs to reduce falls and/or fall risk
- To decide what to do next if the strategies are not effective
Yet another form of monitoring is to demonstrate the specific physical fall prevention devices and measures installed in each domestic unit to the resident. Questions should include: Do you know how to use “grab bar, medic alert device, cell phone, fire extinguisher, etc.?” With a review every few months or so to prevent forgetting is also useful. Once complete, all information should be added to the resident’s official record of ongoing performance.
6. You Make the Difference Resident/Residence
The biggest gift of safety is for everyone involved, residents and residence, to know that YOU MAKE THE DIFFERENCE. It promotes a culture of safety and partnership between resident and the community. Increasing the gift of safety to the resident, there is one further step the community may take, which is to encourage their residents to know that so often with slip and falls they themselves can may the difference.
A final word: The statistics can persist in creating a costly bottom-line for communities. What I have suggested above may not seem to represent an immediate answer to the issue of liability, however much of what I have suggested can be incorporated into the offer of safety from residence to resident, and will make a measurable difference.
About the Author
M.E. Hecht, M.D., is a published author, freelance writer and Orthopedic Surgeon. Her published books and articles have been written for Vogue Magazine, Sunrise River Press, The Wall Street Journal, American Medical News, Medical Tribune, Nations Business and others. She is also author of “A Practical Guide to Hip Surgery” and “The Slip and Fall Prevention Handbook, You Make the Difference” – both books are available online at Amazon.