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Long-Term Care

Falling: One of the biggest, and most preventable, threats to our lives

Hospitals no longer receive payments for treating injuries caused by in-hospital falls.

Hospitals no longer receive payments for treating injuries caused by in-hospital falls.

From flashlights to tai chi to rewards programs, health care providers are using various strategies to prevent falls by patients.

Falling is a dangerous — and very expensive — problem. Its direct medical costs are in the billions nationwide, more than $34 billion, according to recent reports. The total national cost of fall injuries is expected to soar to $59.6 billion by 2020, according to the National Council on Aging.

The Affordable Care Act imposes payment penalties on the 25 percent of hospitals whose rates of hospital-acquired conditions are the highest. Conditions caused by falls in hospitals are among those being measured, so there’s money at stake.

imagesIt’s well known that the risk of falling and being hurt increases with age. The CDC’s Injury Prevention and Control Center reports that every 13 seconds, an older adult is treated in a hospital emergency department for injuries related to a fall. About 20 percent of the elderly who have a major fall are likely to die within a year, according to national studies.

But not all falls involve seniors. No one of any age or situation is immune.

Falls are even an occupational hazard for health care workers. Many have been injured due to slipping, tripping or sliding while on duty in health care facilities. This is especially true for nursing assistants and nurses, says a recent report from the CDC.

The lead author of that study, Dr. Ahmed Gomaa, says that “occupational injuries including slips, trips, and falls among health care workers are prevalent and serious — but more importantly they are preventable.”

National figures from 2013 on the 10 leading causes of nonfatal injuries treated in hospital emergency rooms show how prevalent falls are. In every age category but one, falls were the leading reason for the ER visits. And for the one exception, the 10-to-24 age group, falls came in second.


Keeping falls from happening


“A lot of work on fall prevention is being done in Georgia,” says Elizabeth Head, program coordinator for injury prevention at the Georgia Department of Public Health. “It’s very important that we let the public know what’s available to help our seniors.”

Head is speaking about programs at senior centers that may not receive the attention they deserve: Matter of Balance and Tai Chi for Health.

olderamericans_355px“Tai chi has been researched using randomized control trials,” Head says. “Studies have found tai chi can reduce falls by as much as 30 percent.”

Tai chi is an ancient Chinese martial art with low-stress training techniques beneficial for physical fitness and mental focus. In the past several decades it has spread worldwide, and many programs, especially those geared to seniors, concentrate on exercise and health improvement rather than self-defense.

Both the tai chi and balance programs meet high levels of evidence in terms of being effective, Head says. “In fact, the Matter of Balance has shown a reduction in the fear of falling.”

Head says a major problem with falls is “as we age, no one thinks a fall can happen to them.” And the surprise is what happens when they do fall: fractures, hospital bills and an increased chance that they will fall a second or third time, according to hospital reports.

The Southwest Georgia Council on Aging (SOWEGA), which covers 14 counties, is in the process of testing a vigorous approach to prevention.

Although the SOWEGA studies were statistically small (21 patients in 2013 and 12 patients in 2014), both years showed reductions in falls with the use of tools like grab bars, flashlights, shower chairs and safety education.

“Flashlights have been a big hit,” says Babs Hall, SOWEGA program manager. Clients may not want to wake a spouse during the night, but need to get out of bed for one reason or another. A simple item like a handy flashlight can make a big difference, she says.


Innovative ideas


Since 2008, hospitals no longer receive payments for treating injuries caused by in-hospital falls, based on a 2007 final CMS rule. This serves as a strong incentive for health care facilities to focus on prevention.

Preventing falls “is a top priority throughout the Georgia hospital field,” says Kevin Bloye, a Georgia Hospital Association vice president.

Kathryn McGowan, GHA vice president of quality and patient safety, leads the charge on helping hospitals prevent patients from falling.

“The problem is multifaceted and super-challenging,” says McGowan. GHA looks at patient safety as well as worker safety, she says.

Georgia participates in a network agreement that engages hospitals throughout the state to improve patient safety and lower costs simultaneously. Network hospitals are encouraged to work together to make hospitals a safer place.

image001One North Georgia hospital, Northridge Medical Center in Commerce, has been especially successful with its prevention plans, says McGowan.

“Our plan was straightforward,” says Selina Baskins, a registered nurse at Northridge.

A fall-injury “prevention tree” serves as an incentive to the staff. The artificial tree is made of a wallpaper-type material and laminated, Baskins says. “It has the name of every nurse or nursing assistant on a removable leaf.”

If a patient falls, the nursing team member who had responsibility for that patient sees his or her leaf removed from the tree branch and placed on the ground. The hospital administration has a small monthly rewards plan for leaves that stay on the tree.

“It is simple, but works well,” says Baskins. “It certainly has made the staff more aware of falls.”

Even more important to the plan is a risk assessment for every Northridge patient. “If we note a patient is likely to need extra assistance with walking or getting out of bed, they receive an orange bracelet based on their medications, diagnosis, and balance abilities,” she says.


Nursing homes

“Patients in a nursing home are there for skilled nursing care or possibly rehabilitation,” states Linda Kluge, a program director for Alliant-GMCF, Georgia’s Quality Improvement Organization (QIO), a federal program dedicated to improving the quality of care for Medicare beneficiaries.

“Georgia has 360 nursing homes now,” says Kluge. Of those, 43 had no falls within a six-month period using specific falls prevention tools.

Among other initiatives, Georgia’s QIO addresses opportunities for health care improvement, such as looking at the overall quality of care for nursing home residents. Falling is only one issue, but it is critical.

Dr. Adrienne Mims, vice president and chief medical officer at Alliant-GMCF, says, “We measure mobility in many ways.”

Gait training and strength training play an important part. “Our geriatric management tool looks at how to address patients on a personal level,” Mims says. “Vision, medications and the environment are all items to be considered in the assessment.”


Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.



Aging in place: Limited mobility no longer means moving out of home

The Hamricks modified their Loganville home after Craig's spine injury, including a porch with a dual ramp to the backyard and pool deck, which also has motorized lift chair.

The Hamricks modified their Loganville home after Craig’s spine injury, including a porch with a dual ramp to the backyard and pool deck, which also has motorized lift chair.


Though aging was beginning to affect his normal activities, retired Col. Irv Schoenberg declared, “I’m not moving again.”

And that was that.

Retired Col. Irv Schoenberg heads to his home office — via an automatic stair lift.

Retired Col. Irv Schoenberg heads to his home office — via an automatic stair lift.

Between his career in the Air Force and his subsequent career in private business, Schoenberg had lived in nine states, as well as in Asia and Europe. Now, at his home in Dunwoody, he had come to treasure the feeling of being in familiar surroundings.

“I just prefer to stay in my own home,” Schoenberg said, “for as long as I can.”

He and his wife, Ann, had talked about getting a smaller place eight years ago. With health-related issues to consider, they realized that any such move would be more difficult the longer they waited.

Instead, they decided to stay, but to make some major changes. After consulting an architect, they added a master bedroom to the main floor of the house.

But even after that work, there was still an everyday challenge for Schoenberg — getting to his upstairs office. His years of research resided in labeled files in the second-floor office. And for him, the stairs were no longer manageable.

For the retired military man, who is 88, giving up on using the office was out of the question. It was part of maintaining his independence and normal life. So the couple installed a stair lift, a powered chair attached to the staircase that lets him ride up to the second-floor landing.

These devices, once associated with the ultra-rich and seen mostly in Hollywood movies, are now affordable and increasingly common in American homes.

“The main thing, was I didn’t want to fall again,” said Schoenberg, who had taken a bad tumble on his basement steps.

Among older adults, falls remain the leading cause of both fatal and nonfatal injuries. Recent data show the direct medical costs of falls are substantial. According to the CDC, the estimated cost in 2010 was $30 billion.


Modifying instead of moving


Since the recession of 2008, one of the fastest-growing segments of the residential remodeling industry involves senior home-dwellers. They prefer to stay in the home they’re used to, but need help to remain there.

One of several resources to look for when making home modification plans is CAPS, a Certified Aging-in-Place Specialist program.

A person with CAPS certification has specialized training in the area of helping people make changes in their current environment.

Rick Thaxton, a CAPS specialist with HomeFree Home Modification, worked in the home care provider area for a few years, and has given a lot of thought to home modifications.

“There’s everything out there when people start to look,” he said. It runs the gamut from “A Place for Mom” to a “Granny Pad.” “It’s a matter of what works best for each family.”

“Home is their designated comfort zone,” said Thaxton. And there’s a rewarding feeling when you can help clients meet their basic needs.

It might be as simple as taking out a bathtub and replacing it with a roll-in shower, said Thaxton. Or possibly widening a door to allow for a wheelchair, he added. Or it might include looking to the latest technology.

Improvements in technology have also been a boon to people who want to stay in their homes.

“I think a lot of the technology is most mature in the area of home monitoring and security: locks, alarms, motion detectors,” said John Morris, a research scientist with the Wireless Rehabilitation Engineering Research Center at Atlanta’s Shepherd Center.

“Of course, these can be of use to people with disabilities, elderly individuals and others.”

Morris explained that camera systems can let vulnerable residents know who is outside the door. Motion detectors tell a family member that their elderly or vulnerable loved one is moving about the house (and therefore, presumably OK).

“Beyond the ‘accessible home,’ there may be new solutions for the ‘assistive home’ that helps the resident do things,” he said.

Morris said there are many ideas for computer-based systems that cue or remind senior residents and people with brain injuries to carry out various activities of daily living (such as personal grooming, taking medication or preparing meals).


Dealing with disability


You don’t have to be over 65 to want to age in place.

Loganville resident Craig Hamrick, who is in his early 40s, found that out after a spine injury. It made being home alone somewhat risky if an unexpected problem occurred.

“He was at Shepherd Center with an injury that left him mostly paralyzed,” said Paula Hamrick, his wife.

“We moved into our dream home about two years before the accident happened,” she explained. “We knew we wanted to stay here, but we needed to learn how to make that happen.”

The Hamricks say that, in many ways, they were lucky. Their original builder was a believer in “aging in place.” All doors accommodated Hamrick’s wheelchair. Only the shower door had to be removed and the entry to the shower stall widened. They replaced the shower stall threshold step with a low ramp.

Then they looked for ways to get Hamrick in and out of the house. A motorized elevator platform in the garage filled the bill. The platform allowed for a wheelchair to ride up on the platform and then reach the kitchen floor level from the garage, eliminating the need for steps. It led to an outside door, and the hinges were changed to allow it to swing outward.

“At the time, that was the only way out of the house,” Paula said. She was worried about a potential fire in the kitchen or laundry room, and she knew they had to come up with a new idea for a second exit.

What worked for them was an add-on porch with a door and a dual ramp from the basic living area to the backyard and pool deck.

“Knowing he had two ways to leave the house allowed me to be able to go to work,” she explained. At that time, her employer was more than an hour away, and if her husband had an emergency, she was not close enough to help. Today she is able to work from their home.

The last thing on their list was driving. Cars can be ordered to accommodate many types of disabilities. The Hamricks received their new modified car this year.


One of the early modified cars was used by President Franklin D. Roosevelt in the 1930s and '40s in rural Georgia. Roosevelt, who had lost the use of his legs due to polio, enjoyed driving the totally hand-controlled vehicle to visit locals when he was staying at his Warm Springs residence.

One of the early modified cars was used by President Franklin D. Roosevelt in the 1930s and ’40s in rural Georgia. Roosevelt, who had lost the use of his legs due to polio, enjoyed driving the totally hand-controlled vehicle to visit locals when he was staying at his Warm Springs residence.


The more practical independence that seniors or the disabled have, the fewer caregiving responsibilities fall to their relatives. More than 162,500 clients seeking information and options for seniors and individuals with disabilities were served by the Aging and Disability Resource Connection during 2013, according to the Georgia Division of Aging Services (DAS).

According to recent estimates from the National Alliance for Caregiving, 65.7 million Americans served as family caregivers for an ill or disabled relative.

But “it is especially prevalent among adults ages 30 to 64, a group traditionally still in the workforce.” And for them it’s doubly hard to juggle work, health care, meals, and more.

Sometimes relatives have to take on many of the responsibilities of caregivers even though they live elsewhere. Whether you’re dealing with health care issues from afar via daily Skype calls, or relying on motion sensors to ensure a loved one is up and about, it’s complicated.

Hamrick’s and Schoenberg’s conditions were life-altering. But fortunately, so were the home modifications they got in response. Each time a new home modification was added to allow them more independence, it made life better, more normal again. And it helped them to stay put.

“When I lost my ability to drive,” said Schoenberg, “it was a difficult adjustment.” Being able to go where you want on a moment’s notice is a hard thing to give up.

But being able to stay in his own home has meant everything to him, he says. It helps him to maintain his everyday independence. “I know where things are and I can maintain my own schedule.”


Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

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