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.
It’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.
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.
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.
“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.
“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.”