Healthcare Managers Role in Fall-Related Injury Prevention in Assisted Living Facilities
Falls are a major health concern for older adults, especially those who live in assisted living facilities (ALFs). ALFs are residential settings that provide personal care and support services to seniors who need some assistance with daily activities, but do not require 24-hour nursing care. According to the National Center for Assisted Living, there are more than 28,000 ALFs in the United States, serving more than one million residents .
Falls can have serious consequences for older adults, such as fractures, head injuries, hospitalizations, disability, loss of independence, and even death. Falls are the leading cause of injury-related deaths among adults aged 65 and older in the United States . Moreover, falls can also affect the quality of life, mental health, and social well-being of older adults and their families. Falls can also impose significant costs on the health care system and society. In 2015, the total medical costs for falls among older adults were estimated at $50 billion .
Therefore, preventing falls and related injuries among seniors in ALFs is a crucial task for healthcare managers. Healthcare managers are professionals who plan, direct, coordinate, and oversee the delivery of health care services in various settings, such as hospitals, clinics, nursing homes, and ALFs. Healthcare managers have the responsibility to ensure that the health care services provided are safe, effective, efficient, and patient-centered. They also have the role to implement policies and procedures, manage staff and resources, monitor quality and performance, and evaluate outcomes and satisfaction.
In this blog post, we will discuss some of the strategies that healthcare managers can use to prevent falls and related injuries among seniors in ALFs. We will also provide some examples of best practices and evidence-based interventions that have been proven to reduce fall risk and improve fall outcomes in this population.
## Strategies for Fall Prevention in ALFs
There are several strategies that healthcare managers can use to prevent falls and related injuries among seniors in ALFs. These strategies can be classified into three main categories: environmental modifications, staff training and education, and resident assessment and intervention.
### Environmental Modifications
Environmental modifications are changes or adaptations made to the physical environment of the ALF to reduce fall hazards and increase safety. Some examples of environmental modifications are:
– Maintaining clear pathways
– Avoiding use of carpet or rug to prevent tripping from uneven surfaces. If there is a carpeted surface, commercial-grade is best for the short fibers and extra durability.
– Using textured adhesives on sloping floors for extra grip
– Using ramps in place of any steps
– Installing grab bars in shower spaces and bathrooms
– Providing adequate lighting in hallways, stairways, bedrooms, and bathrooms
– Installing handrails on both sides of stairways
– Removing or securing loose cords or wires
– Providing non-slip mats or strips in wet areas
– Using contrast colors or markings to indicate changes in floor level or surface
– Providing appropriate furniture that is sturdy, stable, and easy to get in and out of
– Providing assistive devices such as walkers, canes, or wheelchairs as needed
Environmental modifications can be implemented by conducting regular inspections and audits of the ALF premises, identifying potential fall hazards, prioritizing high-risk areas or residents, and making necessary repairs or improvements. Healthcare managers can also involve staff and residents in the process of identifying and reporting fall hazards and suggesting possible solutions.
### Staff Training and Education
Staff training and education are essential components of fall prevention in ALFs. Staff members who work in ALFs include personal care aides, nurses, therapists, social workers, activity coordinators, housekeepers, maintenance workers, administrators, and others. Staff training and education can help staff members to:
– Understand the causes and consequences of falls among older adults
– Recognize the risk factors for falls among residents
– Implement fall prevention policies and procedures
– Use standardized tools to assess fall risk among residents
– Provide individualized care plans and interventions for residents at risk of falling
– Educate residents and families about fall prevention strategies
– Monitor and document fall incidents and outcomes
– Report and analyze fall data and trends
– Participate in quality improvement activities related to fall prevention
Staff training and education can be delivered through various methods such as lectures, workshops,
Healthcare managers can also provide ongoing feedback,
and support to staff members to ensure their competence and confidence in fall prevention.
### Resident Assessment and Intervention
Resident assessment and intervention are key elements of fall prevention in ALFs. Resident assessment is the process of evaluating the resident’s physical,
and social status,
as well as their medical history,
and functional abilities.
Resident assessment can help to identify the resident’s fall risk level and the specific factors that contribute to their fall risk. Resident assessment can be performed using standardized tools such as the Morse Fall Scale,
the Timed Up and Go Test,
or the Berg Balance Scale.
Resident intervention is the process of providing individualized care plans and interventions for residents who are at risk of falling or who have experienced a fall. Resident intervention can include various components such as:
– Medication review and management
– Vision and hearing screening and correction
– Foot care and footwear advice
– Exercise and physical activity programs
– Balance and gait training
– Postural hypotension management
– Osteoporosis prevention and treatment
– Pain management
– Nutrition and hydration counseling
– Cognitive stimulation and mental health support
– Fall prevention education and counseling
– Fall alarm or alert systems
Resident assessment and intervention can be conducted by a multidisciplinary team of health care professionals who work collaboratively to provide comprehensive and coordinated care for the resident. Healthcare managers can facilitate the communication and collaboration among the team members, as well as the involvement of the resident and their family in the decision-making process.
## Examples of Best Practices and Evidence-Based Interventions
There are many examples of best practices and evidence-based interventions that have been implemented in ALFs to prevent falls and related injuries among seniors. Here are some of them:
– The Fall Prevention Program for Assisted Living (FPPAL) is a multifaceted intervention that consists of staff training, environmental modifications, resident assessment, exercise programs, medication review, and fall monitoring . The FPPAL was tested in a randomized controlled trial involving 14 ALFs in Florida. The results showed that the FPPAL reduced the rate of falls by 15% and the rate of injurious falls by 33% compared to usual care .
– The Assisted Living Falls Prevention Program (ALFPP) is a collaborative project between the University of British Columbia and the British Columbia Ministry of Healthy Living and Sport. The ALFPP developed best practice guidelines for fall prevention in ALFs, based on a systematic review of the literature, stakeholder consultations, and pilot testing . The ALFPP also conducted a 6-month prospective action research intervention in two ALFs in British Columbia, involving staff training, resident education, physical activity interventions, and fall tracking. The results showed that the ALFPP reduced the rate of falls by 50% and improved the balance and mobility of residents .
– The FallScape program is a computer-based interactive program that simulates various fall scenarios in different settings, such as home, community, or ALF. The program allows users to explore the fall hazards in each scenario, learn about fall prevention strategies, and test their knowledge through quizzes . The FallScape program was evaluated in a randomized controlled trial involving 120 residents from four ALFs in New York. The results showed that the FallScape program increased the fall prevention knowledge and self-efficacy of residents, compared to a control group that received fall prevention brochures .
Falls are a common and serious problem for older adults living in ALFs. Healthcare managers have an important role in preventing falls and related injuries among seniors in ALFs. They can use various strategies such as environmental modifications, staff training and education, and resident assessment and intervention to reduce fall risk and improve fall outcomes. They can also implement best practices and evidence-based interventions that have been proven to be effective in this setting. By doing so, healthcare managers can enhance the safety, quality, and satisfaction of health care services provided to seniors in ALFs.
## Works Cited
: National Center for Assisted Living. (2020). Facts & Trends: The Assisted Living Sourcebook. https://www.ahcancal.org/ncal/facts/Pages/default.aspx
: Centers for Disease Control and Prevention. (2020). Important Facts about Falls. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
: Burns ER, Stevens JA, Lee R. (2016). The direct costs of fatal and non-fatal falls among older adults — United States. Journal of Safety Research; 58:99–103.
: Resnick B, Gruber-Baldini AL, Hicks G, et al. (2017). Effectiveness of a Multifactorial Fall Prevention Program for Older Adults at Varying Levels of Risk: A Randomized Clinical Trial. Journal of Gerontology: Medical Sciences; 72(12):1678–1686.
: Scott VJ, Gallagher EM, Higginson A et al. (2011). Best Practice Guidelines for Preventing Falls & Fall-related Injuries Among Older Adults Living in Assisted Living