5 Fall Prevention Tactics for Home Care Providers

5 Fall Prevention Tactics for Home Care Providers

Too often, falls are seen as inevitable. Home care providers know they aren’t.

Out of fear, older adults who have been diagnosed with conditions that increase the likelihood of falling may become inactive. Family members may begin looking into residential care — especially in cases where one fall has already occurred.

It’s understandable. According to Alberta’s Injury Prevention Centre, 1 in 3 older adults will fall. Most of these falls will occur at home.

If you’re involved in the operation of a home care agency, you’ve probably heard the statistics. But you also know from experience that the majority of patients are happier in their own homes.

Still, providing home care for those at risk of falling comes with serious challenges. Patients receiving at-home care have greater freedom to make their own choices – including choices that make them more likely to experience serious falls.

In addition, as the demand for services booms, many agencies are finding it difficult to implement reliable standards and procedures to deal with adverse events.

Luckily, some fall prevention tactics are applicable across agencies – and surprisingly feasible. This post will look at a few of these tactics, which will be of interest to those in management and on the front lines.

1) Match Caregivers and Clients Appropriately

This one may seem like a no-brainer, but matching clients with service providers who have the skills and experience to deal with their conditions is crucial. Of course, whenever possible, it’s also best to send a client a caregiver that she or he is already familiar with.

The role that well-matched, consistent care can play in fall prevention is often overlooked. Extensive knowledge of a client’s condition can translate into better ongoing risk assessment and a better care plan. Dementia and diabetes are very different conditions – it’s no surprise that the symptoms they cause can lead to very different fall scenarios.

Consistency is also important. Clients are far more likely to accept physical help with risky tasks and advice related to their behaviour when it comes from caregivers they know and trust.

Some home care providers operating in Canadian locations – such Qualicare and Home Instead – view superior client-caregiver fit and caregiver consistency as major priorities. Smaller agencies can also benefit from this kind of thinking, which makes the most of human resources.

2) Encourage Staff to Look for Sneaky Risk Factors

We all know the common risk factors for falls. Dementia, visual impairments, gait and balance issues, benzodiazepine use, and (of course) previous falls are well-known examples.

Most nurses know the potential hazards of these conditions, and many PSWs have practical experience with them. Falls are frequently prevented because caregivers see a clear risk factor and implement the right safety measures.

But not all falls have such obvious causes. According to some estimates, infections are responsible for between 20 and 45% of all falls. In clients with preexisting risk factors (such as dementia) infection can be the catalyst for an adverse event.

Sleep problems are another often-overlooked factor. Poor sleep and frequent awakening can lead to decreased cognitive functioning and walking late at night – both of which are associated with a greater likelihood of falling.

Home care agency decision-makers can reduce falls by encouraging staff members to be aware of less common risk factors and continuously expand their knowledge of potential signs of trouble.

3) Provide Staff with Resources and Educational Opportunities

As the demand for home care continues to grow, many agencies are working to develop more rigorous caregiving standards. Training, education, and access to relevant resources can help caregivers meet new expectations.

Falls are the single biggest cause of home care client hospitalizations from injuries; fall prevention should be a major focus of agency decision-makers looking to educate staff.

As part of a recent initiative that looked at person-centred home care training, Saint Elizabeth developed general guidelines for organizations trying to developing internal education. The initiative included “train the trainer” sessions, which focused on teaching personal support supervisors to run workshops for staff.

If your agency doesn’t have the resources for education development, you can still incentivize or encourage staff members to continue building their skills by pointing them towards authoritative resources and courses (like, for example, the Alzheimer’s Association’s online dementia care training program).

4) Implement a Team Approach to Fall Prevention

An interdisciplinary approach is often the best way to address complex healthcare challenges. When it comes to fall prevention, nurses, physiotherapists, occupational therapists, and nutritionists (among other practitioners) can work together to reach better outcomes.

In the home care landscape – where providers are often described as “silos” who work separately from one another – interdisciplinary and team approaches can be particularly challenging. But as falls in communities increase, interest in team approaches is growing.

Even in smaller organizations, home care providers will likely have varied skill sets and real-world experiences. Arranging care in a way that allows you to capitalize on the many strengths of your team can help you develop new, person-centred tactics for preventing falls.

5) Implement Fall Detection Technology for At-Risk Clients

Sadly, no amount of staff education or guidance can completely eliminate serious falls in older adults. There are times when caregivers just can’t be with their clients. And when clients are alone, accidents can happen.

For those who are most at risk, fall-detection technology can be a lifeline. Wearable emergency products have come a long way in recent years. Sensors can actually determine if a client has fallen and send instant notifications to caregivers, emergency personnel – even family members.

Using the right system, caregivers can initiate instant, two-way communication with clients to assess the potential seriousness of a fall immediately after it’s occurred.

While fall-detection solutions are most valuable for the life-saving emergency care they facilitate, they play a role in prevention, too.

Studies show that significantly limiting physical activity out of fear can actually increase the chances of falling, as can ignoring the possibility of a fall altogether.

Wearable fall detection provides security for older adults so that they can carry out day-to-day activities without feeling anxious. It serves as a reminder for older adults who are less likely to consider falls that they should complete at-home tasks in the safest way possible.

The Big Picture

As healthcare in Canada moves increasingly into homes, home care providers are under increased pressure. Finding solutions to some of the biggest problems in the field – such as the ever-increasing number of falls in the community – will provide a huge challenge in the years ahead.

Through it all, home care professionals are committed to providing clients with security, comfort, and independence. With these aims in mind, agency owners, directors, and managers can start shaping fall prevention strategies that draw on their greatest resources: caregivers.

Feature Image Courtesy: David Amsler

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COPD Education – Onboarding

Objective

To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Actors
Patient, Educator (Nurse, RT, the Physician could also be the educator)

Timelines
One 60-90 min session with the Educator

Description
  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
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COPD Education – Continuous Maintenance

Objective 

To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

Description
  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
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COPD Respiratory Status Follow-up

Objective

Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

Description
  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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