While resident falls remain a common occurrence within the aging services community, data reveals that many of these falls are preventable.
The following seven statistics are presented in the most recent CNA Aging Services Claim Report, which analyzed 2,617 closed claims that were associated with aging services facilities:
- Falls represent 1,117 closed claims of the 2,617.
- Of these 1,117 fall-related claims, 88.5 percent involved failure to monitor and improper care of residents.
- The average total paid by CNA for fall-related claims was $186,589.
- The most frequent location for claims related to falls was residents' beds, in many cases when residents did not receive adequate assistance when transferring in and out of bed.
- Approximately half (48.4 percent)of the falls resulted in death.
- Of falls reported, almost two-thirds (61.1 percent) were not witnessed by staff.
- Factors contributing to resident falls include noncompliant residents, resident neglect and staff shortages.
The volume of falls underscores the importance of focusing on preventive programs and practices. The consequence of these falls demonstrates the urgent need for leadership teams to create compassionate, resident-centered care environments. Aging services facilities are urged to engage in the development of individualized care plans for every resident.
How can risk exposures related to resident falls within the aging services community be addressed?
How can risk exposures related to resident falls within the aging services community be addressed? While we can highlight specific scenarios discussing reasons for the increased frequency of falls, as a healthcare community, we must ask ourselves: Are we fostering a culture that supports resident-centered care to meet the unique needs of each resident that also rewards staff for creating an environment where resident safety is a priority? Does engagement of both the leadership team and resident care team strengthen an organization's ability to improve its fall prevention program and create an environment where falls are preventable?
The following examples highlight two organizations that demonstrated the importance of leadership engagement to reduce fall rates and encourage the industry to engage, lead and succeed.
The leadership team at a for-profit life plan community identified the need to implement a fall prevention program. Rather than simply instituting new policies and procedures, the leadership team established a Corporate Falls Steering Committee. The committee was tasked with developing standards to guide its clinical care and also "hard-wire" the program so that its essential components became sustainable and immune to staff turnover and organizational change. By involving staff early in the process and inviting their feedback, the fall reduction program helped leaders achieve their organizational safety goals.
Notably, collaboration was strengthened throughout the organization, promoting the recognition, participation and approval of front-line staff. Highlights of the program include:
- Viewing resident falls as a syndrome with a constellation of causative factors
- Making clinical decisions collaboratively
- Implementing "universal fall precautions"
- Utilizing evidenced-based fall prevention standards
- Monitoring and analyzing the outcomes of specific interventions designed to reduce falls.
- Documenting and communicating expectations
- Emphasizing proactive medication reconciliation
Another example involves a not-for-profit skilled nursing facility with short-term rehabilitation services. The director of nursing noted that elders fall in nursing homes more than in their homes, attributing these falls to residents' overall frail physical condition, multiple comorbidities and memory impairment.
The facility's leadership believed that providing a safe and homelike environment for residents was an attainable goal that did not require an elaborate set of policies and procedures or excessive revenue.
The organization's fall program includes several components that differentiate it from similar programs, contributing to sustained success:
- In-depth investigations following every resident fall
- Judicious use of personal alarms
- Nursing assistants rotating as hall monitors
The following policies and procedures have been established and consistently implemented:
- The facility is restraint-free.
- Every department undergoes continuing education with an emphasis on fall prevention.
- Residents are checked every two hours during staff rounds.
- Use of psychotropic medications is very low in comparison to state and national norms, and no hypnotic medications are administered to residents.
- All shifts conduct monthly meetings dedicated to the topic of resident falls.
Reducing falls in aging services organizations requires a commitment from the leadership team to engage caregivers, secure the necessary resources for education, in which the entire organization is accountable for preventing falls, ultimately creating a compassionate team focusing on the unique needs of each resident.