People of all ages can have a fall, including those living in an assisted living facility. It’s important that staff know what interventions can be done to decrease the risk and frequency.
First, be sure you have asked the resident and the family about the history of falls prior to admission. Can a cause be determined? It is possible the fall was a simple trip because of uneven ground or related to past medications? Is the likelihood of that contributing factor to be unrecurring or unrelated to fall prevention? Did the resident just complete rehabilitation in a skilled facility? What is the resident’s overall health? Does the resident have a current consult for physical therapy to help determine these things for maximum walking and strength?
Residents can get stronger. Ask them what they would like to do to stay active. Sometimes, residents like a particular physical activity that would help keep them stronger, so provide or coordinate that activity with an outside resource. The key is to encourage and help keep your residents as active as possible. Some residents do not have the internal determination to be active, but with your encouragement they will.
There have been times the physical therapist will give instructions for the resident to walk everyday, even when he/she uses a wheelchair most of the day. How do you communicate the resident’s needs to the staff, and has your staff been trained to meet the needs of each individual resident? Have you made sure your resident assistants have been trained on what each resident can and should do each day? Encourage the staff to find ways to assist the resident to maintain his/her level of independence. If the resident walks, then staff should walk with the resident to the dining room instead of pushing his/her wheelchair. It may take a little more time, but if it keeps the resident stronger, he/she will have less falls even out of the wheelchair and with transfers.
According to AHCA’s Adverse Incident Reporting data site, there were over 1,225 fractures reported in assisted living facilities in 2019. Keep in mind, there could be more that have not been reported. It only takes one fall to have a fracture, but some residents are “frequent fallers.” Are you looking at the root cause of the falls? Sometimes, if the root cause is found, the resident will stop falling or at least not fall as often. If a resident has falls frequently, review if he/she needs a higher level of care to stay safe.
Basic things that can be variable from day to day include clearing cluttered floors in resident rooms, good fitting footwear and variable blood pressures. It is always good to ask the physician for a home health consult to follow blood pressures, even if you have the capability of obtaining the blood pressures. Other action items include:
- Check rugs and carpets throughout the facility. Tack down curled edges and secure edges.
- Discourage use of throw rugs and if resident uses them, only nonskid backing.
- If you wax your floors, use non-slip wax and buff.
- Move trashcans or other objects on floor, out of paths of travel.
- Repair loose or uneven floorboards.
- Good lighting and easy access to adjust lighting is important.
- Don’t forget to have appropriate assistive devices.
Additionally, does your activities program offer active options for strengthening and mobility? A form of tai chi is more effective in preventing falls in older adults than stretching or a multimodal exercise regimen consisting of aerobics, weights, and balance activities, according to a study published September 10 in JAMA Internal Medicine.
Some people say they are afraid for a person to get up and fall. While that is a real concern, not encouraging walking is only going to increase an individual’s risk and the likelihood of doing just that, falling. A fall can be life changing for your residents and staff. Prevention will not stop every fall, but it will help reduce the frequency.
If this is not something you focus on, make it a goal for the New Year to increase fall prevention with your staff and residents.