Community Care and Wellness for Seniors WoodGreen Community Services Community Care and Wellness for Seniors Falls Prevention Strategy/Framework In-home care

Objectives To ensure a falls prevention framework that will help our clients (seniors aged 55 and older) live independently, longer and with dignity in their own home. Falls prevention framework as part of quality improvement within the Community Care and Wellness for Seniors unit

The FALLS Cycle FALL Fear of Falling Increased Risk of Falls Decreased Activity Decreased Strength & Movement Increased Risk of Falls FALL Adapted from Public Health Agency, 2005 Adapted from Public Health Agency, 2005

CCWS Falls Prevention Framework (In-home care) Falls incident reports Falls indicators Other falls reporting Evaluate intervention programs Continuing staff education Accreditation BEEEACH model: Education, Equipment, Environment, Activity, Clothing & Footwear, and Health Management modifications to drive behaviour change Falls Risk Assessment tool Support staff (e.g. PSW) training Falls prevention policies and procedures CCWS quality committee Plan CCWS’ plans to meet clients needs re: falls prevention Do CCWS’ work with clients to reduce falls : BEEEACH model Study How CCWS measures and monitors falls Act CCWS implements continuous improvement to prevent falls Education, Equipment, Environment, Activity, Clothing & Footwear, and Health Management modifications to drive behaviour change

CCWS Falls Prevention Framework (In-home care) Falls incident reports Falls indicators Other falls reporting Evaluate intervention programs Continuing staff education Accreditation BEEEACH model: Education, Equipment, Environment, Activity, Clothing & Footwear, and Health Management modifications to drive behaviour change Falls Risk Assessment tool Support staff (e.g. PSW) training Falls prevention policies and procedures CCWS quality committee Plan CCWS’ plans to meet clients needs re: falls prevention Do CCWS’ work with clients to reduce falls : BEEEACH model Study How CCWS measures and monitors falls Act CCWS implements continuous improvement to prevent falls Education, Equipment, Environment, Activity, Clothing & Footwear, and Health Management modifications to drive behaviour change

CCWS’ Plan to Implement Falls Prevention Falls Risk Assessment & Intervention plan (See Appendix 1) Policy, procedures, guidelines, and forms for Falls Risk Assessment, Prevention, and Intervention (including roles and responsibilities of each care provider – most likely PSW’s) Staff communication and education about falls risk and falls prevention (e.g. Personal Support Worker Training) Recommendation to include Falls Prevention Champions as part of CCWS Quality Committee Team to serve as proxy for regular safety checks and environmental audits, support the investigation of incidents, and lead ‘Falls Prevention Awareness’ month activities

CCWS Falls Prevention Framework (In-home care) Falls incident reports Falls indicators Other falls reporting Evaluate intervention programs Continuing staff education Accreditation BEEEACH model: Education, Equipment, Environment, Activity, Clothing & Footwear, and Health Management modifications to drive behaviour change Falls Risk Assessment tool Support staff (e.g. PSW) training Falls prevention policies and procedures CCWS quality committee Plan CCWS’ plans to meet clients needs re: falls prevention Do CCWS’ work with clients to reduce falls : BEEEACH model Study How CCWS measures and monitors falls Act CCWS implements continuous improvement to prevent falls Education, Equipment, Environment, Activity, Clothing & Footwear, and Health Management modifications to drive behaviour change

Multifactorial Approach to Preventing Falls - BEEEACH model Behaviour Change Equipment Activity Clothing and Footwear Education, Equipment, Environment, Activity, Clothing and Footwear, and Health Management modifications/interventions towards behaviour change Each category includes: description of category, risk assessment, interventions and referral options (if applicable) Scott et al., Canadian Falls Prevention Curriculum

Education Consistent and regular communication with clients, family and/or caregivers and staff is essential to reducing falls and injury from falls. Tools to facilitate communication include: visual identifiers, direct communication with the circle of care, client engagement in falls prevention intervention strategies. CCWS unit educates its home care providers on the following: Definition of falls Falls statistics – frequency, outcomes, and associated costs Impact on quality of life Risks assessment and associated intervention plan/options Risk management and post-fall follow up Clients, family and/or caregiver education and supportive linkages/referrals: Health promotion and education team activities such as: “Healthy talks” e.g. staying safe in the home, diabetes education, etc., client information handouts, etc.

Environment Most falls occur in and around the home and an assessment of the home environment aims to enhance accessibility, safety, and performance of daily living (Public Health Agency of Canada, Report on seniors’ fall in Canada, 2005). CCWS home care providers to assess indoor and outdoor home environment as part of a Falls Risk Factor and Intervention Plan (as shown below) A home environment hazard checklist should also be completed for a more comprehensive environment risk assessment and interventions (Appendix 2).

Equipment Equipment and Assistive devices may reduce the risk of falls if properly used and maintained. If client uses mobility aids or assistive devices, CCWS home care providers to assess based on the Falls Risk Factor and Intervention Plan (as shown below) and intervene accordingly. Staff should also use the inter-RAI CHA to assist with identifying clients with physical function limitations related to gait, balance, etc. beyond the improper use of mobility and assisted devices.

Activity Inadequate physical activity and age related changes such as: decreased strength, balance, and flexibility present a risk factor for falls. CCWS home care providers encourage staff to engage in regular physical activity to reverse age related changes and increase strength, balance, flexibility and endurance. The Falls Risk Factor and Intervention Options below should be used to evaluate falls risk related to physical activity. Staff should also refer to the inter-RAI CHA to assist with identifying clients with physical function limitations related to gait, balance, etc.

Clothing and Footwear Inappropriate, no support and inadequate fit clothing and footwear are key risk factors for falls CCWS home care providers to assess based on the Falls Risk Factor and Intervention Plan (as shown below) and intervene or refer clients as needed.

Health Management Medication reviews and medication reconciliation between transitions is an effective way of reducing the side effects of medications and potential falls risk (Pharmacoepidemiology Drug Safety, Medication use and risk of falls, 2002) CCWS home care providers to assess based on the Falls Risk Factors and Intervention Plan (as shown below) and intervene or refer clients as needed.

CCWS Falls Prevention Framework (In-home care) Falls incident reports Falls indicators Other falls reporting Evaluate intervention programs Continuing staff education Accreditation BEEEACH model: Education, Equipment, Environment, Activity, Clothing & Footwear, and Health Management modifications to drive behaviour change Falls Risk Assessment tool Support staff (e.g. PSW) training Falls prevention policies and procedures CCWS quality committee Plan CCWS’ plans to meet clients needs re: falls prevention Do CCWS’ work with clients to reduce falls : BEEEACH model Study How CCWS measures and monitors falls Act CCWS implements continuous improvement to prevent falls Education, Equipment, Environment, Activity, Clothing & Footwear, and Health Management modifications to drive behaviour change

Quality Measurement & Indicators Falls Indicator Definition and Goals Falls Rate The total number of falls as a percentage of the total number of clients within the target population. The goal should be to achieve an annual percentage reduction. Completed Falls Risk Screening on Admission The total number of clients admitted to service for whom a falls risk screening was performed as a percentage of the total number of clients admitted to service during the identified time period. The goal should be to complete this for 100% of clients. Falls Risk Assessment Completed Following a Fall (Post-Fall Assessment) The total number of clients who experienced a fall for whom a falls risk assessment was performed as a percentage of the number of clients who experienced a fall in a defined time period. The goal should be to complete this for 100% of clients. Falls Risk Assessment Completed Following a Significant Change in Medical Condition The total number of clients who experienced a significant change in medical status for whom a falls risk assessment was performed as a percentage of the total number of clients who experienced a significant change in medical status in a defined time period. The goal should be to complete this for 100% of clients.

CCWS Falls Prevention Framework (In-home care) Falls incident reports Falls indicators Other falls reporting Evaluate intervention programs Continuing staff education Accreditation BEEEACH model: Education, Equipment, Environment, Activity, Clothing & Footwear, and Health Management modifications to drive behaviour change Falls Risk Assessment tool Support staff (e.g. PSW) training Falls prevention policies and procedures CCWS quality committee Plan CCWS’ plans to meet clients needs re: falls prevention Do CCWS’ work with clients to reduce falls : BEEEACH model Study How CCWS measures and monitors falls Act CCWS implements continuous improvement to prevent falls Education, Equipment, Environment, Activity, Clothing & Footwear, and Health Management modifications to drive behaviour change

Program Evaluation All new staff should be oriented and trained on CCWS falls prevention framework and tool Quality indicators used to track outcomes of falls prevention framework Track number/percentage of clients who get who get connected to service following a fall (post- fall follow up) Ongoing staff education and feedback re: Falls Prevention Assessment and Intervention tools Opportunity for quarterly/semi-annual reports based on indicators to be prepared for CCWS quality committee To be discussed

Next Steps Audit public folders and files to ensure revised Falls Prevention Assessment Tool is saved and accessible to all staff Training on revised CCWS Falls Prevention Assessment Tool to be completed in Q4 (January – March, 2013) Falls Prevention Intervention Resource Package documents to be stored at a central location for ease of access Operational processes to support tracking and reporting of quality indicators to be developed Falls prevention quarterly/semi-annual reports to CCWS quality committee To be discussed

Appendix 1

Appendix 2 – Home Environment Hazards Checklist Need updated electronic version