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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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).

11. 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.

12. 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.

13. 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.

14. 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.

15. 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

16. 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.

17. 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

18. 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

19. 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

20. Appendix 1

21. Appendix 2 – Home Environment Hazards Checklist
Need updated electronic version