PREVENTING FALLS IN SKILLED NURSING

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PREVENTING FALLS IN SKILLED NURSING

Preventing Falls in Skilled NursingWHCA Winter ConferenceFebruary 22nd, 2019Carolyn Ham, PTAOlder Adult Falls Prevention SpecialistWashington State Department of HealthLisa BrudvikFitness ManagerSkyline

Falls Are PreventableSafety ModificationsScreeningExerciseCDC 2017Washington State Department of Health 3

Preventing Falls in Skilled NursingFALLS RISK TRIVIA

Falls Prevention TriviaMedicationsHidden Fall RisksChronic ConditionsLevel 1Level 1Level 1Level 2Level 2Level 2Washington State Department of Health 5End

Medications – Level OneThe risk of a fall issignificantly increasedwhen starting orchanging amedication forBloodPressureHomeWA State DOH 6Photo by rawpixel on Unsplash

Medications – Level TwoThree types of medicationsthat increase risk for fallsPain medicationAnxiety medicationSleep medicationPhoto by rawpixel on UnsplashHomeWA State DOH 7

Hidden Fall Risks – Level OneFear ofFallingcausesincreased riskof fallsHomePhoto by Leio McLaren(@leiomclaren) on UnsplashWA State DOH 8

Hidden Fall Risks – Level TwoCan be caused byisolation, lack ofappetite or difficultyswallowing andincreases risk of fallsMalnutritionWA State DOH 9Photo by Thought Catalog on UnsplashHome

Chronic Conditions – Level OneDecreased sensation in thispart of the body, often causedby diabetes, increases risk offallsFeetHomePhoto by Frank Vex on UnsplashWA State DOH 10

Chronic Conditions – Level TwoOlder adults should get theirVision checked every yearto decrease risk of fallsHomePhoto by David Travis on UnsplashWA State DOH 11

FALLS PREVENTION FACTSWashington State Department of Health 12

Falls in Skilled Nursing Falls cost 6,200 per resident per year Half of all SNF residents fall every year From January-June 2018 in Washington, 17% ofSNF residents were reported as having had afall since their last assessment (MDS) Residents who fall infrequently are more likelyto be seriously injured Residents with moderate to severe cognitiveimpairment are at increased redirectedFrom Downloads/nursinghomedatacompendium spxman1.htmlWashington State Department of Health 13

High Risk Groups Age 85 Cognitive Impairment Chronic Conditions Homebound Multiple MedicationsWashington State Department of Health 14

Leading Risk Factors For Falls In SNF Decreased leg strength and balance Environmental hazards Medications Vision and Hearing Problems Decreased sensation in feet, poorly fitting shoes Difficulty with transfers Improper use of assistive devices Urinary Urgency and/or Incontinence Depression Cognitive Impairment* Advanced Age* Chronic Conditions**Non-ModifiableWashington State Department of Health 15

Preventing Falls in Skilled NursingFALLS PREVENTION STRATEGIES

Common Environmental Safety ChallengesA recent study found that more than 30% of recorded falls inskilled nursing facilities had an environmental cause Assistive device height or malfunctiono Should be at wrist or hip heighto 4WW brakes loose (DME retailer or PT)o Wrong AD, using on wrong side Bed transfer set up unsafeo Bed too high/no crash mat availableo AD not close enough to bed Dining room/hallway chair safetyo Should not swivel or rollo Adequate height for safe sit to stand gton State Department of Health 17

Falls Prevention Considerationsfor Bedbound Residents Cushion wedges Transfer Poles Crash mat Care plan 2-person rolling, or place bed next towall for rollingWashington State Department of Health 18

In The BathroomMany falls occur in the bathroomCommon issues in skilled nursing are: Placement of grab bars Slippery floors and surfaces Visual deficits Impulsivity/IncontinenceWashington State Department of Health 19

Bathroom SafetyIdeas to improve bathroom safety: Request staff feedback on grab bar locations,and fix as needed Place signage to remind staff to dry floors andsurfaces Use brightly colored toilet seats for residentswith memory and visual deficits “No Wait” policy for residents with dementiaWashington State Department of Health 20

Medications That May Increase spital/fallpxtoolkit/fallpxtk-tool3i.htmlSpecial care when starting and changing dosesRisk level related to fallsHighDrugs that change mood andthinking: antianxiety, pain andsleep drugsMediumDrugs to treat high bloodpressure and other cardiacconditionsLowDiureticsWashington State Department of Health 21

New Hearing Aid Benefit for Medicaid Enrollees Hearing loss has been shown to be independentlyassociated with falls. Starting in January 2019, hearing aids are be a coveredbenefit for Washington Medicaid enrollees age 20 andolder. During last year's legislative session, the Washington StateLegislature passed ESSB 5179 that requires Apple Health(Medicaid) to cover hearing instruments (hearing aids)when medically necessary. See the Health Care Authority site for this benefit to learnwho is eligible and how to use this benefito gov/pmc/articles/PMC3518403/Washington State Department of Health 22

Depression is Treatable There is a significant bi-directional relationshipbetween depression and falls Depression in older adults may have differentsymptoms:o Trouble sleepingo Irritabilityo Loss of interesto Persistent thoughts of suicide Up to 50% of SNF residents are diagnosed withdepression Depression is not a normal part of aging, and can besuccessfully treated by mental health depression-and-older-adultsWashington State Department of Health 23

Group Activity ExerciseEvidence-based programs are the most effectiveWashington State Department of Health 24

Evidence-Based Group Exercise Several evidence-based falls prevention programscan be adapted for use in Skilled Nursing:o Otago Exercise Program group adaptation Facility PTs can get training in Otago DOH offers scholarships for training and technicalassist with starting a programWashington State Department of Health 25

Resources for Preventing Falls The Agency for Healthcare Research and Quality(AHRQ) free toolkitso AHRQ’s Safety Program for Nursing Homes: OnTime Falls Preventiono The Falls Management Program: A QualityImprovement Initiative for Nursing Facilitieso Preventing Falls in Hospitals Has risk assessment tools that can be hospital/fallpxtoolkit/index.htmlWashington State Department of Health 26

Skilled NursingFitness Program at SkylineLisa Brudvik, Fitness ManagerFebruary 22, 2019

Life Plan community in downtown Seattle Opened in October 2009 The Tower Independent living: 199 apartments The Terraces Assisted living: 48 apartments Skilled nursing: 34 beds Memory support: 28 apartments

Fitness Programming Objectives Physical movement Cognitive health Social engagement Empowerment Purpose Fun!

The Individual What are their barriers? What motivates them? Focus on their ABILITY vs disability. They should leave feeling better than whenthey arrived.

Strategies Considerations Environment: accessibility, natural light, flooring, chairs Time of day Naming of classes Regular evaluation of program offerings Look for opportunity to celebrate success Who are your Champions?

Fitness Offerings at Skyline Fitness classes 35 fitness class per week 10 classes per week with focus on our Terraces residents Range of classes for all physical and cognitive abilities Personal training (fee-based service)

Teamwork Relationships PT & OTCare Planning TeamLifestyle CoordinatorRestorative NursingFamilies Examples of other activities Annual walker and wheelchair tune-ups Skyline Olympic Games IN2L (It’s Never 2 Late)

Every interaction is an opportunity tomake an IMPACT!

Questions? Comments?Lisa k you.

Case Study: Mr. JonesMr. Jones is a pleasantly confused andoccasionally agitated 75-year-old man, who livesin a SNF. He can dress and feed himself withassistance, and he ambulates with a 4WW thathis sister gave him. He has had three non-injuryfalls in the past week, two were in bathroom, andthe third was next to his bed. Mr. Jones statesthat he fell because he “lost his bearings” andthat he was “trying to go too fast.”Caregivers state that Mr. Jones has been gettingup suddenly which doesn’t give staff enoughtime to get there and help him before he falls.What can you do to help him stop falling?Washington State Department of Health 38

Questions?

Washington State Department of Health is committed to providing customers with formsand publications in appropriate alternate formats. Requests can be made by calling800-525-0127 or by email at civil.rights@doh.wa.gov. TTY users dial 711.

skilled nursing facilities had an environmental cause Assistive device height or malfunction o Should be at wrist or hip height o 4WW brakes loose (DME retailer or PT) o Wrong AD, using on wrong side Bed transfer set up unsafe o Bed too high/no crash mat available o AD not close enough to bed Dining room/hallway chair safety

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May 13, 2021 · care) and long-term care (sometimes referred to as nursing home care). Of note, more than 90% of SNFs provide both long and short term care. 9. Skilled nursing care is a high level of medical care often required after a hospitalization for injury or illness. The average length of stay for skilled nursing care is four weeks, and the primary .

guidelines 11 Skilled Nursing/ Rehabilitation Services Five broad categories of Skilled Care: – Observation and assessment – Management and evaluation – Teaching and training – Direct skilled nursing services – Direct skilled rehabilitation services Resident must require on a daily basis