Falls, falls, falls. Definitely risky business right? But why, since most residents who fall in our centers are the ones who fell in the community and at home, before coming to our communities? It's no surprise that if a fall occurred before admission that falls will occur again. Understanding that we may not be able to prevent all falls or injuries, how do we manage family expectations?
Let’s start in the beginning. Many years ago we had “nursing homes”—now we have “subacute care centers,” “rehab centers,” “post-acute care centers,” etc. However, it doesn’t matter what we call ourselves, our mission is to provide quality care with positive outcomes. There is no secret sauce to success and if it were easy, everyone would do it. However, there are a few key elements that may assist in achieving success.
Preventing Falls by Reading Between the Lines
One of the most common practices we observe during the referral process is that staff review medication orders, rule out antisocial behaviors, and assess what specialty equipment is required. These are all important factors in reviewing a referral, but we tend to overlook some subtle things that could assist in identifying fall risk.
If the resident is currently hospitalized, review what is currently being done to assist in preventing falls. Is the resident receiving skilled therapy services related to weakness, unstable gait, etc.? If so, it may be beneficial to take a deeper dive into the documents, looking for a history of falls.
Ask the Right Questions During Admission
Another area of risk is the admission process. Scenario: Daughter is in the admission office signing admission paperwork. The stress she is under is palpable, she knows mom can’t go home with her so when the admissions director asks, “Has your mom had any falls recently?” the daughter says “No” because she's afraid that the admission will be denied. Contrary to common belief, families are not always honest with us. So, if the question was worded as, “What was your mom doing the last time she fell?” or, “When was the first time your mom experienced a fall?” the daughter will feel that we expect that her mom has a history of falls and she won’t be afraid to be honest.
Set Proper Expectations for Fall Prevention
So, we get through the paperwork, the daughter is honest enough to admit her mom has experienced falls at home, and we say, “We have a fall prevention program here.” What do you think the daughter hears? That her mom will not fall! Now we've set ourselves up for failure! It's always better to be honest from the start: “Since your mom has experienced falls at home, it is likely she will fall here. Our goal is to assist in preventing injuries related to falls, but we may not prevent the fall itself.” Then when mom does fall it won’t be shocking to the daughter!
Communicating with Family Members
We talked about the referral and admission process and the importance of being honest and open. However, communication cannot end there! What are your current practices for communicating with family members? Are you using social media sites, communication portals, etc.? Are you only communicating when there's a problem or a negative outcome? Think about it: if the only time your phone rings is when there's a concern, your level of confidence in the care being provided may wane.
That said, if you have a phone call once a week with positive news on your mom’s progress, that occasional negative call is much easier to handle. Many communities use a “guardian angel” program where each member of the management team “adopts” families and maintains communication with them on a regular basis. This fosters a sense of community and family, and encourages open communication!
Bottom line: falls happen. Families can be distressed, but open communication with them will assist in decreasing the risk of claims.
So where do you start? Your QA Reader reports can assist with this process! Review your QA reports, establish a priority list of residents at highest risk, and start there. If a resident has experienced a fall or several falls, consider them a higher risk than the resident who has never experienced a fall. Identify the team member most likely to communicate well with the family and set the process in motion.
Discover how QA Reader has helped other communities prevent falls and reduce risk—download our Advantage Living Centers case study.
