A Paradigm Shift in Fall Prevention

1. Alabama Assisted Living Association Annual Conference 2009 A Paradigm Shift in Fall Prevention

2. What You Already Know… • Nearly 1/3 of seniors fall each year -- over 12 million • ½ of seniors over age 80fall each year • Institutional falls 60% more likely than falls at home • 1.8 million treated in emergency rooms for falls in 2005 • 433,000hospitalized that same year • Current cost of falls per year ~$20.2 billion • Average cost of a fall per person ~$20,000 Falls among seniors is the leading cause of injury death!! Overview

3. Drug Interactions • Vestibular Issues • Biomechanical • Neuromuscular • Skeletal There are Many Reasons for Falls

4. Added staff to care for fall impacts and complications • Lost revenue due to hospitalization or death • Potential for litigation • Increased state regulatory scrutiny • Tarnished image • Increased paperwork The Impact of Falls

5. Initial Fall Fear of Falling Activity Limitation Decreased Mobility, Fitness Increased Risk of Falls Proactive prevention of falls will instill confidence, encourage continued activity, thereby improving overall mobility and fitness Fall prevention is more than simply knowing who your fall risks are … A Downward Slide…

6. Goal 9 – Develop a plan to reduce the risk of resident harm from falls. Goal 9A – Assess and periodically reassess each resident’s risk for falling and take action to address identified risks Goal 9B – Implement a fall reduction program including a transfer protocol and evaluate the effectiveness of the program JCAHO Directives

7. ID high risk individuals, then observe • Primarily vestibular focus • Reactive vs. proactive • Awareness-based vs. Process-based • Limited follow-up • Structurally focused programs sometimes implemented by PT/OT groups within community Traditional Fall Prevention Programs

8. Supplements existing programs • Proactive & process-based • Focuses on chronic instability • Identifies most appropriate candidates • Collaborative effort among caregivers • Empowers facility for better resident care SWG’s Approach

9. Education • Evaluation • Communication of Recommendations • Care • Follow-up A Simple Methodology for Improvement

10. Assessment by doctor - an expert in ankle/foot instability • Thorough structural review: knee, ankle, foot • Custom-made supportive orthotics • From 14-22 Medicare-covered visits with YOUR therapists (or the home health company of your choice) The [fall prevention] program that you have implemented currently in long-term care facilities educates as well as protects the patient, assists the caregivers and saves money Testimonial by Kristine Russell, Publisher/Executive Editor Healthcare Purchasing News – Sarasota, Florida SWG – What is it?

11. Not just an orthotic, but a fall-prevention program, prescribed by a doctor and implemented by the facility’s own PT/OT staff collaborating with SWG doctors • Custom-casted for a perfect fit • Designed to fit patients with foot/ankle deformities • Custom fit will: • Not rub and cause lesions • Be comfortable, encouraging residents to wear them • Dramatically increase stability Why is This Different?

12. Decreases resident falls by up to 50% • Shown to decrease individual falls of participants by up to 90% • Increases resident health: • Improves resident respiratory and cardio function • Improves strength and dexterity in muscles and joints • Increases endorphin production -> stronger immune system • Little to no cost to resident – Typically covered by Medicare Win-Win Benefits to the Resident

13. Complements existing fall prevention programs • Decreases facility falls by up to 50% - “Halo” Effect • No contracts or long term agreements • No cost to facility • Protects facility revenue – resident retention • Potentially adds revenue in terms of additional Medicare-covered physical therapy Win-Win Benefits to Facility

14. Ambulatory, but with severe foot & ankle instability • Unsteady or requires assistance: • Cane • Walker • Gait Belt • Shuffles feet • Exhibits fear of falling • Desire and ability to be more mobile/active • Rehabilitation not effective • Medicare Part B Coverage Who is a Candidate?

15. Identify potential candidates with staff • Interview residents • Conduct gait and balance evaluation • Perform physical screening exam • Collaborate with staff to confirm potential program candidates • Consult with PCP concerning results and recommendations • Inform & educate resident to confirm their desire to participate The Process… Screening

16. Educate resident with respect to process • Prepare an individualized cast of each foot for participating residents • Review cast for quality • Send to manufacturer for construction (10 days) The Process…Casting

17. Custom fit resident’s orthotic to ensure: • Comfort • Fit • Quality • Establish goals with PT: • Confirm proper fit and comfort • Initiate graduated use program to acclimate resident to boots • Educate on appropriate use of orthotic – when to use, when not to use • Develop independence and confidence in ambulation • Communicate goals to resident • Follow up 60-90 days The Process…Fitting

18. Structural falls are preventable • Our mission is to keep your residents on their feet, and healthier in your communities • We identify appropriate candidates for our program, and/or may make recommendations for alternative care initiatives • We provide a holistic, process-based fall prevention program, not simply a product • Our job is to make your job easier • Our work is collaborative, to improve your residents’ quality of life Summary

19. Dr. Donald B. Havey (636) 536-2304 DrDon@seniorwellnessgroup.com A New Approach to Reducing Falls