Caregiver Collaboration is Key to Falls Prevention

Jay V. Patel, PharmD, MBA, is the Clinical Transformation Officer at Seniorlink

Falls are the leading cause of injury in people aged 65 and older in the U.S. The issue is only more pressing when you take into account that the rate of deaths due to falls among people over 65 has climbed dramatically in the past decade. Even when non-fatal, falls take a toll that's both mental -- people who fall often become fearful of a repeat -- and monetary, with an estimated $31 billion in healthcare costs associated with falls each year in the U.S.

But there is good news. Unlike many of the defining health crises facing elderly Americans, falls can be prevented. That's why today we are joining the National Council on Aging in the call for awareness as part of Falls Prevention Awareness day.

We're taking this opportunity to share some of the lessons we've learned during efforts undertaken by Seniorlink to reduce falls within our in-home care model, Caregiver Homes. Our falls prevention initiative has helped us to prove that it's possible to significantly reduce falls, even among an evolving population of individuals with highly complex conditions. 

How We Approach Falls Prevention

In 2012, Seniorlink invested the time to conduct an intensive falls prevention training for the RNs and Care Managers who make up our Caregiver Homes Care Teams. Care Teams visit the homes of families in the program, providing support and guidance for the caregiver and advising him or her on the health needs of the consumer. The course focused on the importance of identifying and documenting falls in the home, and signs to look for as risk factors that could lead to a fall.

The Care Teams then coached the caregivers they work with on the lessons of the training. Since family caregivers know their loved one best, and are most attuned to the subtle changes in condition or behavioral cues, they are an ideal partner in preventing falls. 

Caregiver Homes also employs technology that allows caregivers to communicate with Care Teams daily. This existing communication model also factored into the falls prevention initiative by enabling faster interventions when a risk is identified or a fall occurs. 

The Results

Since the initial training course, the focus on prevention has led to a steady decline in the rate of falls for eight straight quarters to date. (This was after a brief jump due to the increased reporting accuracy -- fewer falls went unreported, so the rate rose). At this point, the rate has effectively halved: from 1.6 per 1000 patient days in 2013 to .83 per 1000 in 2016

By focusing on the caregiver as a key partner in the home to prevent falls, Caregiver Homes was able to improve outcomes, even for a population that is constantly growing and evolving with new families joining, and new Care Teams being hired. Four years after the initial training, the lessons still permeate through all levels of the program, right down to the caregivers. It's a result we're extremely proud to share, and one that will inform efforts in other areas toward overall quality of care through measurable outcomes. 

What's next for falls prevention at Seniorlink? 

As we move forward, we will continue to use technology, namely Vela, our caregiver collaboration platform, to collect specific data points in a timely manner – when we know there is risk, we can tailor personal interventions though content or a timely visit.  We expect technology will lengthen our reach and deepen the level of insights we can capture.  It will make our personal interactions more powerful in reducing falls.

“Predict the preventable” is a mantra in data analysis.  We aim to use our dataset to develop a custom algorithm to predict the likelihood that a consumer will fall over specific intervals (within 30, 60, 90, 180 days, etc.).  The ability to predict those who are most at risk of falling is a powerful tool in reducing falls, which in turn reduces the rate of injuries and deaths amongst those under our care.