WoodGreen Community Services
Community Care and Wellness for Seniors
Falls Prevention Strategy/Framework
In-home care
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
The FALLS Cycle
FALL
Fear of
Falling
Increased
Risk of
Falls
Decreased
Activity
Decreased
Strength &
Movement
Adapted from Public Health Agency, 2005
CCWS Falls Prevention Framework (In-home care)
• Falls Risk
Assessment tool
• Support staff (e.g.
PSW) training
• Falls prevention
policies and
procedures
• CCWS quality
committee
Plan
Do
CCWS’ plans to
meet clients
needs re: falls
prevention
CCWS’ work with
clients to reduce
falls : BEEEACH
model
• BEEEACH model:
• Education,
Equipment,
Environment,
Activity, Clothing
& Footwear, and
Health
Management
modifications to
drive behaviour
change
Act
• Evaluate
intervention
programs
• Continuing staff
education
• Accreditation
CCWS
implements
continuous
improvement to
prevent falls
Study
How CCWS
measures and
monitors falls
• Falls incident
reports
• Falls indicators
• Other falls
reporting
CCWS Falls Prevention Framework (In-home care)
• Falls Risk
Assessment tool
• Support staff (e.g.
PSW) training
• Falls prevention
policies and
procedures
• CCWS quality
committee
Plan
Do
CCWS’ plans to
meet clients
needs re: falls
prevention
CCWS’ work with
clients to reduce
falls : BEEEACH
model
• BEEEACH model:
• Education,
Equipment,
Environment,
Activity, Clothing
& Footwear, and
Health
Management
modifications to
drive behaviour
change
Act
• Evaluate
intervention
programs
• Continuing staff
education
• Accreditation
CCWS
implements
continuous
improvement to
prevent falls
Study
How CCWS
measures and
monitors falls
• Falls incident
reports
• Falls indicators
• Other falls
reporting
CCWS’ Plan to Implement Falls Prevention
o Falls Risk Assessment & Intervention plan (See Appendix 1)
o Policy, procedures, guidelines, and forms for Falls Risk Assessment,
Prevention, and Intervention (including roles and responsibilities of each
care provider – most likely PSW’s)
o Staff communication and education about falls risk and falls prevention
(e.g. Personal Support Worker Training)
o 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
CCWS Falls Prevention Framework (In-home care)
• Falls Risk
Assessment tool
• Support staff (e.g.
PSW) training
• Falls prevention
policies and
procedures
• CCWS quality
committee
Plan
Do
CCWS’ plans to
meet clients
needs re: falls
prevention
CCWS’ work with
clients to reduce
falls : BEEEACH
model
• BEEEACH model:
• Education,
Equipment,
Environment,
Activity, Clothing
& Footwear, and
Health
Management
modifications to
drive behaviour
change
Act
• Evaluate
intervention
programs
• Continuing staff
education
• Accreditation
CCWS
implements
continuous
improvement to
prevent falls
Study
How CCWS
measures and
monitors falls
• Falls incident
reports
• Falls indicators
• Other falls
reporting
Multifactorial Approach to Preventing Falls - BEEEACH model
Behaviour
Change
Clothing
and
Footwear
Equipment
Activity
•
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
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:
o Definition of falls
o Falls statistics – frequency, outcomes, and associated costs
o Impact on quality of life
o Risks assessment and associated intervention plan/options
o Risk management and post-fall follow up
•
Clients, family and/or caregiver education and supportive linkages/referrals:
o Health promotion and education team activities such as: “Healthy talks” e.g. staying
safe in the home, diabetes education, etc., client information handouts, etc.
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).
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.
Activity
• Inadequate physical activity and age related changes such as: decreased
strength, balance, and
flexibility
a risk factor
for falls.
Falls
R i s kpresent
Assessment
Tool
& Intervention
Plan
• CCWS home care providers
encourage staff to
engage in regular physical
activity to reverse age related changes and increase strength, balance,
Client Name:
flexibility
and endurance. The Falls Risk Factor and
Intervention Options
Assessed By:
Date:
below should be used to evaluate falls risk related to physical activity.
Risk Factor
Intervention & Referral Options
History & Physical Activity




Previous falls (within one year)
Impaired mobility
Decreased strength, balance & flexibility
Inactivity or reduced physical activity
 CCAC Physiotherapy
 Toronto Public Health Physical Activity Sheet
 WoodGreen Exercise and Falls Prevention Classes
Equipment
 Improper use of cane, walker, wheelchair or  CCAC Occupational Therapy
other assisted devices
 Yes, please complete Home Environment Hazard
Environment
Checklist (back of page)
 Home Environment Hazards (e.g. loose rugs,
o Home Environment Modifications (e.g. raised
poor lighting, clutter, cracked sidewalks)
toilet seat, grab bars, etc.)
o Refer to Social Work
• Staff should also refer to the inter-RAI CHA to assist with identifying clients
with physical function limitations related to gait, balance, etc.
Risk Factor
Intervention & Referral Options
History & Physical Activity




Previous falls (within one year)
Impaired mobility
Decreased strength, balance & flexibility
Inactivity or reduced physical activity
 CCAC Physiotherapy
 Toronto Public Health Physical Activity Sheet
 WoodGreen Exercise and Falls Prevention Classes
Clothing and Footwear
• Equipment
Inappropriate, no support and inadequate fit clothing and footwear are key
 Improper use of cane, walker, wheelchair or  CCAC Occupational Therapy
risk
falls
otherfactors
assistedfor
devices
Environment
 Yes, please complete Home Environment Hazard
Checklist (back of page)
o Home Environment Modifications (e.g. raised
toilet seat, grab bars, etc.)
o Refer to Social Work
 No
• CCWS home care providers to assess based on the Falls Risk Factor and
 Home Environment Hazards (e.g. loose rugs,
poor lighting, clutter,
cracked
sidewalks)
Intervention
Plan
(as shown
below) and intervene or refer clients as
needed.
Clothing and Footwear
 Foot ulcers / bunions
 Inappropriate/unsafe footwear
 Loose fitting clothes
Health Management
 4 or more medications
 Medications for calming / sleeping




Foot care Clinic/ Nurse
Foot Care Info-Sheet
Refer to Podiatry or Chiropody
Refer to Social Work
 Safe Medication Use For Seniors Brochure
 Sleep Information Package
 Consult with Family Doctor
 Nutritional Deficits
 Refer to Community Dietician (Eat Right Ontario)
 Meals on Wheels or Congregate Dining Program
 Canada Food Guide
 Hearing Deficits
 Canadian Hearing Society
 Consult with Family Doctor
 Vision Deficits
 Optometrist
 Cognitive Deficits
 Adult Day Program
 Refer to Social Work
 Decreased strength, balance & flexibility
 Inactivity or reduced physical activity
Equipment
 WoodGreen Exercise and Falls Prevention Classes
Health Management
 Improper use of cane, walker, wheelchair or  CCAC Occupational Therapy
other assisted devices
 Yes, please complete Home Environment Hazard
Environment
Checklist (back of page)
 Home Environment Hazards (e.g. loose rugs,
o Home Environment Modifications (e.g. raised
poor lighting, clutter, cracked sidewalks)
toilet seat, grab bars, etc.)
o Refer to Social Work
(Pharmacoepidemiology Drug Safety,
Medication use and risk of falls, 2002)
 No
Clothing and Footwear
 Foot care Clinic/ Nurse
 Foot ulcers / bunions
 Foot Care Info-Sheet
 Inappropriate/unsafe footwear
 Refer to Podiatry or Chiropody
 Loose fitting clothes
 Refer to Social Work
Health Management
 Safe Medication Use For Seniors Brochure
 4 or more medications
 Sleep Information Package
 Medications for calming / sleeping
 Consult with Family Doctor
• Medication reviews and medication reconciliation between transitions is
an effective way of reducing the side effects of medications and potential
falls risk
• 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.
 Nutritional Deficits
 Refer to Community Dietician (Eat Right Ontario)
 Meals on Wheels or Congregate Dining Program
 Canada Food Guide
 Hearing Deficits
 Canadian Hearing Society
 Consult with Family Doctor
 Vision Deficits
 Optometrist
 Cognitive Deficits
 Adult Day Program
 Refer to Social Work
 Incontinence
 Blood pressure fluctuations
 Refer to Health Promotion Clinics
 Limit alcohol, sugar, artificial sweeteners and caffeine
 Alcohol (1+ drink per day)
 Prevent a Fall Handout
Revised August 2013
CCWS Falls Prevention Framework (In-home care)
• Falls Risk
Assessment tool
• Support staff (e.g.
PSW) training
• Falls prevention
policies and
procedures
• CCWS quality
committee
Plan
Do
CCWS’ plans to
meet clients
needs re: falls
prevention
CCWS’ work with
clients to reduce
falls : BEEEACH
model
• BEEEACH model:
• Education,
Equipment,
Environment,
Activity, Clothing
& Footwear, and
Health
Management
modifications to
drive behaviour
change
Act
• Evaluate
intervention
programs
• Continuing staff
education
• Accreditation
CCWS
implements
continuous
improvement to
prevent falls
Study
How CCWS
measures and
monitors falls
• Falls incident
reports
• Falls indicators
• Other falls
reporting
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.
CCWS Falls Prevention Framework (In-home care)
• Falls Risk
Assessment tool
• Support staff (e.g.
PSW) training
• Falls prevention
policies and
procedures
• CCWS quality
committee
Plan
Do
CCWS’ plans to
meet clients
needs re: falls
prevention
CCWS’ work with
clients to reduce
falls : BEEEACH
model
• BEEEACH model:
• Education,
Equipment,
Environment,
Activity, Clothing
& Footwear, and
Health
Management
modifications to
drive behaviour
change
Act
• Evaluate
intervention
programs
• Continuing staff
education
• Accreditation
CCWS
implements
continuous
improvement to
prevent falls
Study
How CCWS
measures and
monitors falls
• Falls incident
reports
• Falls indicators
• Other falls
reporting
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
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
Appendix 1
Falls R i s k Assessment Tool
& Intervention Plan
Client Name:
Assessed By:
Date:
Risk Factor
Intervention & Referral Options
History & Physical Activity




Previous falls (within one year)
Impaired mobility
Decreased strength, balance & flexibility
Inactivity or reduced physical activity



CCAC Physiotherapy
Toronto Public Health Physical Activity Sheet
WoodGreen Exercise and Falls Prevention Classes


CCAC Occupational Therapy
VHA Rehab Solutions


Yes, please complete Home Environment Hazard
Checklist (back of page)
o Home Environment Modifications (e.g. raised
toilet seat, grab bars, etc.)
o Refer to Social Work
No




Foot care Clinic/ Nurse
Foot Care Info-Sheet
Refer to Podiatry or Chiropody
Refer to Social Work



Safe Medication Use For Seniors Brochure
Sleep Information Package
Consult with Family Doctor
Equipment

Improper use of cane, walker, wheelchair or
other assisted devices
Environment

Home Environment Hazards (e.g. loose rugs,
poor lighting, clutter, cracked sidewalks)
Clothing and Footwear



Foot ulcers / bunions
Inappropriate/unsafe footwear
Loose fitting clothes
Health Management


4 or more medications
Medications for calming / sleeping

Nutritional Deficits



Refer to Community Dietician (Eat Right Ontario)
Meals on Wheels or Congregate Dining Program
Canada Food Guide

Hearing Deficits


Canadian Hearing Society
Consult with Family Doctor

Vision Deficits

Optometrist

Cognitive Deficits


Adult Day Program
Refer to Social Work


Incontinence
Blood pressure
fluctuations


Refer to Health Promotion Clinics
Limit alcohol, sugar, artificial sweeteners and caffeine

Alcohol (1+ drink per day)

Prevent a Fall Handout
Revised August 2013
Appendix 2 – Home Environment Hazards Checklist