Fall Prevention Care Management in Assisted Living
Can structured care management actually reduce falls in assisted living? Prevention programs work — but only when properly designed and followed. Data shows meaningful results when facilities commit to change. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guests Hiroko Kiyoshi-Teo and Claire McKinley Yoder to discuss fall prevention care management and real-world outcomes.
Kiyoshi-Teo:
Prevention exercise offering look like. Has your care changed after my family member have a fall? Do they have to pay more? Be, make that transparent? So many residents were so scared of that. So there’s a lot that could be done and I appreciate that. We appreciate the opportunity to share thoughts.
Intro
Schenk:
Hey out there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I will be your host for this episode. Today we are talking about, a study done on falls and fall prevention in assisted living facilities in Oregon. And we have the researchers, the academics that the nurses that conducted that study and did that research with us.
That’s Dr. Claire McKinley Yoder. And Dr. Hiro Kiyoshi went on to walk us through what they found, like how the methodology of the study, all that kind of stuff. It’s, it was, it’s a really, it’s a really interesting conversation.
Like I mentioned, we have two guests. We got a panel, we got a certified panel today. So we will do this. We’ll do bio back to back. We have Dr. Hiroko Kiyoshi -Teo PhD. RN is an assistant professor at Oregon Health and Science University School of Nursing, a dedicated nurse scientist.
She focuses on fall prevention and improving quality of life. For older adults. Her research supported by national and local grants explores how motivational interviewing and person-centered care can reduce fall risk outside of work. She enjoys cooking, camping, and traveling with her two daughters, ages seven and 13.
And we also have Dr. Claire McKinley, Yoder. Dr. Yoder or Dr. McKinley Yoder is an assistant professor at Oregon Health and Science University and has been teaching nursing for over 20 years. Most of those in a community setting. She has expertise in academic practice. Partnerships to address social and structural barriers to health equity.
And they both conducted this research, which I’m going to tell you is called Fall Prevention, Care Management Implementation and Outcomes of a project to reduce fall risks of older adults in assisted living facilities. And that’ll be linked in the show notes. So if you want to read that study in its entirety, you can.
It’s. Very interesting what they were able to find. And there were some actual auxiliary benefits that we’ll discuss at the end of the episode. But anyway Dr. McKinley Yoder and Dr. Kiyoshi-Teo, welcome to the show.
Kiyoshi-Teo:
Thank you for having us.
What inspired this fall prevention care project in assisted living?
Schenk:
I really want to set the table for everybody out there. How did you both come to want to conduct this study?
Kiyoshi-Teo:
Sure I can take this one. So actually the impetus came from nursing students learning for their population health. So they were, at that time they were working with Gresham Fire Department and looking at all the EMS calls that comes through, and they were identifying that a large number of those calls were related to falls.
Which was surprising. And then the firefighters are like, oh, this is such a major issue these days. We rarely go to a fire. We ver often go to help people with falls. What’s going on? And the students took a deeper dive and then they found out that it was nursing homes that were calling a lot related to falls.
So we were trying to figure out students and faculty what we can do and what the next. Steps were and that’s when I got called in. And what can we do? And, part of the clinic will really have students work on the care management aspect of nursing care management. It is a very important role that nurses have in pulling in resources together, education.
Behavior change. So it’s perfect. Let’s do something related to care management for fall prevention and let’s target these assisted living facilities that’s calling a lot for falls, and that’s how it got started.
Can you walk us through how the fall prevention plan worked?
Schenk:
So walk me through now that you identified hey let’s look into this and see what we find out. How did you go about it? Selecting the facilities. How did you go about getting the data? What was that process?
Kiyoshi-Teo:
Yeah. We had this really interesting program in place with the School of Nursing and Aggression Fire department. So we had a very, innovative thinker of the fire department who knew then, wanted to improve the public health as.
Aspect of the fire station’s role. And they were working very closely with a faculty in residence ki faculty like Claire, who are assigned to this Gresham neighborhood. So they were able to share all these calls, data with us as a quality improvement project. That’s why we were able to identify like 10 top 10 assisted living facilities from fire department data. And then. We contact them and see if they’d be interested in participating in offering a student clinical that would also have a research project aspect to it. That’s how it got started.
Environmental and clinical contributors to falls are examined on the impact of preventive health measures in elderly populations.
Schenk:
It is amazing that the fire department was integral to that process. I would’ve never imagined that.
Kiyoshi-Teo:
Yeah. And it was really cool. Claire, I think you should speak to that. Yeah. You were integral to that.
Yoder:
Yeah. So they’re one of our partners and we have students, we have clinical students with them every term. Really addressing non-urgent calls because the majority of the calls that they get are not somebody having a heart attack or a stroke.
It’s somebody who’s fallen, somebody who really doesn’t have the resources to manage whatever condition they have. And. They don’t have anywhere else to go, so they call 9 1 1 ’cause they don’t know what else to do. And so our that, that’s one of our clinical placements and they make referrals to us.
But, and as Hero said, there was this, there were quite a few falls that had been happening and they were like, this is a thing we’re seeing a lot. And especially, in the assisted living facilities, there’s the. People may be hesitant to to. Reach out. There’s a lot of shame involved with falls and so people don’t want their family to know, they don’t necessarily wanna talk with their primary care, things like that.
And when, and Hero has done this fall prevention research in other settings and thinking about how we can decrease some of the stigma and then also this is really valuable. Learning for students. Some of the, like when we were looking at the literature, a lot of students don’t get much in the way of this kind of multifactorial look at fall prevention.
It uses a walker. It’s, pick up rugs, but it’s not all the other things that were included in this. And so I think it was a really great opportunity for both student learning and for addressing the issues in the community.
Cognitive impairment and its role in fall prevention are explored on the impact of preventive health measures in elderly populations.
What role did student nurses play in implementing the program?
Schenk:
So was it mostly like interviews or did you know how you were, like you’re sitting the students in there to talk to people once they got like the police or the fire department’s emergency report or something like that?
Kiyoshi-Teo:
So I can talk about that. So what we did, so once the nursing home said, yes we can partner with you. So we went and we said, tell me who of your residents are at high fall risk and who’s falling a lot. And then they would identify people who are at high fall risk, and then we would reach out to them to see if they would be part of the clinic.
Multifactorial strategies to reduce fall-related injuries are reviewed on the impact of preventive health measures in elderly populations.
Clinical and also be part of research. And because of the research element because we the one of the outcomes relied on surveys, we did need to include people with enough cognitive skills to respond to the survey. So we had to leave out people for that reason. But we had a total 25 individuals across two assisted living facilities who met the cognition criteria, who were.
Identified as fall risk, had to fall and willing to participate. And then this we, so a pair of students, two students were assigned to one resident and then they will visit them every week during their clinical for one hour, for five to six weeks. So they would develop a relationship over time.
Families seeking legal guidance after a serious fall may find help from a Georgia nursing home abuse lawyer handling fall cases.
And then the first two visits were pretty scheduled. So every nursing intervention starts with assessment. So the first two visits mostly focused on. Physical assessment because it’s kind of functional, right. Strength and balance, vision, nutrition, sleep, mental health, all that assessment.
And also the report building, right? Building trust ’cause we are. Going into each resident’s room, their private space. So we really, and talking about something that’s threatening to them. A lot of, like Claire said, not many people wanna talk about falls. So we needed to establish time to build trust so that the residents would feel comfortable enough to, share those thoughts about their fall risks and their, in our most thoughts about what they need to do to keep them safe.
Local support is also available through a Canton nursing home abuse lawyer for fall injuries.
Schenk:
So the $64,000 question is a, after that six to eight weeks of the clinicals, of the interviews, of the, of looking through the data, what are some of the things that you guys found? What are some of the things that potentially are causing these falls? And as Claire had mentioned, what are some of the things that maybe we’re not thinking about that would reduce the likelihood of false?
Kiyoshi-Teo:
So there are many things that students identified, and for this study, we really wanted to make sure it’s interprofessional. Because fall risks are not caused by one thing, but it’s a layer of risk factors, right? So low vision combined with lower. Ability to maintain balance and their environment, new environment, maybe they’re getting more forgetful.
So each factor contributes to high thought risk. So students assessed all of ’em. And so we also had an expert consultant pharmacist, nutritionist. So for a resident who has nutritional needs, a lot of residents have very poor nutrition. Their weight increases. Or they decrease just very poor metabolic health.
Residents and families in Cobb County can consult a Smyrna nursing home abuse lawyer
So for that resident the students worked with a dietician team to work on a diet menu that would work with her appetite and her tremor to, help with that. We also worked with residents related, it was a diabetic patient on diabetes. Blood sugar management because she didn’t like the, the food that was provided.
So she was eating her own snacks and that wasn’t helpful. So things like coordinating medication management, talking to their provider, involving family members, raise a question. This resident is on 10 different meds. Is this. It’s all appropriate. And then really coaching patients to have a conversation with their primary provider about potentially changing their sleep medication because that’s a high fall risk medication.
What can we do about it? So they worked on all various aspects of fall risk management.
Key distinctions between care settings are explained in What Makes Assisted Living Facility Cases Different.
Schenk:
I would’ve never thought about the nutrition component being a factor in falls. What about the the issue of toileting or rounding for toileting? Was that, did that come up w with the students?
Kiyoshi-Teo:
Sure, yeah. Toileting major, falls in the bathroom is a major source that it happens. So for frequency on timing and then also related with elimination is intake. So a lot of the older adults don’t take enough fluids because they don’t wanna go to the bathroom as frequently. So balancing things out, try to hydrate earlier in the day and drink less at night or type of fluids.
They may be drinking a lot of coffee during the day and that’s not very helpful and makes the person want to go to the restaurant more. So working towards that and really for one of the residents with a serious like colitis issue really revisiting that issue and bring it up to their providers to really reassess that and not let it pass as a norm for that resident.
What outcomes did you see among residents after the intervention?
Schenk:
This is all amazing. So when the students are coming up with these ideas, okay, let’s make sure that resident A has, a higher calorie intake or we’ll make sure that she has, so that she likes to eat, like we’ll bring some whatever from her. Her granddaughter will bring in whatever.
These things are going into the care plan, I imagine, and then we have data in terms of falls after that. So did where did the study go after that? Did, was there an effect after all of these, interviews of, six to eight weeks and changing things about did it have an effect.
Kiyoshi-Teo:
Yeah. So we did want to measure the impact of this intervention. Of course, we wanted to get there, but the reality was at that time, because this was pre COVID in Oregon the data related. Stated the falls were collected very inconsistently. There wasn’t a mandate, and maybe, it varies by state, but we didn’t have a reliable source of fall data collection definition of falls.
So that’s actually something that we worked closely with assisted living. And again, here we are also building trust and rapport with assisted living management as well because they’re trying to do their best. To keep their residents safe, but they’re so under-resourced. We were shocked. I’m a medical surgical nurse by background in hospitals.
We have quality officers whose job is dedicated to keeping patients safe. And, a data analyst who would, know. Those ins and outs about definition and keeping track of things? No, these people had handwritten notes about when residents fell and in their hard copied, patient charts.
Data points critical to identifying fall risk are discussed in Key MDS Data to Identify Fall Risk in Nursing Homes.
So it really wasn’t reliable. So what we relied on were one of the things called concern about falling falls, efficacy, outcome. So it’s a self-reported outcome. It’s researched a lot and it’s basically seven questions that ask about how concerned are you about getting up from a chair going down the slope or stairs and it, the higher level of concern.
It puts them at the higher risk for falls. So we were trying to see if their concern about falling would decrease. Having had students care management visit, we also thought their confidence to decrease their falls will increase. And maybe their importance to prevent falls would also increase as well.
So those were the outcomes that we measured for this, fairly small scale study.
Practical prevention strategies are outlined in Five Ways to Prevent Falls in Nursing Homes – Episode 122.
How did motivational interviewing support fall prevention goals?
Schenk:
I feel like it’s and I said this before, but assisted living and personal care homes, I feel are the wild west. There’s no federal regulation, as y’all both know. Yeah. It’s state by state.
And even with federal regulations with what constitutes a fall and things like that, the resident assessment instrument that’s uniform across the country, you still have one nurse would define a fall differently than the next nurse. Let alone assisted living where there is no federal uniform definition.
So I can imagine how difficult it is and how probably frustrating as researchers and nurses are, you want that data, but it’s. A lot of it is not necessarily accurate. Like at least with nursing home residents, you at least might have the MDS assessments that are pretty standard.
Yoder :
I think my, my perspective is really looking at that student learning and student experience. And and I know that’s not necessarily the purpose of this show, but I think that, making those those connections can I think one thing that we found is that when the students were meeting, they were working really closely with the resident care managers and with the, the nursing aides and talking with them about, okay, so here’s what we’re working on with this person.
Medication-related fall risk among older adults is analyzed on the impact of preventive health measures in elderly populations.
It would go on the care plan, but it was also the, IT. It really benefited the people working there as well because, you have these students in there who have all these ideas and then you have the faculty also, who are bringing in new ideas and I think sometimes it can be hard because, I think there’s something here in Oregon, like 400% turnover in staff and so that can be really hard to have really.
Legal accountability following serious injuries is examined in Episode 42: How Nursing Homes Can Be Liable for Injuries From Falls.
Well-prepared staff to do these, to do this work. And so having students and faculty there can support the professional development of the staff. And also, we had a person who had not. Gone down to dinner in months. She or she would only go in a wheelchair and by the end of the eight weeks she started getting up and she would just walk with the student.
She’s oh, those nursing student boys are so cute. I’ll walk with them. And so sometimes it’s just having someone new, someone who can. Take some extra time to be able to really get into what are the big concerns for this person and, and build that rapport.
And I think that resident care managers and CNAs definitely do that, but, so I think there, but there’s a benefit of students being able to come in because they just bring a whole different lens and energy and all of that.
I just think it’s a really valuable opportunity.
Broader long-term care options are explored in Episode 210: Assisted Living Facilities and Understanding Long-Term Care Options.
What lessons can other assisted living facilities take from this project?
Schenk:
Of course if two nursing students come to my office every day and ask me about how I was doing and what I was doing with my life, I would feel way better. I can’t even, like just the psychological component, forget the fall prevention stuff, just the psychological component of two people or however many people coming in.
Every day or every week or whatever, and asking about the person and being concerned about how you are doing, man, I’m, that’s, I’m on top of the world now. That’s, so just that alone is amazing. And I can also see your perspective as well about then you potentially have the staff, which is probably maybe temporary or whatever.
They’re like, who do these kids think they are when they leave? We’re the ones that have to do the real work or whatever. So I can definitely see a little bit of that conflict. But this sounds great. I’m so happy that you both are doing this type of research and do this type of work and it can only benefit everybody in long-term care.
So I really appreciate you both coming on the show and sharing your knowledge with us.
Kiyoshi-Teo:
Thank you so much for the opportunity. Yeah, we hope things like this could expand and we’ll be happy to be resources to anybody that’s interested. Right now we’re also doing a community fall risk assessment.
Inviting people to come send me annually and involving nursing students to do that as well. So we just need to make, get normalize, that falls. Preventable, right? It’s not something that should be tucked under the rug, but something that could be actively worked on. And asking questions, asking if the family’s looking for new homes for their adult parents.
Ask about what you are doing for fall prevention? How are you keeping your residents active? What are your fall prevention exercise offerings look like? How are the. Does your care change after my family member has a fall? Do they have to pay more? Make that transparent? So many residents were so scared of that.
So there’s a lot that could be done and I appreciate that. We appreciate the opportunity to share our thoughts.
Recent findings on fall risk and injury prevention are discussed on the impact of preventive health measures in elderly populations.
Schenk:
No problem. Very well said. All right, folks, I hope that you enjoyed this episode. If you have an idea for a topic that you would like for me to discuss, please let me know. If you have an idea for a guest that you would like for me to talk to, please let me know that as well.
New episodes of the Nursing Home Abuse Podcast come out every single Monday. Also be sure to enter the contest, so when the Nursing Home Boost Podcast coffee mug. Let’s see. I guess that’s about it. This is actually my last recording for this season. I think. I’m not sure when this comes out, but I think at this point I’ve recorded 60 episodes in a matter of a couple months, two or three months.
This feels wild. It’s almost like a sendoff, but not quite because I’m not sure chronologically when this episode comes out, but you can tell I’m by my voice. I’m beat. But anyway, we’ll continue to pump these episodes out every single Monday, folks, and with that, we’ll see you next time.
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Hiroko Kiyoshi-Teo’s Contact Information:
Claire McKinley Yoder’s Contact Information: