KATHLEEN WEISSBERG: Thank you so much, Rhonda. Thank you so much for having me. I'm very excited to be presenting alongside you today.
RHONDA DEMENO: We are happy to have you. And next, Camille Jordan. Camille is the senior vice president of clinical services of Brookdale Senior Living. Welcome, Camille. So thankful that you could partake in this activity today.
CAMILLE JORDAN: Thank you so much, Rhonda, for having me. It's a pleasure to be here with each of you today.
RHONDA DEMENO: Well, we are really excited to talk about fall management and some of the best practices and address some of this information. Fall prevention, we know, should be a multifaceted approach that involves collaboration among the caregiving team and family members.
So, we're going to hit on some of those topics. But just to frame this specific topic on falls. The CDC reports are telling us that falls are the leading cause of injury-related deaths for adults aged 65 years and older. And fall deaths continue to be on the rise. The WTW Senior Living claims benchmark study also found that falls continues to be the number one driver and the most frequent claim that the senior living industry is experiencing.
So let's start off by uncovering some concepts about falls and get some background information about senior care and about this rising risk for communities and residents. Kathleen, my first question goes to you. Can you walk our listeners through the scope and incidence of falls for the senior living industry?
KATHLEEN WEISSBERG: Thank you, Rhonda. I'd be happy to do that. Great question. And you're absolutely right. The CDC does report the top cause of injury and death in adults over the age of 65 are falls.
And it's interesting. Some new data from the CDC was just released this month. And it's based on 2020 research and 2021. So that's pretty recent. And the 2020 data is showing that about 14 million, or 27.6%, almost 28%, of our seniors reported falling.
Now when you look at that data, slightly more women than men. So females, we're looking at about 28.9%. So what? 29% versus males, 26.1%, experienced some fall. When we look into the 2021 data that they pulled together-- now that was based on 127,700 some odd people.
So almost 128,000 people were integral in this particular study. They found-- and this number is just staggering, I think-- 38,742. That's pretty specific. So almost 39,000 unintentional fall-related deaths in this particular study.
And I think what really stands out in that data is that number is higher than in the previous 20 years that they've been looking at this data. The death rate currently is sitting at 91.4 per 100,000 men, 68.3 per 100,000 females. And we can drill that down. And I won't bore you with all of these statistics. But you can even drill that down to a state level.
For example, if you look at state-specific data that they've published, the Western and the Midwestern states seem to have higher rates of falls for whatever reason versus states in New England and in the South.
But I think the takeaway here if you look at that in aggregate, all of those numbers, there's clearly some urgency to this issue. Because despite the fact that we've had all of these efforts related to falls and fall programming and fall identification and fall risk and all of this in our senior communities, the numbers still to be increasing at somewhat alarming rates. So something clearly that we have some urgency to address.
RHONDA DEMENO: Yes. And every year when we gather the claim data and we produce our report, it's pretty alarming to me. And we have to go a step beyond this. What are we doing about this? It's almost like an epidemic because we're seeing these claims.
So from your experience, Kathleen, what are some of the reputational risk surrounding the falls? And I guess this is the two-part question. What impact have you seen by having a really solid fall management program? What's the impact for senior living communities?
KATHLEEN WEISSBERG: Again, great question. So I will speak to that maybe in three parts. The impact of having a program, the impact of maybe not having a program, and then, of course, what's the reputation.
So again, every year, three million people are treated in the ER for fall-related injuries. 800,000 are hospitalized. Maybe it's a head injury. Maybe it's a hip fracture. I mean, we are seeing our seniors, particularly in skilled nursing, hospitals analyzed for hip fractures 300,000 annually. Again, that's a staggering number.
So first of all, if you look at this from a skilled nursing perspective-- I'll start there-- there are quality measures related to this. So there's a short stay quality measure related to rehospitalization. Also measuring emergency department visitation or visit use. If we look at some of those quality measures for our long-stay individuals, there's one very specific to individuals experiencing falls with major injury.
I'm going to focus on hospital readmissions here for just a quick second. That impacts, let's be honest, the bottom line. There are penalties associated with that for multiple different providers. And it's something that, of course, we don't want to see happen. But those quality measures equally as important.
When you look at that, a lot of these are publicly reported. And as individuals are looking to maybe place their loved ones in a community or they're looking at care, they may look at that in determining where to go for care.
And I think sometimes, that data is a little bit skewed. Maybe it doesn't tell the whole story. But the person on the other end doesn't know that. And they're looking at that. And the reality is your reputation is on the line.
If you are seen as this provider or community where, there's a lot of falls. There's a lot of folks going to the hospital. What does that say to that person? So I do believe that, yes, your reputation is on the line.
And so for a fall prevention program or a fall management program, you alluded to it already, Rhonda. I would just say this. We are measuring things, and we've been measuring this for a very, very long time. But we have to go beyond measuring and we have to actually implement and do something about that. And we'll probably get into that even more.
But I would also say this. Think about the impact to the senior related to that fall, the trauma associated with that fall. Once they've fallen then they have fear of falling, they have anxiety. Does that lead to a decline in activities of daily living, a decline in mobility?
Social isolation, they don't want to go out of their house anymore because they're afraid or don't want to go to an activity. It impacts quality of life. It impacts satisfaction. And if they are transferred to the hospital that's a whole other level of trauma.
So I think from my perspective, we can't afford not to address this in senior living. And as we are addressing it, it has to go beyond that measurement. And we need to actually do something about it, if you will.
RHONDA DEMENO: Excellent response. I know I always go back. And for those of you that have listened to our podcast, I always use my mother as an example having been in a memory care unit, falling. I mean, that trauma and emotional trauma. And it really plays a big part of their impact of their overall well-being.
And we will be addressing that in future podcasts in this particular series. And we'll address more of it as we move forward with our conversation. So we do know that there are many factors that contribute to falls. There's intrinsic and extrinsic factors. Kathleen, can you really speak to those intrinsic and extrinsic factors and how communities may address that?
KATHLEEN WEISSBERG: Absolutely. So again, if we look at senior living, assisted living, independent living, even senior housing if you go that far, the factors are the same. History of falls is a big predictor of falls. A fall in the recent year or the recent six months, fear of falling, cognitive decline, even other things. Things like polypharmacy and drug interaction.
Having proper footwear. Having proper footwear when you go out doors if there's snow or rain. The environment, having it free from debris and clutter or leaves. Or even in that individual's apartment or their residence, having a bedspread that is dragging on the floor. Water on the floor. Something like that.
And I can go on. Balance, vision, nutrition, range of motion, strength, sleep quality, blood pressure, communication, exercise, fitness, home hazards. I mean, a huge list of these both intrinsic and extrinsic factors. And again very interesting. Very timely.
An article was just published, or a study was just published, in the Annals of long-term care. And it actually looked at not just long-term care, but it was looking at senior care in general. And individuals, what were the factors that were causing, if you will-- that were actually inherent in their transfer from their living residence to a hospital over--
It was a 27-month period that they looked at. And they had close to 2,000 participants in the study. And they found that individuals who have cognitive impairment, one of the things that I just mentioned, frequent or occasional episodes of incontinence.
And what was really interesting about the incontinence is that it wasn't necessarily the trip to the bathroom that was causing the slip, trip fall, what have you, it was coming from. Individuals would leak on their way into the bathroom. And then just not remember that and slip on that coming back to their bed.
Individuals 80 years of age or older, individuals who are female. So these are those factors most strongly associated with a transfer to the hospital with a fall. And again, when think of that, when I look at that huge list that I just read through, there's a lot going on there.
And I think the message is it clearly takes a team. There is no one person who will address all of these things. We have to have nursing and pharmacy and some level of physician involvement. Some level of nutrition and therapy, et cetera.
We really need to work together. And obviously with the senior as well. And those provider communities who can, again, not just measure, but who can incorporate these types of findings and these types of factors into developing-- I'll call them meaningful care plans for lack of a better way of describing it. But plans that involve the senior will help them to mitigate those falls, will help them to address some of those high risk fall behaviors. So my message is it takes a team.
RHONDA DEMENO: Really good information and the perfect segue to my next question. And Camille, this question goes to you. As a nurse-- and I've worked in nursing operations for many years for many large organizations. And it always seemed like the fall program was owned by nursing for some reason. Camille, what can the community do to improve their overall fall management program? And what steps should the provider community really take to make their fall management program a comprehensive program?
CAMILLE JORDAN: Yeah. Thank you, Rhonda. This is a great question. And it does take a team, as Kathleen said as well. So improving a community's fall management program definitely requires a comprehensive approach that involves the care associates, residents, families, and all health care professionals. Not just nursing.
So think some steps that communities should take or providers should take in their fall management program is really take a step back and do an assessment and evaluation of their current fall management program. Evaluate existing fall prevention measures. Identify areas that may need improvement.
Staff training is crucial. They need to ensure that all staff receive proper training on fall prevention strategies including identifying fall risk, assisting residents with mobility, and using any assistive devices that the resident may have correctly. And also implementing ongoing education and training programs that keep staff updated on the latest best practices in fall prevention.
The resident of course should be the core and the center of any fall management program. So conducting a regular fall risk assessment for all residents to identify those that are at higher risk. And then customizing their care plans to address the specific needs based on that resident's risk.
The resident of course should be the core and the center of any fall management program. So conducting a regular fall risk assessment for all residents to identify those that are at higher risk. And then customizing their care plans to address the specific needs based on that resident's risk.
And then also engaging the resident. Promoting the residents involvement in fall prevention strategy activities are crucial. Getting them in exercise classes, balance training, and other educational programs, and encouraging residents to report any changes in their health or their mobility promptly.
Fostering open communication between the staff the resident and families regarding fall prevention strategies and any concerns. And of course, always bringing in those health care providers, including therapists and other professionals, that may help develop that comprehensive fall management plan.
RHONDA DEMENO: All excellent points. And it ties back to education and training program. Can you really opine on how staff training and education about fall prevention techniques contributes to creating a safer environment for seniors in their senior living community?
CAMILLE JORDAN: Oh, absolutely. Staff training and education about fall prevention techniques. This is an essential component in creating a safer environment for seniors in senior living communities or even at home.
By equipping staff with the knowledge and skills to identify potential fall risk and implement preventative measures, the overall well-being and safety of the residents can be significantly enhanced. So we need to make sure that staff are well trained and can identify environmental hazards and personal factors that increase the residents risk for falls.
And some of these factors may include looking at slippery floors, poor lighting, improper footwear, or mobility issues. And by recognizing these risks, staff can take proactive measures to help address this particular incident for the resident.
Personalized care. Educating them on a better understanding of each resident's unique needs, their medical conditions, fall history. This knowledge enables staff to tailor care plans and assistance to address individual fall risk effectively and training staff on how to implement preventative strategies such as ensuring the walkways are clear, installing grab bars in the bathroom, lighting in common areas, and any mobility aids that a resident may have.
Staff can be trained also to monitor residents medications for potential side effects that may affect balance or cognitive function. And this ensures that medications are taken as prescribed and any adverse effects are promptly addressed.
And trained staff also can effectively communicate with residents and their families about fall prevention strategies and the importance of adhering to safety guidelines. This collaborative approach fosters a shared commitment to safety between residents, the care associate, and the family.
RHONDA DEMENO: So another question I have. I know it seems like there's always a standard that communities have that fall assessment will be completed on admission or quarterly or after an incident. Do you feel that that's the best practice? Or is there something else that you would recommend on conducting regular assessments? And not only focusing on falls, but also on cognition, on the cognitive capabilities of the resident.
CAMILLE JORDAN: Yeah, I think these assessments, of course, are valuable and they provide valuable insight into resident strengths, limitations, any potential risk factors as it relates to falls, or their cognitive ability. So it really has to be an individualized approach. And recognizing that each resident is unique.
Customized assessments allow for personalized strategies that address specific challenges and promote independence. And having this as a collaborative process allows us to involve the resident and their family in the assessment process. So that their insights and input can be provided to the Care Associates and offer a well-rounded understanding of the residents abilities and preferences.
And then that multidisciplinary team that includes healthcare professionals such as nurses, physical therapists, occupational therapists, speech therapists. This helps to bring it all together and combine a comprehensive assessment for the resident.
RHONDA DEMENO: So what you're basically saying is one-size-fits-all is not the approach and collaboration is very important?
CAMILLE JORDAN: Yeah. I mean, conducting assessments at specific intervals, such as admission, during care plans, or annually, yes, that, I think, is the standard in the industry. But it also has to be tailored in those ad hoc moments of when a resident may be having a slight change or need a little bit more assistance to recognize that and do that assessment at that time.
RHONDA DEMENO: So you mentioned collaboration. And I'm going to go back to Kathleen. Kathleen, can you explain how your therapist worked directly with nursing to address falls? And what goes into that? And which strategies have you found successful in that collaboration?
KATHLEEN WEISSBERG: So I have to echo what Camille is saying because it's so well said. It is collaborative. It's interdisciplinary. And I think sometimes, somebody does fall or something happens. And there's a referral to physical therapy. Hey, so-and-so fell. Can you take a look at them for balance?
But just what she said. I'm going to echo that. We need to look at all of those factors. If balance wasn't the issue, if the issue was vision or the issue was medication interaction or something, we've missed it. We've missed our opportunity to really intervene and do what's best for the senior.
So I would say, again, working directly with all staff, not just nursing, to identify what those factors are. And Camille mentioned education. I could not agree more.
I think it's so important to work not just with nursing staff, but all staff. What if there's a fall in the dining room, or the dining area? What if somebody went on an outing and the van driver or something noticed maybe not a fall, but a near fall or something?
So that education. That's one of the things that I think is so important is that we're providing, we're working together for that education appropriate to an individual's position so that everyone identifies some of these risk factors that we're seeing. So I go back to that, is just working through each one of those facets.
And I don't know if this is the right time to talk about it, but we can talk a little bit about just in general, what we're seeing in the therapy realm and what we're focusing on. You can tell that I'm a researcher by background. But studies from the early '90s that have been replicated so, so many times. Just to work on strength, just to work on balance isn't enough. We have to work on a lot of other things.
RHONDA DEMENO: Really good points. I'm going to switch the conversation now to barriers. As a nurse and working in the industry for many years, it seemed like for senior living, there were some barriers. And oftentimes, they were financial barriers. Or residents or family members, when you mentioned rehab, they really weren't motivated to really seek out rehabilitation because they were thinking more from a traditional standpoint. You get rehab after a fall, or you get rehab to treat a specific condition.
So, Camille, the question goes to you. What do you see as barriers for residents wanting to participate and get involved in a rehab program?
CAMILLE JORDAN: Some of them are just may be knowledge and being well informed and educated about the program and what it entails. A lot of our seniors, they get caught into the pricing realm, and what is this going to cost me? And not looking at the physical and emotional benefits that a therapy program will help them in the long run to stay at their optimal level of well-being.
So, I think really, being well informed is the biggest barrier that we see.
RHONDA DEMENO: And how about you, Kathleen? Can you provide any other information on barriers?
KATHLEEN WEISSBERG: I can think of a few off the top of my head. And for me, it comes back to how are we addressing that fall? So, if it is a cognitive limitation, obviously, that can be treated. You treat that because some cognitive limitations can improve. But dementia can technically be a barrier to some degree.
And even in allele, we are seeing mild cognitive impairment. We are seeing some level of maybe early, even mid stage dementia. And that requires a totally different intervention. And so, making sure that whoever is intervening to assist that person developing that plan of care really understands what that person with dementia needs.
And I think there is a physical barrier too. And I think you hit on it to a degree, Rhonda. That traditional rehab maybe isn't the best thing for this person. Again, we can tease out now. And I love this. That when we look at somebody who falls, we know that they have a slower gait speed. They walk slower. They spend less time in what we call single limb support. So, when you're walking, when you're standing on one foot and swinging that other leg.
Their cadence is different. Their stride length is different. Their base of support is different. And we can certainly assess that. There's artificial intelligence now to assess that. And that's a whole topic in and of itself. But we also know that individuals who walk naturally at about a 45, 46-minute mile, that's 1.3 miles per hour, they are at a higher risk for mortality and falls.
So, if that barrier of just the quote, unquote, traditional rehab may not have that best outcome. So, I would say those are two big barriers. And my third one that just jumps out at me is a system of communication. And again, if I think about somebody who's living in their apartment, or whatever their residence happens to be, did they fall, and we just don't even know about it? Did they have a near miss in the bathroom, getting out of the tub or something, and we don't know about it?
So, if that barrier of just the quote, unquote, traditional rehab may not have that best outcome. So, I would say those are two big barriers. And my third one that just jumps out at me is a system of communication. And again, if I think about somebody who's living in their apartment, or whatever their residence happens to be, did they fall, and we just don't even know about it? Did they have a near miss in the bathroom, getting out of the tub or something, and we don't know about it?
RHONDA DEMENO: And that flows really well into my next question. And it's about data analysis. And how can ongoing monitoring and data analysis of all incidents and near-misses-- I know you had brought up the near miss Kathleen. How can that contribute to the continuous improvement of fall prevention strategies? So, I'm going to ask Camille that question.
CAMILLE JORDAN: All right, great question. So ongoing monitoring and data analysis of fall incidents and near misses are integral in the continuous improvement of fall prevention strategies in the adaptation of the senior living environment. By systematically collecting and analyzing data related to falls, senior living communities can identify patterns, trends areas of improvement.
So, some of the things that they need to look at when you're analyzing this data is pinpoint specific locations or circumstances where falls frequently occur. So, identification of the high risk areas. This insight allows for targeted interventions and modification in those areas to reduce the likelihood of future incidents.
Pattern recognition. So, by analyzing data over time, patterns and common factors contributing to falls can emerge. So, for instance, specific times of days, activities or resident groups might be associated with an increased fall risk.
Individual assessment. Data analysis allows staff to identify residents who might be at higher risk or following based on their history or near misses of incidents. This enables tailored interventions and additional support for those individuals.
And then monitoring and analyzing data to help evaluate the effectiveness of implemented fall intervention strategies or prevention strategies is crucial. If certain interventions are not producing the desired outcome, then adjustments should and can be made.
Adaptation of strategies. So based on data analysis, senior living communities can adapt their fall prevention strategies to address newly identified risk, any emerging trends, or changing needs the resident might have. And data analysis informs us of decision making regarding the allocation of resources. So high risk areas or factors can be prioritized for targeted interventions while strategies that have proven effective can receive continued support.
RHONDA DEMENO: It's really, really good information. So, data is really telling the story. And what I'm hearing from you, Camille, is that we should be leaning on data to help us drive our fall management and prevention programs. Kathleen, did you have anything to add to that?
KATHLEEN WEISSBERG: I don't. I think it's eloquently stated. I would completely agree. And there are certainly ways to measure this. I go back to that. We need to figure out what that systematic way is.
And Camille hit the nail on the head. It's very individualized to a community and to that senior to measure those falls. Because what gets measured gets managed. Is that not the case?
RHONDA DEMENO: Great feedback there. I'm going to address both of you with the question about communication. I know we brought up the importance of communication. So what communication strategies are essential for ensuring that both residents and their families are informed about fall prevention measures, emergency protocols, and available support within the senior living community? Camille, I'd like to start with you on this closing question.
RHONDA DEMENO: Great feedback there. I'm going to address both of you with the question about communication. I know we brought up the importance of communication. So what communication strategies are essential for ensuring that both residents and their families are informed about fall prevention measures, emergency protocols, and available support within the senior living community? Camille, I'd like to start with you on this closing question.
So clear and transparent communication helps to foster a sense of trust, empowerment, and collaboration. Some of the ways that we can foster this is through the initial orientation. Provide comprehensive orientation sessions for new residents and their families. Cover topics such as fall prevention, policies, any emergency procedures and available resources. Provide them with informational brochures, pamphlets, handbooks, and things that outline fall prevention guidelines and those protocols.
And then hosting regular meetings on information sessions where residents and families can learn about fall prevention updates, safety measures, or any changes in protocol. But what is so important is also is conducting those personalized assessments and personalized care plans with the resident and family to collaboratively create care plans that include fall prevention strategies for that individual.
And just open, honest, transparent communication is crucial about the community's commitment to the resident's safety, the steps being taken to prevent falls in any incidents that occur along with the corresponding actions that are taken.
RHONDA DEMENO: Yes, I think full transparency is so important, especially setting those early expectations up front, explaining policies. Really setting the tone that, your loved one may have fallen at home. They may fall here. But you're going to make every attempt to make the environment as safe as possible. Kathleen, do you want to add anything to that?
KATHLEEN WEISSBERG: I think the only thing I would probably just put an exclamation point on. I think from a therapy perspective, we spend time with our seniors and their families really speaking to those risk factors that I mentioned early on. I'm thinking of a specific program that has been rolled out where you work through each element systematically.
Looking at vacation interactions. Looking at diet. Looking at fitness level, et cetera. Things that maybe that individual and their family didn't even consider as a risk factor. Because sometimes, they have this aha moment and say, oh, I didn't realize that could have contributed to this.
And Camille hit on this too. Bringing that senior and their family, they become an active part of the process. They don't go through this passively. They are active. They have homework. We're asking them questions. They have action plans maybe to talk to their doctor or their nurse about. But they understand the why behind it.
And I think the more that we involve them from that education standpoint, the better it is for that follow through because they do understand that. And I think we have to ask some of those questions. And again, there are-- one of the big ones that we look at is fear of falling. And fear of falling leads to avoiding specific behaviors. And avoiding those behaviors leads to more falls. And it's this vicious cycle.
So, asking questions. How have your activity patterns changed? And again, standardized assessments, going back to that data. Learning more about those patterns. And if it does, becomes this aha moment. So, I would say that education and just systematically, again, working through all of those elements to identify that individualized plan of care is just so critically important.
RHONDA DEMENO: So, the two of you have done an excellent job today walking us through some of the concepts, the importance of communication, the importance of assessment. Camille, do you have any final thoughts?
CAMILLE JORDAN: Yeah. Thank you, Rhonda. I just want to say a few critical takeaways from today's session. It's just remembering that prevention is the key. And the best way to address fall mitigation is through prevention. And identifying and eliminating fall hazards is the first step in keeping yourself safe and others safe.
And then also seeking help. If you or your loved one is at high risk for falls, not to hesitate to seek help or assistance, whether it's physical therapy, home modifications, or support from caregivers there's resources available to improve safety.
And spread awareness. Share information about fall mitigation with your friends, your family. Awareness is a key part of preventing falls and ensuring safety of our loved ones. And just remember fall prevention is a shared responsibility. By taking proactive steps and encouraging others to do the same, we can create safer environments for everyone and reduce the risk of falls and their associated injuries.
RHONDA DEMENO: Very well stated. And Kathleen, any takeaways or final comments for today's audience?
KATHLEEN WEISSBERG: I don't know that I couldn't have said it any better. What's the saying? It takes a village. I do truly believe that this is a team effort. And the senior does need to be at the center of that team effort. And addressing all of those factors on a regular and routine basis, measuring them.
And I think sometimes we take a passive stance on something. It was a one-off. There was some water on the floor. OK, there was water on the floor. But why didn't the individual see that water or recognize that as an issue? So, I think really, really deep diving some of those factors and measuring those. So, I think we summed it up pretty well.
And I think sometimes we take a passive stance on something. It was a one-off. There was some water on the floor. OK, there was water on the floor. But why didn't the individual see that water or recognize that as an issue? So, I think really, really deep diving some of those factors and measuring those. So, I think we summed it up pretty well.
Thank you very much, Kathleen, for joining us today.
KATHLEEN WEISSBERG: Thank you, Rhonda, for hosting and having me. And of course, thank you, Camille, for joining me today.
RHONDA DEMENO: And thank you, Camille, for joining us today and really sharing your expertise in this valuable information.
CAMILLE JORDAN: Absolutely. Thank you, Rhonda. And thank you, Kathleen. It was a pleasure to be here with both of you today.
RHONDA DEMENO: Thank you so much. And thank you all for attending our podcast. We encourage you to listen to all episodes on fall management to get a comprehensive overview of the importance of a sound fall management program.
This series focuses on the importance of keeping residents safe and on their feet, the trends of fall claims, artificial intelligence monitoring for fall management, and the importance of disclosure. This concludes our first episode of our fall management series. Thank you very much.
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