Culture Change, Shifting the Conversation from Fall Prevention to Increased Mobility

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It’s hard not to talk about falls when we speak about the care of older adults.  Falls are a frequent topic of concern for both family and professional caregivers.  And for a good reason, they can cause serious injury, render a person immobile, and will often leave the individual fearful that they will fall again. In addition to the safety concerns of the individual, fall prevention has become a top priority in almost all care communities. Because of severe consequences and even law suits that are taken against professional caregivers when an older adult falls while in their care.

And yet, with so much attention on the topic and so many preventative measures in place, falls of older adults still occur both in and out of the professional care setting. So is it possible to ever really eliminate this issue? On September 11, 2017, I had the pleasure of attending an event that worked towards offering answers to this question.  Entitled the Unintended Consequences of Good Intentions: Balancing Improved Mobility with the Risk of Falls, this workshop was organized by the Advancing Excellence in Long-Term Care Collaborative and hosted by Forest Hill of D.C., and it was truly a meeting of the minds.

Facilitator Anna Ortigara, RN, MS, FAAN, Organizational Change Consultant, PHI, started us off with a question, how many of us in the room had shown up to learn about fall prevention? Almost all of us raised our hand. She then asked, what if I told you we aren’t going to talk about fall prevention but rather increased mobility? Although it may sound like just another name for the same issue, the thoughtful discussion that took place through this new lens reflects how critical attention to language is while creating programs and policies for our older adults.

An Interdisciplinary Panel

Panelist Members

  • Physical Therapist, Hilary G. Forman PT, RAC-CTSVP of Clinical Strategies Division, Healthpro-Heritage
  • Risk Manager, Paul A. Greve Jr. JD RPLU Executive Vice President, Willis Towers Watson Health Care Practice
  • CNA, Iye Jalloh, Fores Hills of DC
  • Executive Director/Administrator, Mary Savoy MS, LNHA, Executive Director/Administrator, Forest Hill of DC
  • Family Member, Janice Dabney

The expert panelist assembled for the facilitated discussion represented all sectors of health care. And each viewed the concept of increased mobility through a different lens and shared the opportunities and challenges in embracing this new model of care.

Obstacles to Maintaining Mobility

There was overwhelming agreement that the Culture in skilled nursing slows the move towards increased mobility.   Mary Savoy notes that there is a culture of protectionism among care workers many who are concerned with the repercussions of a fall. Often over protecting to keep their residents safe. Hilary Forman furthered this idea by making a note of the reactive culture in care homes often handling issues as they occur rather than proactively seeking solutions before they arise.

There was also a consensus that federal regulations can sometimes hinder the process. Established to protect residents from harm, rules take very few situational details into consideration. And to meet the documentation and statistical ratings to keep care homes in good standing takes time away from an organizations ability to concentrate on much else.

What change can we make? “Accept falls,” says Forman.  The more time we spend preventing falls means, the less time we can devote to keeping the resident mobile and physically active. It’s only when we accept falls that we can move forward and create systems that support mobility.

The Family’s Role, How do you Talk to Families about Mobility and Falls? 

Paul Greve referred to the need for care homes to prioritize conversations with family members.   Noting that if family members were offered more information and awareness on the benefits of mobility, they could be more accepting of the risks of falls and less likely to pursue a law suit.

Janice Dabney agreed that communication with staff and building relationships with her mom’s care workers made a world of difference in her perception of the home and her understanding of fall risks.  But also noted the importance of the physical lay out of the facility, low staff to resident ratios, and a culture of teamwork were all excellent ways to promote mobility.

Savoy noted that breaching this topic is difficult because we want families to feel confident in the care that we are providing for their loved ones. But Iye Jalloh believes relationships with the resident and consistency in staff assignments are the best way to care for residents, promote their mobility, but also develop relationships with families.

Accepting Falls and Mitigating Risks

The conversations that occurred by both the panel and the attendees offers hope that a future of increased mobility for our residents in care homes is possible. As a field, we should all start having open conversations about the realities of falls and ways we can mitigate risk. Involving family members, as well as federal and state regulatory bodies, are essential to this conversation. We all have the same end goal, to keep residents safe while increasing and maintaining their mobility.

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