Older adults who reside in senior living and skilled nursing communities fall more often than community-dwelling older adults; about half of all residents fall each year, and 10–25% of those falls result in fractures or concussions. Fall-related injuries come with significant medical costs; about $50 billion is spent each year on fall-related injuries and over $750 million is spent related to fatal falls. A recent survey of over 400 aging services executives and care providers found that, before any potential claims occur, falls cost each community an average of $380,000 annually. The average cost of a single resident fall is $4,743 in assisted living and $6,306 in skilled nursing, mostly driven by an increase in care level, additional administrative cost, and increased care staff cost.
According to the CNA Aging Services Claim Report: 11th Edition, resident falls continue to be the most common cause for claims at 40.4% among the top allegations in aging services. The report also finds the average amount paid for fall-related claims in 2021 to be $227,199, a 15% increase from 2018. Death is the most common outcome associated with fall-related claims at 59.4% of the claim distribution, followed by fractures at 30.7%.
ECRI provides an array of proven solutions for managing falls and reducing the risk of fall-related claims. Notably, ECRI developed a three-year Collaborative designed to strengthen falls management programs using a data-driven approach that employed Quality Assurance and Performance Improvement practices to drive purposeful change. In the first 18 months, ECRI helped members reduce the rate of falls by 11% and saved the client approximately $2.7 million in fall-related claims and litigation.
Falls Management Policies
Aging services leaders should ensure that falls management policies are implemented, and that clinical and nonclinical staff follow the policies. In the event of a fall, organizations that do not have written policies could be found liable for failure to establish policies for resident safety.
Major areas that should be addressed in a falls management policy include:
- Composition, responsibilities, and goals of a falls team
- Definition of a fall and near miss
- Falls risk assessment requirements for residents, visitors, and employees
- Facility and resident living space assessments to identify hazards likely to contribute to falls
- Responsibilities of staff
- Initial and ongoing education of clinical and nonclinical staff
- Intervention strategies
- Appropriate responses to falls, including protocols for investigation
- Event documentation and reporting requirements
- Collection and review of data for trends
- Revision of intervention strategies based on data
- Falls rates reporting within a quality improvement plan
- Promotion of the falls management program and risk awareness
Policies should target all care levels and business lines, including independent living (IL). Communities should ensure that all policies, resident agreements, and contracts state their response to falls in IL, and residents should be educated on this response as early as their community tour as potential residents.
A multidisciplinary committee, such as the risk management and/or quality committees, should review policies targeting falls at least annually. The Falls Self-Assessment Questionnaire can be used to identify the strengths and weaknesses of the organization's falls prevention programs and to guide improvements.
Staff Education and Training
Staff education is an essential, mandatory, ongoing process that is necessary for the success of a falls management program. Post-event analyses of falls often identify incomplete staff orientation and training, particularly of new staff, as one of several contributing factors for serious falls. Clinical or direct-care staff should also participate in hands-on training to build skills and demonstrate competency.
When designing staff falls education and training programs, leaders should consider potential barriers to successful implementation. Time is a major factor—especially for direct-care staff that have residents to care for. Training should be designed to engage staff, spark active participation, and allow staff to ask questions and troubleshoot real situations.
Falls management training can fall into a repetitive regimen. Reliance on computer-based training for routine falls education does not promote engagement between the learner and the objectives. A new, popular training element among aging services providers is an escape room. The goal for escape room training is to provide a resident-centered, engaging, and memorable experience that puts staff members into real scenarios often requiring teamwork to identity intrinsic and extrinsic risk factors.
Setting Realistic Expectations
Setting realistic expectations with residents and their family members involves informing them of what services the organization can and cannot provide, what staff can and cannot do, and what changes families may observe in their loved one during the aging process. Aging services organizations should set realistic expectations for the care and services they provide to residents and effectively communicate those expectations to residents and family members during preadmission and orientation, during meetings throughout the resident's stay, in print materials, and on the organization's website.
Setting expectations also helps establish a relationship with the resident and family based on honesty, trust, and openness. When this is achieved, family and residents are more satisfied, leading to a greater likelihood that they will work with the organization to resolve complaints rather than file a claim.
Learn more about how ECRI's Senior Care Solutions can help you enhance your falls program and reduce the risk of fall-related claims.