Fall Prevention in the Community - Coursework Example

Fall Prevention in the Community Final Report Nu 461 Community Health Nursing Myrlande Rigaud Service learning final report NU 461 Fall prevention inhome care Theoretical Model/Conceptual Framework My project focused on decreasing falls in the home care population at the Chelsea HealthCare Center, Massachussetts. Falls can have lasting psychological and physical consequences, particularly fractures and slow-healing processes, and patients may also lose confidence in their walking abilities. Injuries from falls lead to functional decline, institutionalization, higher healthcare costs, and decreased quality of life. The useful tool that provides guidance to marketers in this endeavor is Maslows Hierarchy of Needs. During acute illness, individuals must satisfy their physiological needs. If these needs are not met, patients have a greater risk of experiencing a fall. Initial fall risk assessment is critical to plan intervention and individualized care plans. The conceptual framework used for the fall implementation came from the Institute for Healthcare Improvement. Using the three phases of framework for Spread, I helped in the development of home safety by educating the home care population on how to prevent falls. The underpinnings of the framework include leadership, set-up, better ideas, communication, social system, knowledge management, measurement, and feedback. I used all these factors to promote effectiveness of falls in the Chelsea HealthCare Center. Organization Description The corporate organization of Chelsea HealthCare offers proven programs that reduce the fear of falling and help to prevent falls. Every staff member is well-trained in programs for fall prevention and to reduce the fear of falling. I reviewed the fall prevention program in their home care setting; they offer practical strategies to reduce fear of falling and increase activity levels. Participants learn how to control their fear of falling, set realistic goals to increase activity, change their environment to reduce fall risk factors, and exercise to increase strength and balance. The Elder Affairs Division identifies the total needs of the citys population who are over 65. Furthermore, the service is designed to promote and implement services to meet those needs and to coordinate and enhance existing elderly services. The division ensures extensive outreaches are made to linguistic minority elderly communities within Chelsea, as well as other difficult to reach elders, so as to provide equal access to elder services. “The mandate of the Division of Elder Affairs is to provide services to the seniors of the City of Chelsea. The Citys goal is to offer resources and services which will allow them to develop their strengths and function productively and independently in their homes, and in the larger community. The City has always, and will continue to acknowledge the value, dignity, diversity and wisdom of older adults. The Division operates the Chelsea Senior Center for those seniors who are ambulatory. Services are also provided for seniors who are frail, homebound or handicapped, in coordination with Chelsea, Revere, Winthrop (CRW) Elder Services, the regional agency on aging” (Chelsea City Hall, n.d.). “Under prospective payment, Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of the beneficiary” (Home Health PPS, 2012). The adjustment for health conditions, clinical characteristics, or service needs of the beneficiary is referred to as the case-mix adjustment. The home health PPS will provide HHAs with payments for each 60-day episode of care for each beneficiary. Also, some residents pay privately and are thus under the Medicaid payment system. Needs assessment I met with Chelsea’s Director of home care L. Z. and identified 10 elderly people who needed to be part of a fall prevention program. There were cases of elderly falling at a concerning frequency and the assessment was established to minimize and prevent unnecessary falls. Evidence –Based The Massachusetts Department of Public Health (MDPH), in collaboration with other state agencies and community partners, has taken leadership to reduce the incidence and severity of falls and fall injuries among older adults in Massachusetts. According to the Department of Public Health, “Fall injuries are an enormous threat to the health and well-being of older adults in the Commonwealth of Massachusetts. Falls among older adults represent a serious and often preventable public health problem. Furthermore, this is the leading cause of fatal and nonfatal injuries among older adults aged 65 years and over in the United States and in Massachusetts” (Unintentional Fall-Related Injuries Among Massachusetts Older Adults, 2008). I want my program to be more suitable for older adults by allowing small group sessions to be led by a trained professional. Planning The objectives for the project are to reduce and prevent falls in the Chelsea community, particularly residents from the home care population and fall prevention program for the elderly. As we all know, older people who fall lose self-confidence and do not like to go out. Inactivity can lead to social isolation and therefore loss of muscle strength and balance, which increases the risk of falling. As part of the program, I offer muscle-strengthening and balance-retraining exercises of increasing difficulty, combined with a walking program. The program is delivered by either a PT experienced in prescribing exercises for older adults, or a nurse or home health aide who is given special training and receives ongoing supervision. I met with the director of the home program at Chelsea to see how we can prevent falls in the home care setting. The corporate staff from Chelsea implemented lifeline and home safety evaluations by a physical therapy specialist. I did not have any barriers in the form of planning. On the project team, the people who were involved were the director of home care, a registered nurse, a physical therapist, two home health aides, and a physician. I used my computer for a PowerPoint presentation I developed along with handouts and flyers. Most importantly, I wanted them to be aware of their situation and find and understand why they are at risk for falls. Healthy People 2020 To prevent falls, the project met the Healthy People 2020 objective and goal. “Healthy People is a set of goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the United States” (Healthy People, 2011) One of the objectives of Healthy People 2020 is to increase the number of people who receive evidence-based clinical preventions. This ties hand-in-hand to the goal of minimizing falls among Chelsea’s elderly community. Implementation The director of home care screened 10 elderly people between the ages of 65 to 82 for high risk for falls. I decided to do a presentation on fall risk that consisted of pamphlets, a PowerPoint presentation, tips on home safety, and a list of resources on how to prevent falls. I created the flyers and went to local print shop to print them out in bulk in order to distribute them. Afterwards, I trained the staff at the Chelsea clinic to continue the programs. Everyone was tested and gave a scenario on ways to avoid falls. Evaluation The objectives were met: All 10 elderly people present at the fall presentation program were engaged in a range of relevant fall preventative strategies. Most of participants voiced that the problem of frequent falling was inactivity, which leads to decreased mobility and balance. The program’s goals are to improve balance, strength, and physical performance for older adults. Here are some examples of the program: E. G., a 71-year-old, attended the presentation on fall prevention. Since then, she has noticed significant increases in her strength and activity levels. The presentation identified home safety risks and she has since made safety modifications to her home. M. J., a 76-year-old, fell four times in one year; this resulted in a partial hip replacement. She was able to put her fear of falling aside and faithfully follow the instructions from her physical therapists. After physical therapy and participating in the prevention program, she has regained her activity levels with no fear. J. F., a 78-year-old resident, was having concerns about his balance. He received a flyer about an upcoming balance class in his community and signed up. He learned about steps he can take to reduce his risk of falling. Since then, he and his wife have noticed improvements in his balance and activity level. The balance class included learning opportunities about integrated movements, vision training, and cognitive and balance exercise skills with the goal of preventing injuries from falls. The feedback from all participants was positive and very effective. Final Reflection I enjoyed the experience and am glad I was able to be part of the fall prevention program in the Chelsea community. I plan to continue to educate the residents and have a refresher class on fall prevention every quarter in order for them to maintain their progress. As a nurse working in a rehab center, this was very informative and has enlightened me on different ways to help prevent risks other than falls. Furthermore, my intention is to have an MBA in elderly care; this experience has really helped progress my knowledge. I will definitely use this in a clinical environment because it is useful and there is always room for preventative care. References Chelsea City Hall. (n.d.). Retrieved from http://www.ci.chelsea.ma.us/Public_Documents/ChelseaMA_Elder/index?textPage=1 Healthy People. (2011). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/nchs/healthy_people.htm Home Health PPS. (2012). Centers for Medicare & Medicaid Services. Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/HomeHealthPPS/index.html?redirect=/HomeHealthPPS/ Unintentional Fall-Related Injuries Amogn Massachusetts Older Adults. (2008). Massachusetts Department of Public Health. Retrieved from http://www.mass.gov/eohhs/docs/dph/injury-surveillance/unintentional-fall-injuries-old- ma-adults.pdf Read More