Falls are the most common cause of nonfatal injuries in those > 65. True / False
True
60% of community-dwelling individuals > 65 fall each year. True/ False
False 30%
Falls are the most common cause of accidental death in those > 65. True/False
True
Falls account for up to 80% of re-hospitalizations in the first month post hospital d/c. True / False
False 15%
What is a fall?
“An unplanned descent to the floor (or extension of the floor, e.g., trash can or other equipment) with or without injury. All types of falls are included, whether they result from physiological reasons or environmental reasons.”
What are some community risk factors for falling?
BUM-PEC
- Benzodiazepine or sedative-hypnotics (prescribed for anxiety and/or insomnia)
- Use of 4 or more prescription medications
- Muscle or joint impairments
- Postural hypotension
- Environmental hazards
- Co-morbidities (DM, Alzheimer’s, CVA…..)
What are some predictors of fractures after a fall? (7)
FAB-CHOW
- Female sex
- Age > 75
- BMI < 22.8 kg/m2
- Cognitive impairment
- History of CVA
- One or more ADL impairments
- White race
What are some fall prevention strategies?
CHEF-EVE
- Cataract surgery
- Home visits for safety evaluations
- ED fall risk assessment
- Fall prevention clinics
- Exercises (such as Tai Chi)
- Vitamin D supplements
- Elastic hose/binding
Name of tool that assesses fall risk in Inpatient setting?
- what does it evaluate? (5)
- advantages/usefulness
EViL T2’s
Called STRATIFY Risk Assessment Tool: Evaluates Hx of falls, Visual impairment, Level of agitation, Toileting needs, Transfer ability.
- Easy to administer and effective at predicting falls in 1st week of inpatient admission
(Source: http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk-tool3g.html)
What are some complications asssociated with falls?
- Delayed healing
- Post-fall anxiety syndrome
What are some challenges we are faced with after patients (older adults) fall?
- Reluctance to report falls as fear that will lose independence
What are some types of senior living?
- In-home care
- Assisted living
- Living w/family
- Living independently- Medical alerts, personal care aides, CNAs
- Nursing homes
- Homes for those w/Alzheimer’s
- Continuing care
Who are Personal Care Aides (PCA) and what do they do?
Individuals that provide at-home, non-medical assistance (helping with keeping house, preparing meals, transportation, medication reminders, dental care, toileting)
- Non-medical assistance may include respite and/or companion care services
- May visit home multiple times/week, 2-8 hrs. /visit
- BLS national hourly wage average is $10.20/ hr (@ 8 hrs./day for 250 days = $20,400/yr.)
- Those employed by agencies more likely to be insured and bonded
- Local services include Home Instead, Right at Home, Visiting Angels
What type of training / schooling does PCAs require?
PHI National Study showed that:
Few states have well-defined training standards
- 12 states have no training requirements
- 27 states leave training to the agency-employer
- 14 states require no more than 40 hours of entry-level training
Those states that have training lack uniformity (across state)
A growing number of PCAs are employed directly by beneficiaries
Is there any training resuirements for PCAs in Georgia?
- PCAs employed by agencies are required to complete at least 40 hours of agency-provided training
- PCAs employed by beneficiaries must complete 12 hour certification course
Who are Home Health Aides & what services do they provide?
- Individuals that offer skilled care: checking patients’ pulses, temperatures, respiration rates; assisting with medical equipment
- Visit less frequently than home care aides.
- Assist with ADLs and exercise (if regimen prescribed)
- Change non-sterile dressings
- Supervise medication
- Take BP
- Do NOT assist w/housekeeping respite care, transportation
CNA Training requirement in Georgia (one e.g.)
- State Requirement: 85 course hour
- National Nurse Aide Assessment Program Exam (NNAAP)
Savannah Tech: 2 terms for 13 credit hours
Some things to know about medical alert systems
- Costs
- 3 examples
- how are they worn?
- how are they billed?
- what is their range of operation?
- how are they activated?
- User may depress button or utilize an auto alert system in the event of a fall
- Costs range from $26 to $50/month
- Wristband or neck pendant
¨Examples: Life Alert, Lifeline, Medical Alert
- Contract period (may range from days to months
- Activation Fee
- Range of operation (300 to 600 ft)
- Ability to contact local 911 (if out of home/range
- Automatic fall detection
- Monitoring services – in house or outsourced
What is Adult Day Care and some services they might provide?
- common services (3)
- average cost
- Local example (name)
- hours
- cost
- staff
- Provide supervision and social activities in a structured setting during the day. Can administer medicine, provide nail care, assistance w/eating. Other services available (for extra charge)
- The national average is $67 / day ($17,000 - $18,000/year)
- Local centers: Senior Citizens, Inc.
- Open M – F, 7 a.m. – 6 p.m.
- On site nursing staff
- $40/day (half days also available)
What is Assisted Living / Personal Care Homes?
- Residential facility that provides housing, food service and one or more personal services for two or more adults who are not related to the owner/administrator
- May be single home or apartment-type facility
- 24 hour supervision
- Assistance with medication
- Meals served in dining room
Savannah examples: Buckingham, John Wesley, Habersham- Cost is ~$37,000 annually
What are some questions that should be asked when considering the use of an Assisted Living facility?
- Basic services provided
- Price per size/number of bedrooms
- Staffing (esp. at night)
- Written POC for each resident? Updated
- Additional services available should resident’s needs change?
- Is self-administration of medication permitted
- What is the procedure for responding to a medical emergency?
- Ancillary services available? Are you permitted to bring caregivers from outside?
- Does community accept long-term care insurance?
What is a Skilled Nursing Facility & the services that they provide?
- cost
- how can it be paid for?
- Local examples (5)
- Offers 24/7 care
- They provide all housekeeping, medical and social needs
- Cost- $240/day for private room, ~ $212/day for shared room ($77,000 - $88,000 annually), although might qualify for Medicaid (pt. will lose SSI benefits)
- Medicare assists with payment of first 100 days only
SNFs in Savannah: Abercorn Rehab, Azalealand, Five Star Rehab, Pruitthealth, Riverview etc
What are some features of the Alzheimer’s facility?
- What are they?
- cost
- 4 local examples (names)
- Facilities designed specifically for patients w/Alzheimer’s
- Specially trained staff
- Cost- $4,500 - $5,500/mo or $54,000 - $66,000 annually
Savannah Facilities- Savannah Commons, Savannah Cottage, Station Exchange (Richmond Hill)
Summer Breeze (Hilton Head)
What is a Senior Independent Living Residence & services provided?
- services
- cost
- local examples (5)
- Meals are generally provided (can pay for 1 or more
- Like many apts, facility includes laundry and recreational facilities
- Cost- 2000 - $2800/mo or $24,000 - $33,600/year
Places in Sa- Buckingham South, John Wesley, River’s Edge, Savannah Commons, Savannah Squares
