Flooring and Safety.

In an effort to gain more comprehensive information about the role of facilities in therapeutic care for the elderly, a newly funded research project has been initiated in New England with, as its initial focus, safety as it relates to flooring. This study is funded by CHER, the Coalition for Health Environments Research, and is supported by leading professional associations, architects, interior designers, suppliers, healthcare providers, researchers and government agencies.

Regarding the importance of safety in long-term care, the numbers are in-- from such leading authorities as the Centers for Disease Control and Prevention and the American Academy of Ortho-paedic Surgeons--and the numbers are startling:

* Of the 1.5 million nursing home residents nationwide, approximately 50% fall at least once each year.

* Among people 85 years of age and older, 20% of fall-related deaths occur in nursing homes.

* Each year, 350,000 hospital admissions and 60,000 nursing home admissions are the result of hip fractures.

A recent study in a long-term care facility in the state of New York indicates that flooring surfaces can play a significant role in helping to prevent injury from falls. In this facility, where the average age of the resident population hovers around 85, slips and falls on a typical resident floor accounted for 43 falls, resulting in seven fractures per year in a single unit. The flooring surface of this unit consisted of hard VCT (vinyl composition tile). Tile was used because it is durable and because maintenance feels it is easy to keep clean.

The facility manager, attempting to deinstitutionalize the environment, tried commercial carpet on some units, but inspection of one unit less than three years after installation disclosed carpet wear and fading; also, the carpet had retained odors, and fluids had wicked through to the subfloor, making thorough cleaning impossible.

Research done in a university biometrics laboratory had shown that cushioning the fall of an elderly individual can reduce the forces typically associated with fracture of a hip or wrist. In an effort to test the benefits of soft-surface flooring in this context, the owner installed a demonstration unit of a newhybrid flooring called Powerbond [R], manufactured by Collins & Aikman, which is a cushioned, sheet-vinyl material with a dense, soft, carpet-like surface. The hybrid soft-surface flooring material with a dense cushion backing produced significant results--the researcher estimated that this design would provide the force attenuation necessary to reduce fracture risk by about 50%.

We have been monitoring the safety performance of the Powerbond-installed unit in the New York State nursing home. During the first year, falls were reduced by approximately one-third, which we attribute in part to the flooring--because its floors are not slippery when wet or dry, acoustics are improved, wheelchair and walker mobility have not been affected, and glare from reflections on shiny floors has been eliminated.

Of particular interest to us, however, was the reduction of injuries resulting from the falls that did occur. There were no fractures during the first year. Furthermore, the owner found that the soft-surface flooring was easy to clean, with maintenance costs and disruptions significantly reduced.

Although research on flooring in several facilities is now under way, we conclude that preliminary results suggest that safety can be positively impacted by selection of proper flooring materials. There are now soft-surface materials available that can help promote a warmer, more acoustically appropriate, more residential environment that, in the process, contributes to increased resident safety and well-being. NH

Judith Yarme, RN, is director of the Health care Facility Research consortium, and Howard Yarme, PhD, is research chair for the International Floorings Manufacturers Association (IFMA) Healthcare Council.