Reducing resident falls. (Assisted Living Review).

Resident injury due to falls continues to be one of the leading causes of liability claims against assisted living providers. As insurance rates continue to rise, the financial cost of failing to manage risk is underscored. Most importantly, a high percentage of those residents injured in falls have diminished quality of life following the accident. Nearly 50% do not live beyond the next 12 months.

Looking for the good news? The good news is that much can be done in the assisted living setting to prevent falls, injuries, and liability suits. Providers who understand why falls occur can dramatically improve outcomes in a two-step process that involves adjustments to the physical environment coupled with appropriate staff training.

The causes of falls are both external and internal. The leading external causes include:

* wet or slippery floors

* throw rugs

* inappropriate footwear

* poor lighting or confusing color scheme on the floor

* extension cords

* poor placement of equipment or furniture

* stairs, steps, or beds at inappropriate heights

Many of these situations are easily avoided or can be quickly corrected, given appropriate staff training. Here are some easy-to-implement training strategies:

* Train your staff to be sensitive to the dangers of wet floors. Spills need to be cleaned up immediately and wet areas dried.

* Extension cords should be kept away from foot-traffic areas or any other place where someone might easily trip.

* Explain to the entire staff how important good lighting is to resident safety.

* During holiday seasons, tour the community to ensure that decorations are safely positioned and that furniture has not been repositioned in a way that will impede the residents' safe movement.

* Caregivers should pay particular attention to residents' footwear to ensure that dangling laces or inappropriate heels don't create an unnecessary risk of falls.

* Use an Environmental Safety Checklist each day to ensure the community is free of hazards that might cause falls.

"Internal" causes of falls--resulting from the resident's physical or mental condition--are more difficult to control and prevent. Specific internal causes include:

* unsteady gait

* poor vision

* incontinence

* medication side effects 

* seizures or strokes

* cardiac abnormalities

* nutritional deficiencies

* depression

While you might not be able to prevent some of these conditions, you can introduce appropriate resident-assessment programs that will identify whether a resident is at risk for falls. A fall assessment should be performed on the resident at the time of move-in and regularly thereafter.

Some simple proactive steps can help reduce falls within your community, for example:

* Symbols such as a leaf or star can be placed on the resident's door, wheelchair, on his or her medical records, and above the bed as a simple reminder to the caregiving staff.

* Offer an exercise program for residents. Regular exercise will help the residents improve muscle tone and build strength, which will reduce the likelihood of falls.

* Some residents benefit from the use of shoe orthotics that increase balance and stability, reduce pain and stress, and can help reduce falls.

* Form a fall-management committee that will involve staff members in identifying those residents at risk for falls and work together to find ways to minimize their risk.

* Ensure that your caregiving staff understand the proper use of assistive devices. They should visually ascertain that the tips of canes, crutches, or walkers are rubber-covered and in good condition, and that wheelchairs are in good working order.

* Caregivers should make sure that eyeglasses or contact lenses are clean, and that hearing aids are properly operating and worn appropriately.

* Assist residents to the bathroom on a regular basis to prevent urinary urgency. Caregivers can help prevent this situation by encouraging regular visits to the bathroom and watching for visual cues that the resident needs to visit the bathroom.

* Encourage residents at risk for falls to wear a responder pendant. While this will not prevent falls, it will alert staff to a problem and allow them to respond more quickly.

What If a Resident Falls?

If a resident does fall, it is important for caregivers and licensed staff to:

* Reassure the resident.

* Immediately alert the nurse or supervisor.

* Avoid moving the resident if he or she is in pain, or is unable to move certain areas of the body. Follow your organization's protocol to alert licensed staff.

* Carefully document the incident.

No fall should be treated as insignificant. When a fall occurs, a careful assessment of the resident should be completed with an eye toward helping avoid future falls.

Ongoing caregiver training is essential. It might not completely eliminate falls within your facility, but regularly focusing on the situations that give rise to risk and finding ways to minimize it will build the foundation for ongoing risk management and a reduced incidence of resident falls.

Barbara Shoemaker is managing director of ALFA University, the training initiative of the Assisted Living Federation of America. The University has developed a comprehensive Risk Management Video Training Program in conjunction with TAGWEB, a leading risk-management consulting firm. For more information about the risk-management training program and available consulting services, contact ALFA University at [phone] or e-mail [e-mail]. To comment on this article, please send e-mail to [e-mail].