MAKE YOUR HOME SAFER FORUM Thursday 7 April 2016

Transcription

1 MAKE YOUR HOME SAFER FORUM Thursday 7 April 2016

2 Acknowledgment of Country I would like to show my respect and acknowledge the Noongar people; the traditional custodians of this land and of the elders past and present, on which this event takes place.

3 Stay On Your Feet Falls Prevention Program Falls are the leading cause of hospitalisation in older adults and cause more deaths in people 65 years and over per year than road crashes. Falls are preventable. The Injury Control Council of WA coordinates the delivery of the Stay On Your Feet WA program with support from the Department of Health. Aims to reduce the incidence of falls amongst older adults in the community. Community awareness raising activities and resources. Capacity building and resources for health and community care professionals.

4 Stay On Your Feet Resources

5 Make Your Home Safer Campaign February April 2016 Campaign key messages: Falls are preventable. Make you home safer to help prevent slips, trips and falls Ask your GP about an in-home assessment. Use your Home Safety Checklist and action plan to check your home for hazards and make safe changes. Let someone know if you have falls.

6 Make Your Home Safer Forum 5.00pm Forum open 5.10pm Anne Pressley The OT s Role in Falls Prevention 5.55pm El Bennet Enablement Training for Support Staff 6.40pm Break 6.55pm Claire Cunningham Liveable Housing and Falls Prevention 7.40pm Activity 8.00pm Forum close

7 Anne Pressley Senior Occupational Therapy, Aged Care Assessment Team, Osborne Park Hospital Senior Occupational Therapist working in the Aged Care Assessment team at Osborne Park Hospital. 17 years experience in the Rehabilitation and Aged Care clinical area. Majority of past roles have involved assessing falls prevention risk factors and implementing falls prevention interventions to Occupational Therapist Falls Specialist position at Osborne Park Hospital, covering the Joondalup region until funding ended. Has worked in acute care and community rehabilitation settings in Perth and London for a range of client groups.

8 Beyond Mats & Poor Lighting: The Occupational Therapist s role in Falls Management Anne Pressley, Senior Occupational Therapist Rehabilitation & Aged Care, Osborne Park Hospital

9 Falls 1 in 3 community dwelling people over 65 fall each year. Falls are multi-factorial. Environment is a likely trigger. Behaviour, cognition, culture & experience shape client attitudes.

10 Occupational Therapists, Environment and Falls An occupational therapy home visit, as part of a multifactorial strategy, is strongly recommended based on high quality evidence (NHMRC level A) when considering hazard reduction, training and education. Patients who will particularly benefit are those who are at high risk such as those with vision impairment and recent hospitalisation. Waldron, N., Hill, A. & Barker, A. (2012)

11 What Skills Does the OT Offer in the Home Environment? Specialist assessment of function in unique environmental contexts. Knowledge of the functional impact of a range of medical conditions & disabilities. Specialist skills in activity analysis, task gradation and adaption. Knowledge of cognitive and perceptual issues relating to function. Skills in applying goal setting, self management and behaviour change strategies. Extensive knowledge in a range of environmental modifications, functional strategies and creative solutions to address limitations and hazards.

12 Specialist Assessment of Function in Unique Environmental Contexts Detailed observation of a client s performance of functional activities and transfers within their home and community. Consider function over 24 hours. Consider culture and values. Determine range of risk factors. No one size fits all approach. Consider resources already in place.

13 Knowledge of the Functional Impact of a Range of Medical Conditions & Disabilities Stroke Diabetes Parkinson s Disease Arthritis Dementia

14 Specialist Skills in Activity Analysis, Task Gradation and Adaption Tap into usual methods where possible. Consider task demand and cognitive load. Dual tasking is important. New, safer methods rather than undoing ineffective habits. Rehabilitation versus Compensation. Least intrusive interventions.

15 Knowledge of Cognitive and Perceptual Issues Relating to Function at Home Planning, awareness, attention, memory and orientation. Visuospatial skills Anxiety & depression

16 Fear of Falling Cycle Acknowledgement: Falls Specialist Service, SCGH

17 Goal Setting, Self Management and Behaviour Change Strategies Set goals. Ownership of the environmental and functional strategies. Sense of self efficacy. Education. Intervention takes time to have an effect. Pick the three most important factors and tailor.

18 Behaviour Change Prochaska & DiClemente, 1983

19 In Summary Physical changes to the home environment are only one aspect of the Occupational Therapist s role. Analysis of functional activities give a unique understanding of the client s behaviour and values. Client must be receptive to change for any falls intervention to be effective in their home. Some risk is beneficial. Don t underestimate fear of falling.

20 Environmental Modifications / Functional Strategies Before After

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22 Falls Sensors / Alarms

23 Monitoring Infrared, sound modalities. Baseline data on usual routines & activities is used to determine unusual changes which may be indicative of a fall. Privacy issues.

24 Questions?

25 El Bennet Operations Manager, Melville Cares Inc. Over 25 years experience in the area of human resource management and training Previously worked at Perth Zoo, Skywest Aviation and the WA Municipal Association (WA Local Government Association) 2002 Started consulting business 2008 Started as the Manager of Operations at Melville Cares Certificate IV in Training and Assessment Certificate III and IV in Aged Care and Disability Diploma in Community Management Nearing completing of an Advanced Diploma in Community Sector Management.

26 El Bennet Operations Manager, Melville Cares Enablement Training for Support Staff: Sustainable Behaviour Changes

27 The Problem Getting enablement and falls prevention messages to support staff working directly with the client. The Strategy In-house enablement training

28 Building the Client and Support Worker Relationship Trust and confidence take time! Relationships and monitoring of the client journey is successful when: Provide client with a familiar face, Visit client at regular times, and Create a comfortable environment to openly discuss issues.

29 Why Enablement Training is Effective Educates support workers by providing the necessary information to feed back to clients. Grows support worker confidence to deliver enablement strategies appropriately. Facilitates open discussion between management and grass root level workers. Breaks down the them vs us barrier between the client and support worker.

30 The Importance of Team Work Older adults may find it difficult to take ownership of their health problems or other issues they are concerned about, particularly as their independence is often diminishing with age. Clients are encouraged to share their issues and concerns with support workers as they can then begin to work together to address them.

31 How Enablement can Assist Clients to Reduce their Falls Risk Support workers are encouraged to discuss falls related risk factors that exist in and around the client s home. By sharing and discussing the Stay On Your Feet Home Safety Checklist with clients, support workers can open a dialogue about falls risk factors and prevention strategies. Enablement training of Support Workers at Melville Cares has assisted to produce positive client outcomes. By providing staff with the latest education and tools to introduce to their clients in their own homes. Falls prevention initiatives can be identified with the client, their options discussed, an action plan agreed upon and necessary changes acted on.. all in the one visit! However this time frame differs between clients.

32 It s OK to talk about the issue but what then? Breaking habits Each client visit is an opportunity for the support worker to encourage behavioural change. It may be necessary for the support worker to remind the client of the reasons behind a particular change and the consequences for not sustaining that change. Support workers, along with the client and their care team, can provide the long term support, regular monitoring and feedback to health professionals. Communication to all parties is vital The client journey is recorded using informative progress notes and enablement tracking.

33 But Why am I Doing this? The role of the Support Worker As a support worker (also applicable to other health and community care professionals) understanding of your working role and how it fits into the big picture is important. At enablement training, the Community Care Common Standards are fully explained using real life scenarios of best practice in relation to the client and support worker journey in action. This one-on-one interaction between managers and support workers creates opportunities to ask questions of why am I doing this? The manager can then explain by linking the Community Care Common Standards to every day practices that relate to the organisations policies and procedures.

34 Questions?

35 BREAK

36 Claire Cunningham Accredited Access Consultant and Occupational Therapist, Planot Worked as Occupational Therapist for seven years prior to commencing Access Consultancy six years ago Accredited Access Consultant and has completed studies in architecture Launched consulting business Planot 12 months ago Undertakes work in both the commercial and residential sectors

37 Livable Housing Claire Cunningham, Occupational Therapist and Access Consultant (Accredited with ACAA), Planot ,

38 Falls Where do they occur? Anywhere, however, greater risks are presented by poor lighting, uneven floors and wet or uneven paths If older adults begin to experience falls, what may be introduced? Mobility aids such as walking sticks, zimmer frames, wheeled zimmer frames, four wheeled walkers and wheelchairs Generally, do people s homes accommodate these mobility aids?

39 Stressful Events Death of a loved one Loss of job, changing jobs or retirement Illness Moving house Relationship breakdown

40 Impact of Environment Phillippa Carnemolla Industrial Designer New research suggesting minor home modifications cans facilitate a person to remain in their home as they age. Ramps Rails Minor bathroom modifications

41 What can we do? Plan The answer lies in planning rather than in modification There are many ideas and initiatives in the access community, but these are unlikely to be taken up unless written into the building code.

42 Documents to Guide Practice Liveable Housing Guidelines Liveable Homes Adaptable Housing Standard AS Australian Standards National Construction Code Australian Government - Limitations They are not fit to an individual They do not address access challenges in relation to obesity, nor mobility scooter access, stretcher beds etc.

43 Universal Design Seven principles of Universal Design Equitable use Flexibility in use Simple and intuitive use Perceptible information Tolerance for error Low physical effort Size and space for approach and use

44 Liveable Homes Path of travel from carport or street, preferable covered Adequately lit path and front entry Prune back garden to provide unobstructed path of travel Eliminate thresholds at front entry, and all entrances if possible Landing at front door with sufficient space on the latch side

45 Liveable Homes cont. Adequate door widths throughout the home Handrails on any stairs (though eliminate stairs if possible) Circulation space around furniture Door hardware Location of switches and controls Bathroom and tapware Kitchen design

46 Livable Design Case Study 1

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50 Livable Design Case Study 2

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81 ACTIVITY

82 Case Study 82 year old man of Italian background. Lives with his wife in large market garden style property (two storey house). Experienced a stroke with residual balance and right upper limb incoordination. Independently mobile with a walking stick however experiences near misses at times. Experiences dizzy spells since the stroke and fell once in hospital. Reluctant to use shower, get dressed, use internal steps or steps into garden without help. Voices a fear of falling. Previously independent in all daily activities and worked daily in garden. Main goal is to return to gardening.

83 Case Study Questions What are the likely functional issues this man may face following his stroke? Picture yourself conducting a Home Assessment with this gentleman. What environmental issues may be present in his home? What are some likely falls risk factors in this case? What strategies might you suggest?

84 Questions?

85 Thank you for attending the MAKE YOUR HOME SAFER FORUM Thursday 7 April 2016

86 Stay On Your Feet WA is coordinated by the Injury Control Council of WA and supported by the Department of Health.