Falls Prevention in Residential and Care Homes A North Wales Perspective

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1 Falls Prevention in Residential and Care Homes A North Wales Perspective Promoting mental wellbeing how can you play your part? Dafydd Gwynne & Lee Parry Williams, Public Health Wales

2 Aims Background of the North Wales Falls Prevention Project Overview of prevention and early intervention in Care Homes Identify key learning points Confirm future challenges and opportunities

3 Regional Direction Local Delivery

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5 North Wales Project Older People Living in their Own Homes in the Community INTEGRATION Older People in Hospital Older People Living in Care Homes 3 settings sharing 3 key features: 1.) Proactive identification of those at highest risk 2.) Comprehensive multi-factorial risk assessment 3.) Access to appropriate interventions to reduce risk

6 Risk Factors Multi-factorial Intrinsic Balance and gait - coordination Loss of muscle mass & sedentary behaviour Medication Alcohol Foot health & footwear Sensory impairment Diet & hydration Co morbidities (e.g. CI or dementia) or infections Postural hypotension Loss of confidence and poor mental well-being Extrinsic Trip hazards Poor lighting or colour contrast Mobility aids Stairs or uneven / slippery surfaces Lack of bed rails Poor access to the toilet Change of environment Temperature

7 The Five Ways to Wellbeing Evidence Based Actions to support Wellbeing Do we do these already? Could we do more?

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9 Prevention and Early Intervention in Care Homes Sharing our experiences The Journey to Date The Tool The Trial Implementation The training

10 The Journey to Date Falls in Care Homes Implementation Group multiagency Developed Service Model Developed the N. Wales Falls MRA and Care Plan Tool Launch of the Falls Risk Assessment Tools Trial

11 Service model for Care Home Sector provides overview of the key responsibilities and also a reminder of the procedure in the event of a fall.

12 The Tool Based on earlier document developed in Wrexham and Flintshire A package of support including: Guidance for completion Multifactorial Risk assessment Summary Care Plan Record of referrals and follow up Record of unmet needs Review recording Support documents- footwear suitability /nutrition prompt/culprit medication

13 Who - when- by? On admission everyone over the age of 65yrs Anyone who is but is judged to be of higher risk due to underlying health condition Reviewed if circumstances change and/or minimum monthly Registered nurse/senior carer

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16 The Trial Implementation 3 month period Facility for feedback Support for Implementation Support via Local Implementation Groups

17 Implementation & Training 1: 1 Care Home visits Study days Opportunities for learning Opportunities for feedback Sharing experience

18 I do worry about litigation relating to falls and our documentation is not as good as it could be, therefore I think this paperwork will benefit our home. I thought the training was very interesting and very important to the work we do. I welcome the introduction of such a comprehensive assessment process that will hopefully ensure that practitioners record effectively to support good quality care. Recording unmet interventions are very much welcomed to support decision making.

19 Reflection... Making progress Positive response from all concerned Challenges keep coming Importance of falls prevention in the wider context of healthy ageing

20 Open discussion Ethics of preventing falls in care homes: how do we enable equal access to preventative interventions? Cognitive Impairment and Dementia: preventing falls amongst this high risk group. We know what works for falls prevention, so it s not so much the what?, but the how? Falls Risk Assessment Tools: The challenge of integrating tools into existing care home assessments, enabling their use, and avoiding overload Supporting wider wellbeing what do we do now, and how do we do more of the 5 Ways? (Connecting, Taking Notice, Being Active, Giving, Learning)