Reducing falls & fractures in Sheltered Housing

1. Reducing falls & fractures in Sheltered Housing South Ayrshire Partnership Project JIT Telecare Development Programme Dr. H Hall Feb 2011

2. Partnership Falls Project (telecare) N&S Alert Services, Sheltered Housing, ICT, Care and Repair • Phase 1: • Data management • All falls • RED FLAG Repeat fallers Phase 4: Fast Access to ICT Phase 2: Cross sector Training Phase 3: Role development

3. Preliminary data for one locality (SA) indicated approx 200 fall call outs per month with 20% repeat fallers 20 additional cases per month for community rehab team Capacity not available To complete pathway: Without putting severe pressure on ICT To set specific health care targets Isolated SA Sheltered Housing sector for a similar but smaller scaled initiative JIT project proposal March 2010 Partnership project (Alert)

4. South Ayrshire JIT falls project • Based in Shelter Housing Units: designed to • Reduce falls & fractures • Shift the balance of care from reactive to preventative approach. • Aims: • Reduce falls in the sector by 10%, • Unscheduled hospital admissions by 20% • Deliver joined up services • Inform development of falls pathways for larger cohorts of high risk fallers across Ayrshire & Arran

5. 5 phased project • Consisting of: • Data management & identification of fallers through registers • Falls education & role development of wardens • Fast access for fallers to community rehabilitation via the Integrated care team (ICT) – falls pathway • Self management of residents: fall prevention ‘cascade training’ by wardens to residents: “Positive Steps” • Evaluation (Jan – March 2011)

6. Evaluation Inform the development of future A&A fall prevention programmes • Measure care targets (10% reduction in falls, 20% reduction in unscheduled hospital admissions from SH) • Improve our understanding of ‘self management’: assessing the impact of ‘warden led’ falls prevention training to SH residents • Determine the type & nature of intervention used in the delivery of ‘home based falls prevention approach’ • Gain an understanding of the capacity needs & costs involved in delivering the home based preventative approach

7. Pre-project work… • SH falls data was reviewed prior to start date • 5 months data: • 116 falls, 18 A&E attendances,14 unscheduled hospital admissions recognised need to shift care balance from reactive to preventative • 3 month trial of referral link (Wardens ICT): • All appropriate, managed within existing ICT capacity, those referred had no further falls or hospital admissions

8. Preliminary work • Audit of ICT case load: • 20% of existing case load identified as ‘fallers’ requiring home based preventative approach • Little information concerning the nature of care delivered - ? evidenced based, OTAGO • Joint sessions to review & augment the ICT data system to: • capture additional information concerning care outcomes, disciplinary input, interventions employed, liaison & time spent with patients

9. Data management Training Role development Intervention (ICT) Evaluation Updated registers across all SH units Falls prevention & management training delivered to all SH wardens Joint meetings – ICT, SH Joint sessions to co-design ‘Positive Steps’ training for residents i.e. format, content, delivery method, associated hand held teaching aids Compiled the ‘Positive Steps’ boxes for each unit – cost, contents A final joint session – nags & snags Engaged the assistance of the NHS resource centre staff: Promote “Positive Steps” House master copy Review & update JIT SH project: March - Aug 2010 Falls engagement process

10. Organising & selecting the learning material for the “Positive Steps” boxes

11. Compiling the “Positive Steps” boxes

12. Promoting the resource

13. Data management Training Role development Intervention Evaluation Launch of “Positive Steps”: Oct Osteoporosis Event Day Oct Wardens Bone health training Development of self management & well being programme – increased NHS input (dementia, healthy eating) – led to older persons educational scoping project in A&A Development of “Little Steps” Data collection – falls registers Winter planning workshops – falls Evaluation: Questionnaire devised & distributed for residents undertaking “Positive Steps” training Analysis of 30 faller data files JIT project Aug - Dec 2010

14. Analysis of 30 data files • 30 randomly selected falls patients, referred from various agencies to the ICT, between March & July 2010 • type, nature & cost of care involved in home based falls prevention programmes • link with IRF work stream

15. Mean age 83.6 years • senior elderly population most relevant to receiving home based prevention • Less than ½ of the cohort were identified as fallers by referring agencies (mostly GPs) • hidden problem? • Prevalent outcomes: to increase patient safety & prevent deterioration that could lead to hospital admission • 9 patients however were admitted with either an existing or new health issue

16. Care needs were complex (chronic + acute) • Range of disciplines, MD health & social care interventions • Most had multiple risk factors for falls, • ½ had equipment needs • All but one needed ‘Case management’, • 22 had onward referral needs • High liaison contacts – 19+ care agencies contacted to facilitate care • Large variation in length of care: • mean length of time to complete programme = 4 weeks + 5 days • shortest 45 mins, • longest 9+ weeks

17. Types of interventions

18. 4 disciplines involved in delivering home based falls care • Principle input was for facilitation & coordination of care (geriatric specialist nurse) & for physical rehabilitation (Physiotherapy/TI) • Total cost of team to deliver care to cohort (based on active time spent with patients, pay scale band at mid point with employers NI/SA added) & travel costs: = £3156

19. Falls Prevention in Sheltered Housing – summary • Although a small pilot sample, it appears cost effective to deploy NHS/local authority resources to prevent falls • Reasonably modest levels on input for the interventions can have significant effects • Reshaping care to multi-disciplinary hubs will impact on the effectiveness of falls prevention through assisting the coordination & communication of care • Age of cohort has suggested a developing & continued need for home based falls prevention in A&A • Future capacity: predominant need for ‘coordination of care’ by geriatric specialists (traditionally nurse led) & Physiotherapy • Future capacity: PSI led continuing community based exercise programmes • High satisfaction levels (Sheltered Housing staff, SAC & health staff) for targeted partnership working which has delivered staff training, role development & fast access for residents to specialist health care

20. JIT project Jan-March 2011 • Evaluation • Currently gathering data for final analysis to determine if met targets – 10% reduction in falls, 20% reduction in unscheduled hospital admissions • Qualitative impact of “Positive Steps” • Resident questionnaire analysis • Focus groups • Need for additional learning resources – final spend • Cost analysis for preventative approach • Calculating the reactive care costs of the 9 patients admitted to hospital • Seeking involvement of a health economist • Progression of the “Repeat faller” reports across A&A