Canada's home-care agencies face tough measures to prevent falls under new accreditation rules that, for the first time, go right into the private homes where seniors live.
"The risks in the home are very significant," said Wendy Nicklin, president and chief executive officer of Accreditation Canada, which since January has required organizations providing home care to do "fall proofing."
It's a daunting but crucial task, say health-care leaders, especially since half of all falls occur inside the home. According to figures from the Canadian Institute for Health Information, 54,694 seniors were admitted to hospital for falls in 2007-2008; the figures do not include Quebec.
Accreditation is mandatory in Quebec for all public and private health-care institutions; in Alberta, government-funded health organizations must obtain it. Though voluntary everywhere else, virtually all hospitals and other health-care institutions seek it.
Prevention strategies for falls to minimize injuries have been required by hospitals and long-term care facilities since 2009. Such a strategy can include identification of those at high risk of falls and staff training.
Toronto Rehab, a complex continuing care hospital, has gone so far as to make fall prevention everyone's job: staff are expected to be mindful of spills on floors, ensure a patient's call bell is within easy reach and make certain that brakes are engaged on wheelchairs. Since implementing this policy, it has seen its fall rate decline from 5.1 falls per 1,000 patient days in 2008 to 4.1 falls per 1,000 in 2010-2011.
But many other hospitals and long-term care facilities across the country are struggling to implement an effective fall-prevention strategy: Over the past two years, 180 failed to meet the requirement, according to figures provided by Accreditation Canada. Another 484 met the requirement and about 213 more are to be assessed this year.
Accreditation Canada's Home Safety Risk Assessment began in January. It includes efforts at reducing falls for any organization that provides services in the home. The assessment requires a review of the outside and inside of the home, fire and fall hazards, plus medical conditions requiring special precautions.
Of the 28 organizations providing home-care services assessed since January, three have failed to meet the requirement and 25 have passed; a further 227 have yet to be assessed by Accreditation Canada. Many of these organizations are responsible for thousands of patients.
Names of institutions that fail to meet the fall-prevention requirement are not made public nor do the institution lose its overall accreditation on that one failure.
Stacey Daub, chief executive officer of the Toronto Community Care Access Centre, which has 23,000 clients a day, spent a year preparing for her organization's January accreditation, which it passed.
Fall proofing, she said, is part of a broad safety program where care co-ordinators check inside and outside the home for poor lighting, slippery floors, throw rugs and the absence of grab bars near a toilet or shower. These checks are frequent for patients at high risk.
"One of the most important places we go is the medicine cabinet," said Ms. Daub. "We've taken pillow cases full of medications out of people's homes."
During a visit to an east Toronto home on Monday, a nurse examined the stairs and a pharmacist inspected pill boxes of Katharina Lackner, who at 84, has a form of Parkinson's disease. She is cared for by her 87-year-old husband, Norbert.
The disease, which causes tremors, rigidity and instability, has put the once-avid gardener at high risk of falls due, in part, to poor peripheral vision. Twice during the 90-minute assessment Ms. Lackner fell backward into a chair as she tried to sit.
"She's at a very high risk of falls," said Anne Stephens, a clinical nurse specialist with the Toronto Central Community Care.
Her recommendations included a second handrail down the stairs, yellow tape on each indoor step, a transfer belt to help Ms. Lackner get out of bed, the repair of uneven pavement outside the home, shoes with a secure back, and a referral to a movement disorder clinic.
During the same visit, pharmacist Norm Umali opened plastic pill containers containing daily doses to find three pills for one day, six for another. Ms. Lackner had been filling the containers herself; Mr. Umali instructed her husband to verify the correct amount. She should also take medication at the same time each day.
"Taking pills on time as prescribed may help to lower the risk of falls," said Mr. Umali, "because the medication is prescribed to improve movement control."
On a provincial scale, Bernie Blais is heading an initiative of all 14 Local Health Integration Networks and 36 public health units in Ontario. They are preparing a toolkit for hospitals, long-term care homes and other health facilities that will help assess when a person may be at risk of falling, with information on prevention and even on educating family members.
"The whole idea is that injuries from falls can be prevented - not all of them but a large majority of them," Mr. Blais said in a telephone interview from Orillia, Ont. "Most of what we need to do is not costly but the injury is very costly … we will save money because we are doing the right thing."