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SHN RISK Summit: The State of Falls

This article is sponsored by SafelyYou. This article is based on a Senior Housing News virtual discussion with Shirley Nickels, COO at SafelyYou, Payam Parvinchiha, Vice President of Network Quality and Innovation at SCAN Health Plan, Austin Elkin, Vice President at Berkshire Hathaway Specialty Insurance, and Jim Altrichter, National VP of Clinical Services at Anthem Memory Care. The discussion took place virtually on November 16, 2022 during the SHN Risk Summit. The article below has been edited for length and clarity.

Shirley Nickels: We know that each second of each day in the United States, someone aged 65 or older is falling and the aging population is growing and so will the number of falls. Today, we want to talk about the state of falls and how we can come together to think differently on how to reduce risk of falls. To help address this critical and growing issue, SafelyYou has developed a comprehensive report called The State of Falls. This was based on a survey of over 400 executives and care providers across senior living. What we found is that while this is a very complex crisis, there’s also a great opportunity for reducing risk. Today, I have an expert panel to talk about how we can go beyond the status quo and break down silos and misconceptions around falls, really around how we reach our goals in mitigating risk.

Payam joins us as a corporate Vice President of Network Quality and Innovation at SCAN Health Plan. He and his team lead SCAN’s collaborations with medical group partners working to divide innovative ways to deliver the highest quality of care. Previously, Payam held medical management positions at Anthem, including as medical director of virtual health, and served as medical director of CareMore Health, overseeing home-based care for seniors. Before that, he gained valuable expertise in hospice and hospitalist medicine leadership roles.

Also joining me is Austin Elkin who is a Vice President of underwriting within the Healthcare Professional Liability Group at Berkshire Hathaway Specialty Insurance. He serves as a senior care practice leader and is responsible for the underwriting strategy and execution for the senior care professional and auto liability product lines within the U.S.. He has supported the healthcare and senior living industries for over a decade providing solutions both as an underwriter and claims professional.

Austin was a founding member of BHSI’s Healthcare Group and has held positions at Zurich Liberty Mutual and Kaiser Permanente. We also have Jim Altrichter, National Vice President of Clinical Services at Anthem Memory Care. Jim brings years of experience in a broad range of areas and settings to his position, overseeing all clinical services at Anthem. Jim has fine-tuned his skills through working in a variety of clinical settings including skilled nursing, chemical dependency, critical care, and outpatient clinics. Working closely with medical and nursing colleagues, Jim has been instrumental in the development and implementation of behavior management plans and training programs related to Alzheimer’s, dementia and other cognitive disabilities focused in assisted living and memory care settings.

Thank you all for joining me today. We know from industry research through the CDC and NCOA and the National Institutes on Aging that falls are the leading cause of both fatal and non-fatal injuries for older Americans. One in four older adults falls each year, every second and older adults over 65 fall every 11 seconds. Those older adults are actually treated in the ER and every 19 minutes, an older adult dies from a fall event. This is costing our health system over 50 billion a year and this cost will actually double in the next 10 years. By 2030, there will be 72 million older adults experiencing a combined 52 million falls every year, a cost of 100 billion per year. For those living with Alzheimer’s and other forms of dementia, this fall impact is much greater. They actually fall twice as often. I know some of you’re probably looking at this number going like, “Wow, that seems extremely high.

How is it doubling just within 10 years?” I don’t know. Payam, if you can maybe give a little bit of color from your physician background? Why is that? Is it because the population is just growing exponentially or is there a specific cause of this?

Payam Parvinchiha: It feels like the cost has doubled already over the past year, compared to where we were pre-pandemic. I think there’s a lot of factors involved. The demographic shift to an older population that you all obviously have been seeing in your communities is clearly a component of it. There’s more and more seniors and as the baby boomers age, there’s just a massive amount of more people living with not just dementia but chronic disease as well. One of the challenges of an improved healthcare ecosystem where we can keep people alive longer is unfortunately, we’re keeping people alive sicker longer.

Again, you guys are all seeing that very clearly in your communities that 10 years ago, what your average 85-year-old resident looked like is much different than today because previously, when you made it to 85 or 90, it’s because you lived a somewhat healthy life to make it there. Now with medical advances, luckily I guess, we’re keeping people alive a lot longer dealing with significant chronic diseases. The dementia prevalence is also increasing significantly in that population as well for a variety of factors that epidemiologists have not, I don’t think accurately still identified.

The pandemic accentuated the reality of if people at that stage aren’t experiencing physical activity, the risk is falls. Again you guys all have seen it, I’m sure in your communities, whether it’s related to the pandemic or related to staffing shortages, where just this population when they’re not active are just more prone to falls as a pretty direct outcome.

Nickels: I would think senior living operators are also serving a higher acuity level.

Parvinchiha: Absolutely. I think the shift away from nursing homes is becoming more and more, it’s still going on. I think again, the nursing home impact related to the pandemic again and the negativity around nursing homes is going to shift even more older adults with medical issues into assisted living predominantly where, again, these types of events are going to be more frequent.

Nickels: Really getting ahead of this and really changing the way that we reduce the risk of falls is more imperative because the likelihood, the frequency of falls, and the risk of those are also doubling in a sense. We really want to be able to bring some color and a different perspective today. What can we do? We all have a responsibility to reduce risk for our most vulnerable population. From SafelyYou, for us, our focus and a mission is to provide safer dementia care using our AI video technology and our remote clinical team.

We do believe that we can provide a voice, especially for those living with dementia, to reduce their risks of falls and future falls and then obviously provide the care staff and the teams the right tools to be able to support them.

With SafelyYou, I’m going to get into some of our data to lead into some of the statistics around what we know about falls and then also in combination to The State of Falls report and what we learned. From SafelyYou, we’ve clinically reviewed over 60,000 fall events and we average almost 200 falls per day and our clinicians are reviewing.

From our expertise, we really want to be able to provide today and the panelists a different perspective of actual events and what we actually are able to witness because 95% of falls are unwitnessed and we think we have a perspective to help reduce risks for our operators. First off, we know that the majority of falls are not requiring ER support. About 2% of our detections require an ER visit. That means of all of the events that are actually taking place on-site, how do we help enable that care team and their medical professionals with the right support and tools to reduce the frequency and obviously the severity and nature of those events, knowing that the majority do not need to go out to the ER.

In addition, as I talked about the majority of falls, 95% are unwitnessed. That means the resident is alone in their room when they do have a fall event. Again, how do we understand how those events are taking place? We also know that close to 20% of falls are actually silent. What that means is that a resident falls on their own in the bedroom and then gets back up without anyone ever knowing it. This actually got up to about 22% during the pandemic peak. It’s now been averaging back out around 17% again, which is great. It means that teams are now obviously trying to mitigate risks in the room and also making sure the resident is out of the room in activities and in a common area space and engaged. We also know, SafelyYou, that when somebody is found in a room, typically they scoot themselves around the room, which makes it really difficult to solve a fall or find out the root cause. About a third of the time, a resident will scoot from one location, like by the bedside to the doorway, 30% of the time by the time that they’re found within minutes. Again, how do we better understand how falls are occurring to mitigate future falls and obviously, the severity and nature of those fall events.

SafelyYou believes that falls really can be prevented. There are a lot of mitigation strategies out there, whether or not it’s SafelyYou or other technology tools. I know Jim uses a couple of other technology tools that he can talk about today. There’s also just better assessments, better care planning, leveraging other care providers like Payam’s team, and obviously leaning in with your insurance care like Austin.

We’ll go through that, while you have other resources that are available to you where we can’t prevent falls. Here this is just a graph showing that by leveraging technology as an example, you can reduce the rate and frequency of falls by using tools that you do have. Within the SafelyYou population, we wanted to better understand if we enabled certain technology tools and allowed the caregivers and the clinicians on-site to better serve those residents and understand how falls are occurring, can we actually reduce falls? We can. We showed a 47% reduction in that fall rate.

The state of falls today. It is a crisis, but it’s extremely complicated as I mentioned. We know that the care teams on-site have a lot to balance. They have demands from families. They obviously have demands from the residents themselves. Obviously the staffing challenges, just the health system in general. It’s a huge emotional toll. There’s a physical burden to it and what we want to do right now is to lead into what we learned from that report that we conducted.

The SafelyYou Report which we conducted here this past spring, we commissioned Merrill Research as a third-party research firm to conduct both quantitative and qualitative research of 210 executives. That spanned over 200 care champions at care facilities across the U.S.. This was conducted in April and May timeframe. Then in addition, SafelyYou conducted an online survey in July to measure and quantify American sentiments around falls and aging. This survey captured responses from a broad distribution of over a thousand adults, aged 42 and over.

First off, this is just the profile of the survey background of the operator that we conducted this on. This gives you an idea of how we wanted to make sure that we had a good distribution of the voice of the operators. Between split, between both assisted living and skilled, different size of facility, community sizes, also occupancies, challenges. Then also just a variety of executives.

Then in addition, when we surveyed the community, the care champions, again, we wanted to make sure that we had a good distribution of different perspectives from those participants. This gives you, again, that split between the different types of community types, different regions, and whether or not they already had fall systems in place. This is what we found out.

First off, from an American adult, the risk of falls from their own individual awareness in their aging journey, we want to ask about their fear of falling and their awareness of falling. What we found is that adults are taking steps to prevent falls. They understand that as they age, their risk of falls and their mobility will impact. 54% are doing strength exercises, they’re purposely doing those. 47% are working to improve their balance.

We also heard that 86% of people don’t even tell anyone about their falls, and that falls that are unknown and they go untreated. Close to 20% of adults, 71 and older avoid activities out of fear. When you’re looking at this, and again, I’ll get into more questions with the panelists, but the individual awareness, when you’re thinking about your population and who you’re serving in your communities, they are feeling like this burden. Especially independent living in AL, they are trying to do more strength training and things like that. They also know they’re likely falling alone in their room and they’re embarrassed. How do we help prevent these for them and obviously still keep them engaged?

Now, transitioning over to the risk of falls from the operator perspective, we want to ask questions from the operator and understand their awareness of falls. Majority, 85% believe that falls can be prevented and that 97% report that fall mitigation is very important to the quality of delivering care. What I also thought was interesting on this last bullet was that 84% calculated the cost of falls to their organization.

This really means that operators today understand that risk of falls is really important and their service delivery and also know that it is costly. From an awareness perspective, I think it’s amazing that people are aware of falls, but what are they doing about it? Maybe there is some lack of additional awareness. This is a question for the panelists right now, if operators and individuals are aware of their risk of falls and people are aware of it, then why are falls still increasing?

Why are falls still such a huge complicated crisis? If we can just start the conversation out right now, where do you think the largest gap is in both individual awareness or even the operator awareness to help start mitigating falls? Jim, do you want to start us off?

This excerpt has been edited for length and clarity. To watch the full discussion on video, please visit:

SafelyYou goes beyond fall detection, providing rich insights and an expert support team to empower fall prevention, helping you deliver person-centered care. To learn more, visit: https://www.safely-you.com/.

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