Warning: Falling at a care home. Prevention is better than cure!

Care home falls are one of the biggest fears and risk factors for fragile and elderly residents. When you place a spouse or relative into a care home, you rely on the care home’s integrity and professionalism to look after your loved one at a time when you are no longer able to. Of course, no one knows what goes on behind closed doors when you leave your relative at night, but you have to believe and have faith that they will be looked after as you would want, in a safe and caring environment.

Putting a relative into a care home can be a very traumatic and emotional time for families, as they effectively hand over control and entrust responsibility for their relative’s daily care to a third party. That, too, can have an unsettling effect on the individual, as they move into unfamiliar surroundings and have a new regime imposed on them to suit the care home, which may not necessarily chime with the individual’s or family’s wishes.

However, too often, circumstances dictate that, unfortunately, for various reasons, there is no viable alternative other than to place a relative into a care facility. The necessity to provide 24-hour professional care in a safe environment, trumps the family’s ability to cope and care for their relative at home. Natural feelings of guilt or failure are common but have to give way to the comfort of knowing that your relative will (hopefully) be in a secure and caring environment, dedicated to their wellbeing.

Some care homes provide marvellous, first-class, attentive care. Others, you hear about can sadly fall way below expectations and CQC standards, and become a source of anxiety and despair, leaving families hugely frustrated.

Admission to a care home:

On being admitted to a care home, multiple risk assessments should be carried out to look at all your relative’s needs, top-to-toe. A cursory checklist as a ‘tick’ box exercise is likely to be grossly insufficient and perhaps be indicative of poor levels of care to follow.

In many cases, patients are transferred directly from hospital into a care home. Upon discharge, the hospital should provide the care home with a Discharge Summary with notes (eg diagnosis, present complaints, relevant investigations and results, medications (including any stopped or changed), discharge destination, physical ability and cognitive function, advice, recommendations and future plans including results awaited, actions and outstanding investigations, etc). However, it has been known for Discharge Summaries to be rushed, incomplete, misleading or inaccurate. Handovers from hospital can sometimes, unwittingly, fail to follow basic advice from the patient’s consultants or specialists, leading to mismanagement of the patient’s care needs when they enter the care home.

Even though the Discharge Summary is a useful starting guide sheet for care homes, in our experience, they should not be relied on as being sacrosanct. As above, they are prone to human error and omission. A responsible and diligent care home should start afresh and carry out their own detailed risk assessments at the point of first admission in order to formulate a bespoke Care Plan(s) specifically tailored to meet their incoming resident’s needs.

The same risk assessments should be undertaken for a patient returning after a period in hospital as in-patient, in case their condition has changed. No one size fits all and every resident’s risks are different. Thorough assessments are vital to creating a good foundation for attentive care.

Falling:

Falling is one of the biggest fears and risk factors for fragile and elderly residents.

Residents who are unsteady on their feet or with cognitive impairment such as dementia, can be at high falls risk.

We commonly hear from families that a parent has fallen out of bed, fallen in the corridor or bathroom. Many falls go unwitnessed and out of sight of staff on duty or any CCTV cameras. If the care being provided is as good as the care home’s marketing often claims, you have to ask how can such accidents happen if there is supposed to be proper care and supervision in place!

Top 5 causes of falls:

The most common causes of falls are due to:

• Impaired vision:  E.g. caused by cataracts or glaucoma alter vision;
• Medication: Increasing medication can increase the risk of falling. Some drugs (e.g. sedatives/ anti-depressants / strong painkillers) reduce mental alertness, can cause confusion, affect balance and gait, and cause a drop in systolic blood pressure while standing;
• Weakness, low balance and lack of mobility: can lead to many falls;
• Chronic conditions: Pain from arthritis can put pressure on joints and result in changes to gait. Other conditions such as Parkinson’s, heart disease, a stroke, cardiac arrhythmia (slow or fast heart rate) can lead to dizziness, cause poor balance or alter the way limbs function and increase the risk of falling;
• Hazards: or obstacles left lying around in the way.

All falls, whilst always regrettable do, of course, happen more frequently with elderly residents. However, residents at high risk of falling or who fall repeatedly (even without sustaining serious injury), should be a cause for real concern; not only for the individual’s own safety and wellbeing, but as it could be indicative of the lack of all-round care, or staff shortages at the care facility. Especially, as many falls reputedly happen at nighttime when staffing levels are lower and/or when residents are left unsupervised and perhaps able to wander.

Proper Falls Risk assessments should be done at the outset on admission, and then continually reviewed, to ensure they are still fit for purpose as residents inevitably become more frail and less mobile with age. Usually, a Falls Risk Assessment Tool (FRAT) is used.

Prevention is better than cure!

You should ask to see the care home’s risk assessments to check they are accurate and actually reflect your relative’s mobility.  Good record keeping is essential, and particularly so, if your relative is seeking NHS Continuing Healthcare Funding. The care records should include every falling incident and near miss, injuries sustained, what was the cause of the fall, and what measures were implemented to prevent further similar occurrences.

Reassessment should also be undertaken regularly if the resident’s condition changes.

Depending on the level of assessed risk, here are some simple things to consider that could reduce or eradicate the risk of causing serious injury:

• Should 1:1 care be implemented?
• Do grab rails and other aids need to be fitted?
• Should bed rails be put up at night?
• Is a crash mat needed by the side of the bed to minimise injury in the event of a fall?
• Should an alarm be fitted in case the resident tries to get out of bed or leave their room unaided?

Consequences of falling:

A fragile or elderly person who falls and suffers a hip or leg fracture, is most likely to sustain an irreparable and (often) inoperable injury (due to high risk of surgery under anaesthetic) – which could render them less able to walk, or worse, permanently immobile – and wheelchair or bed bound.

Rehabilitation in an elderly person, especially with brittle bones, osteoporosis or osteopenia, can be more challenging, if indeed, it can be undertaken at all. Elderly people generally take longer to heal and so will endure more pain, discomfort and inconvenience whilst rehabilitating.

The transformation from being independently mobile (even if needing some assistance) to becoming completely immobile can be devastating for the individual, and have a dramatic adverse impact on their mental and physical wellbeing.

Elderly hip fracture survivors experience worse mobility, loss of independence in function and decreased (physical) quality of life – usually resulting in increased care needs.

Reportedly, a resident with cognitive impairment such as dementia, increases the risk of falling and a hip fracture by three times compared to someone who is cognitively intact.

Sadly, falls can lead to a deterioration in an individual’s overall health and impact on other areas causing added or new complications, and resulting in a rapidly premature demise.

How to use the Fast Track Pathway to get immediate Continuing Healthcare Funding within 48 hours!

Common problems associated with falls:

Immobility: whether lying in bed or sitting too long (in a wheelchair) can cause pressure sores to bony prominences (eg buttocks, heels, feet, ankles, elbows) which can be extremely painful and, if not treated quickly, can deteriorate rapidly and become infected and life-threatening.

The dangers of pressure sores, pressure ulcers and bed sores

Incontinence: Toileting accidents, caused by immobility, can leave residents in understaffed care homes in soiled and wet clothes for hours before being attended to. Wet patches can develop causing skin breakdown and irritation, with the risk of developing into deep pressure sore areas if not inspected, monitored and treated regularly.

Communication: Some residents can’t tell you that they have fallen or are in pain. We have known injuries go undetected for days until a family member has been to visit their relative and, to their horror, uncovered an injury or deformed leg, raised the alarm prompting an investigation or safeguarding enquiry.

Sometimes, the injury has gone unnoticed by staff due to difficulty interpreting the resident’s inability to communicate reliably.

On occasion, the startling lack of contemporaneous notes in the daily care records can naturally lead families to believe there has been a cover-up by staff to hide blame. A recording of an ‘unwitnessed’ fall in the records can be a clue and imply neglect.

If you suspect neglect or fault, you must not ignore the matter. You place your relative into the care home’s trust and are fully entitled to expect that, as a minimum, that they will be safe and not allowed to fall.

Cognitive impairment: Research indicates that a hip fracture can lead to cognitive decline (eg Alzheimer’s) or accelerate its onset.

Summary:

Unfortunately, falls by elderly and fragile residents in a care home are quite common and can have serious consequences – both mental and physical.

We suspect that most falls could and should have been avoided with proper risk assessments, good care and supervision, attention and constant reviews and monitoring.

Please! If your relative is in a care home, please ensure that the opportunity and chances of falling are eradicated or minimised, wherever possible to avoid injury.

Finally, if your relative is vulnerable and at high risk of falling, consider whether this will increase their chance of successfully being awarded NHS Continuing Healthcare Funding. For more information visit our website: www.caretobediffernt.co.uk or contact us directly.