Falls in aged care: providers balance rights and risk
Managing the “risk of choice” in a consumer-led aged care environment is complex, say providers following premature deaths report.
Managing the “risk of choice” in a consumer-led aged care environment is complex, say providers following premature deaths report.
While aged care providers need to ensure facilities are as safe as possible for residents, they must also consider how a “black and white focus” on falls prevention could compromise quality of life, says Sandra Hills, CEO of Victorian provider Benetas.
Ms Hills said that while last week’s report into premature deaths in aged care provides important insights, consideration must be given to a person’s right to self-determination.
The research by Monash University Professor Joseph Ibrahim found that 15 per cent of the 21,672 deaths examined were premature and potentially preventable, and falls were the most frequent cause of these deaths (82 per cent).
Ms Hills said her organisation often worked with residents, their families and allied health teams, to identify how they can be best supported to live a happy life. For some this might mean walking unassisted or not wearing devices intended to prevent harm, she said.
“We need to work out how we can honour the older person’s right to choose, while maintaining their safety as best as possible,” said Ms Hills.
“Managing the risk of choice, particularly in the current landscape of consumer directed care, is a very complex issue for providers.”
In 2015 Benetas partnered with the National Ageing Research Institute (NARI) to better understand falls and ways to mitigate risk.
“We know that it only takes a relatively low impact fall for an older person’s health to be compromised and for this reason we want the likelihood of a fall to be reduced as much as practicable,” said Ms Hills.
“Our work with NARI has helped us develop a comprehensive falls prevention pathway for our clinical teams to follow,” she said.
‘Manage risks intelligently’
Dr Stephen Judd, CEO of HammondCare, cautioned against a situation where residential staff became “fixated on compliance rather than fostering a good quality of life” for the people they are caring for.
“Rather than trying to eliminate risks, we must manage risks intelligently,” he said.
Dr Judd said that while there had been “incredible” improvement in aged care provision in the past 15 years, he agreed that there was more to do.
However, better care will not come through greater regulation or process but through market competition, he said.
If the Commonwealth uncaps the supply of aged care beds, as recommended by the Aged Care Sector Committee, operators could establish new services wherever needed, as has been done in the home care market, Dr Judd said.
“This would enable greater true choice for prospective residents and ultimately lift the standard for residential services.”
Related AAA coverage:
- Premature deaths report puts focus on falls
- Aged care residents the ‘poor cousins’ in falls research
- Call to action on falls prevention
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I don’t believe that better care comes through market competition …. that’s the PROBLEM … aged care facilities are being run like businesses and all that matters is PROFIT! We need to introduce true person centered care practices, increase staffing levels, improve staff education and change the culture of care in these places … we need to encourage a less clinical and more home like environment where people are treated with dignity and respect!!
The risk of choice?
When will providers address the risks they choose to take by failing to provide enough staff to undertake clinical surveillance, a critical factor in falls prevention whilst maintaining “a good quality of life”?
But its not just providers…
When will Govt understand that the funding required for quality aged care must not be limited to the hands-on care determined by resident need, but must also include funding for appropriate levels of RN supervision of care staff and the clinical surveillance of residents.
It’s quite apparent that deregulation has not led to improved care. Mr Judd’s assertion that uncapping bed supply will lift the standard doesn’t make sense…we cant even provide a decent standard of care for the ones we’ve got.
Why not start by addressing the fundamentals?
Adequate numbers of well trained care staff…stop loading untrained staff with unreasonable responsibilities and cease advocating for the removal of RNs.
The right equipment: low beds, ditch the bed-rails, antipsychotics and physical restraints
Collect and analyse detailed falls data…don’t just count the number of falls/month…to identify the specific reasons your residents are falling (hint: it’ll most likely be due to shortfalls in the first two points above)
It’s about time we all stopped lying about ‘person centered care’. It just doesn’t exist. Any provider promoting this model should be held accountable and explain just how two junior AINs deliver person centered care to thirty high care residents with dementia?
Real personal care requires much more than just completing a two page personal history that gets filed away in the progress notes.
Education is the key for cares the government allows cares to pass a 3 month course and a lot of these carers are unable to read or write to a standard of an accurate and true documentation.
Staff do not know how to monitor residents a specially if the resident is at risk of falls.
Yes I agree a resident Mrs Jones is Mrs Jones to staff but to the facility she becomes Mrs 300.000.
The resident doesn’t have a face just a $ sign
It is clear to me our elderly are a thorn in the side of the government, and a money making prospect to facility owners.
My father has been in aged care for 11 wks due to a fall ar his hpme ,we thought he would be safe in aged care but has had 7 falls in 11 weeks all because of stupid laws to do away with bed rails apparently classed as Restraints !!!!!! well at 94 yrs of age and now covered in cuts n bruises possible hip fracture he is supposebly safe !!!!!!! im soooooo dissapointed $400’ooo to be eligible for aged care and almost $900 a week not happy