Falkirk Falls Management Project Progress Report

1. Falkirk Falls Management Project Progress Report Linda Saunders Team Manager Falkirk Council MECS For JIT Telecare Event 18/05/11

2. Falkirk Area Falls Management Person falls and is identified by: - Care and Support at Home Scottish Ambulance Service (Uninjured Fallers Housing with Care Service Residential Care Service Central Scotland Fire and Rescue Service ( Bariatric fallers) MECS Service • Monitor and • record falls • Deliver • OTAGO • Programme • Staff falls • Awareness • Training • complete • Checklist in • planning • to pre-empt • referral thru GP • All work in progress • Falls to be • monitored thru • home care • staff • To Inform HC • Manager • To Notify GP • All staff to have • Falls Awareness • training • Monitor and • record falls • Deliver • OTAGO • Programme • Multiple fallers • Referred direct • Staff will have • Falls awareness • Training in May • 2011 Falls Mobile Op Coordinator carries out Assessment • M & H Assessment • Home Fire Safety Risk Assessment • Info re Falls Management Project & Advice Booklets • Telecare solutions including automatic falls detectors • Environmental Risk Assessment • Falls risk assessment + Timed ‘up and go’ Multiple fallers currently referred to GP Multiple Fallers Referred to/for: Community Care Teams for SW inputs • ReACH Team • Day Therapy GP refers • Multifactorial Assessment • Programme of appropriate input and therapy • OTAGO Training etc.

3. Falls Stats Within The MECS Service YEAR Falls Attended Users Falls per user 2002 1768 4213 0 .42 projected 2003 1429 4600 0.31 2004 1409 4904 0.28 2005 1487 5600 0.26 2006 1524 5598 0.27 2007 1291 5939 0.22 2008 1964 6014 0.33 2009 1897 6084 0.31 2010 1897 6055 0.31

4. MECS falls stats - details • These figures represent a potential prevention of some 5913 falls from 2003 to 2010 if compared with the pre-intervention rates of falls per service user. • In 9 years 6300 new MECS Service Users have been provided with information booklets/tapes containing useful information about falls prevention • 14,371 falls have been attended by MECS Mobile Wardens • A total of 702 frequent fallers amongst the MECS service user group who have been subject to appropriate assessment/multifactorial assessment in relation to their falls. • All people who have fallen have had their GP notified of their falls within a week.

5. Falls Prevention - Residential Care Homes • Falls awareness training sessions in all Falkirk Council care homes completed • Sessions have included basic advice on available Telecare solutions • So far 68 members of staff have attended • Most had never had any previous falls awareness raising sessions • Most had no idea what Telecare was • All could think of residents who could be assisted by their increased knowledge of both prevention strategies and the provision of Telecare • Sessions stimulating interest amongst these staff to attend more in depth sessions on Telecare awareness

6. Falls Prevention - Residential Care Homes • 4 out of 6 Council residential care homes now have some form of Telecare equipment installed to help support residents who were falling to prevent further injury and potentially moving on to alternative care provisions • Beginning to recognise potential for service re-design through the use of Telecare alerts to provoke a reactive response rather than proactive rounds of care provision - often seen by residents as being restrictive and intrusive • Ongoing work with residential care unit managers to produce a falls management strategy common to all the care homes and compatible with the work currently being undertaken by Ann Murray from QIS and Edith Macintosh from the Care Commission • Negotiations underway to facilitate unit managers making direct referrals to Reach

7. Falls prevention in Housing with Care • All staff to have falls awareness training sessions in May 2011 • Falls amongst residents are recorded and monitored • Frequent fallers are referred direct to Reach for multifactorial assessment • Beginning to recognise potential for service re-design through the use of Telecare alerts to provoke a reactive response rather than proactive rounds of care provision - often seen by residents as being restrictive and intrusive • Working with unit Managers to develop a unit falls environmental risk assessment tool based on the work of Ann Murray and Edith McIntosh for Residential care Services

8. Joint Working with Central Region Fire and Rescue Service • This agreement ensures discreet assistance with manual handling for bariatric service users following an illness or fall with the moving and handling team directed by trained and experienced Social Care staff. • Joint approach across Forth Valley area • Agreement between Forth Valley NHS, Falkirk, Stirling and Clackmannan Councils with Central Region Fire and Rescue Service

9. Joint Working with SAS on Non-Injured Fallers in Falkirk • Approximately 200 uninjured fallers per month attended by Scottish Ambulance Service • Some people left at home who might have social care requirements as a direct result of their fall and immediate incapacity. • The potential for these people to become regular fallers/callers to SAS or to be transported to hospital and for admission to hospital for “social” reasons. • No referrals on from SAS for other inputs after their initial response to the faller. • MECS/24/7 Crisis Care Team/Scottish Ambulance Service/NHS Forth Valley Fastrack Team discussions have taken place • Difficulty in reaching cross Forth Valley agreements because of 3 different Local Authority referral/assessment processes/emergency service provision • Pilot in Falkirk area commenced for 6 months from 3rd may 2011

10. SAS Pilot - Outcomes expected • Fallers attended by SAS referred on to MECS and Fastrack through agreed falls screening tool • Fallers referred provided with alarm equipment to call MECS for future assistance and assessed for further telecare needs • Fallers referred included in the Falkirk Falls Management process at an early stage • Fallers provided with up to 3 days of Crisis Care service through Social Work 24/7 Team and longer term care needs assessed within this period. • Reduction in unnecessary future calls for assistance to SAS • Reduction in unnecessary admissions to hospital • Reduction in future social care requirements by Crisis Care inputs aimed at re-enablement • Formal evaluation of pilot to establish outcomes and efficiencies

11. JIT funded extension to MECS Falls Management Project • With funding from the Joint Improvement Team Telecare Development Board the Falkirk Falls Management Project has appointed a Mobile Operations Co-ordinator from MECS for a period of one year from 1st July 2010 to undertake specific work with people referred to MECS in relation to falls they have been experiencing.

12. Specifics of the extended project • Prioritising the assessment of all outstanding referrals as the result of falls • Assessing the individual in their own home for appropriate telecare equipment • Support to individuals with telecare solutions installed to achieve maximum compliance and early re-appraisal of technology including planned return/support visits • An environmental risk assessment/ specific falls risk assessment • A timed get up and go measurement • A referral-on , where appropriate, to the Community Care Team, REACH or Day Hospital • Provision of Falls Prevention booklets, Simple Solutions catalogues and information about the Handyman and Small Repairs Service • Training other MECS assessors to work in similar ways for the future

13. Falkirk Falls Management Flowchart (Page 1 – MECS Assessment) Referral received by MECS Service Prioritise the referral from recorded information File into Category folders Falls MOC will retrieve referrals as per category recorded Falls MOC visits to undertake assessment Discuss need for Keys MECS assessment Proceed Service Agreement Including Waiver to share Information with Health & SW colleagues M&H Risk Assessment/ Risk Assessment & Telephony Supplier Declaration Forms completed Give Falls Advice And booklet “slips, trips and Broken hips” Give MECS booklet “falls Management Project” Do Not Proceed Discuss with NOK or Referrer Proceed Pass paperwork to MECS admin staff after referrals to CC duty work or Reach have been processed Do Not Proceed Pass M&H Risk Assessment and Risk Assessment to MECS Staff Add service user to live database on Saturn Pass Paper to MECS Admin Staff Resources Co-ordinator Updates Falls Project Data Sheet Saturn updated Case Closed File papers Papers filed

14. Falkirk Falls Management Flowchart (Page 2 –Additional Assessments) Referral received by MECS Service Prioritise the referral from recorded information File into Category folders Falls MOC will retrieve referrals as per category recorded Falls MOC visits to undertake assessment Assess for Telecare Solutions using Telecare Specifics Form Assess Home Environmental Risks Assess for Home Fire Safety referral Arrange installation Of suitable equipment Pass referral to Central Scotland Fire and Rescue Services Assess Falls Risk & Timed Get up And Go Refer to Duty Worker for C. Care Team Refer to Reach Team by Agreed Referral form Give simple Solutions Catalogue Or Care & Repair Details Re-visit early to check Pass to Reach If necessary Or file in S.User details In MECS Office Processed through Reach priority levels Processed by Marion Thomson of CSFRS Processed through C.Care Team Eligibility Process Revisit as required or At day 4 Passed to appropriate Watch for visit Visit at Day 7 or on Request/by judgement Refer to Day Hospital Arrangements Made to visit Service user/ Patient Allocated to a CCTW For assessment And provision Visit arranged Visit at Day 28 or on Request/by judgement Equipment installed or Recommendations Back to MECS Visit as required

15. Emerging Statistics from 10 months 358 - Referrals made to the project to end April 2011 for people with a previous falls history 250 - Assessment visits undertaken to end April 2011. 25 - Service provision declined at assessment visit due to health improvements since referral 9 - Service provision declined, reason unknown 4 - Service discontinued as admitted to Long term care 6 - Service discontinued as Deceased 7 - Service discontinued due to charging 47 - Have been assessed and are waiting on service installation (charging/keys etc). 10 - The number of weeks the project will be extended by to recompense for periods when the postholder was deflected into service operational issues.

16. And there’s more……… Of the 152 installations to end April 2011;- • 20 - Have been supplied with Tynetec Sayphone units with adjustable sensitivity automatic falls detection • 119 - Have been provided with more generic community alarm equipment • 2 - Have been provided with other forms of telecare equipment in addition to generic alarm • 13 - Have been provided with the “telephone service” • 140 - Have had no falls since service provision! • 7 - Have had 1 fall and are being monitored for further falls and inputs required. • 5 - Have had 2 or more falls since service start and are receiving/been referred for ReAch input

17. ……and more yet! • 220 people have been given falls prevention information re “Slips, Trips and Broken Hips” booklet • 7 people were left with a “Simple Solutions” catalogue to access small aids independently ( 100% increase) • 122 referrals have been made for home fire safety assessments by the Central Region Fire and Rescue Service • 11 referrals have been made to the Community Care teams for further assessments of need (100% increase) • 24 referrals have been made to ReAch for multifactorial assessments ( in the same period for the last 2 years this was 43 and 50)

18. Falls and Telecare • Many service users have had traumatic experiences following falls and “long lies” with no means to obtain assistance. • A few have experienced significant injuries as the result of previous falls. • Many admit to having reached a stage where they were reluctantly beginning to believe that they could not continue to live independently for much longer. • Others have hidden their falls from others out of fear that this might lead them to having to leave their homes. • For many the provision of falls prevention information and a hard look at the risks in their living environment are probably enough to reduce the risks of further falls and the addition of telecare equipment provides a measure of confidence for the individual. • Most service users and their carers had no knowledge of the types of equipment which could be provided to monitor or try to prevent falls but were generally receptive to suggestions to try something.

19. Finally…. • Telecare has a real part to play in promoting confidence/preventing further some of the medical emergencies which can occur as the result of prolonged periods lying injured following a fall. • Service users tell us that they feel more secure in the knowledge that if they have a fall, someone will be alerted and come to help them. • It is not always necessary to employ highly sophisticated equipment as ,for many, access to the community alarm service is all that is required and ,indeed ,all that will be accepted by some. • Where the Altera care software was available to monitor their relative, families appreciated the innovative technology which facilitated this. • With telephone follow-ups/return visits to those experiencing teething difficulties with their falls detectors to alter the sensitivity of their equipment , a higher rate of compliance with wearing falls detectors can be established. • All service users seen as part of this project will be sent a satisfaction questionnaire and the evaluation of this provided to JIT at the conclusion of the project. • The impetus of this project will not be lost as all MECS assessors will be trained to undertake this fuller assessment process with those with a history of falls into the future.