FALKIRK AREA FALLS MANAGEMENT PROJECT UPDATE FEBRUARY 2011

1. FALKIRK AREA FALLS MANAGEMENT PROJECT UPDATEFEBRUARY 2011 LINDA SAUNDERS FALKIRK COUNCIL

2. Falkirk Council Falls Management Person falls and is identified by: - Home Care CSF & RSL Bariatric Fallers SAS Uninjured Fallers Housing With Care Residential Care MECS Service • All work in progress • Falls to be • monitored thru • home care • workers • 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 to have falls • awareness • training • Monitor and • record falls • Deliver • OTAGO • Programme • Staff had falls • Awareness • training Falls Mobile Op Coordinator carries out Assessment • Home Fire Safety • M & H Assessment • Env’mental Risk Ass’ment • Falls risk + Timed ‘up and go’ • Info re Falls Mng’ment Project & Advice Booklets Multiple fallers referred to GP Multiple Fallers Referred to/for: Comm. Care Team • ReACH Team • Day Hospital Telecare Solutions GP refers • Multifactorial Assessment • Programme of appropriate input • 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. Stats - details • Significant nos. were introduced to MECS throughout 2008/9/10 because of a previous falls history and the substantial increase in falls attended in 2008/9/10 reflects their inclusion on the Service. • These figures represent a potential prevention of some 1866 falls for 2008/9/10 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 • 525 people who have previously experienced two or more falls in a 6 month period have been offered a referral into the “Falls Management Clinics”

5. Stats – more details • 281 referrals to REACH have been made up to end November 2010 and 3 to Day Hospital. • 418 other people who had multiple falls were already known to the Day Hospital or to REACH and already therefore in receipt of ongoing falls advice from REACH staff • A total of 702 frequent fallers amongst the MECS service user group who have been subject to appropriate assessment in relation to their falls. • All people who have fallen have had their GP notified of their falls within a week.

6. 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

7. Falls Prevention - Residential Care Homes • 3 out of 5 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

8. FREQUENT FALLER TELECARE FUNDED PROJECT

10. Conclusions to date • Not everyone who has falls needs specialist equipment • Many will feel adequately supported on the generic community alarm service • Some simply refuse to have automatic falls detectors • Those who had the highest falls risk have had automatic falls detectors installed with their consent • They have benefited from more frequent contact with the assessor • They express high levels of self confidence and reduced fear • In most there is evidence that their falls have reduced since this intervention • It is more difficult to persuade people who have had a generic service to move to automatic falls detectors than to persuade new service users to accept this equipment • There have, surprisingly, been no other telecare needs established in the service users to date

11. Conclusions contd • Most people seen have already benefited from an OT assessment and have aids and equipment suitable for their needs in place • Most people have fairly recently benefited from a recent medication review where they have been in hospital or where their GP has been working with them recently • Most people have not had an eye test in the last two years • Despite the higher number of frequent fallers being seen there is no increase in referrals to REACH with this intervention in place because advice is being given at the assessment about environmental hazards • There has been an increase in referrals to Community Care Teams, mainly for handrails and stair banisters • We feel there will be much to learn about fallers by the end of the year of the project

12. Stats to date • 181 frequent fallers have been visited so far • 34 have since discontinued service ( mainly because of the recent onset of charging) • 65 are awaiting installation (mainly because of the recent onset of charging) • Of 82 installations so far 73 have had no further falls • 5 have had 2 or more falls but are now receiving Reach inputs • 4 have had 1 fall and are being monitored for further falls

13. Joint Working With Scottish Ambulance Service The group consists of representatives from; • Falkirk MECS Service • Scottish Ambulance Service • Fast Track • Social Work Crisis Care and 24/7 team • Falkirk Telecare Partnership • Falls Lead from NHS Forth Valley

14. Draft 8 Pathway for Fallers in Falkirk Area Who Call Scottish Ambulance Service Call received at EMDC (Emergency Medical Despatch Centre) MECS Service User or has Falkirk Home Care Service? Triage Non MECS Service User and no Falkirk Home Care Service Injured requiring transfer to hospital or Uninjured/minor injury treated at scene but concerns Re welfare which indicate service user should not be left at home Pass to SAS Crew Pass call to Falkirk MECS Control on 01324 Uninjured/minor injury Treated at scene, no Immediate concerns for welfare but potential for further calls Uninjured/minor injury treated at Scene some concerns re welfare which should be addressed within a few hours No medical concerns and no mobility/ functional concerns - discharge home Convey to hospital • No medical concerns • but mobility/functional • concerns – Refer to • Fast track • Concerns which cannot • be addressed • immediately • - admit to ward If Medical Concerns Admit to Ward SAS treat & refer at scene Complete Referral form & fax to Falkirk MECS on 01324 506550 Fastrack on 01786 Pass to Mobile Wardens for Moving & Handling Fastrack Assessment of Mobility/ functional needs MECS Assessment of Critical Needs including risk assessments Rehab in a hospital setting by ward staff Provision of appropriate Walking aid and adaptive Equipment if required. Referral if appropriate to SW and Therapy Services E.g. Crisis Care, Home Care, Rehab at Home, Reach, Day Hospitals No concerns, Close case Telephone 24/7 Team to request Crisis Care Inputs Add to SWIS For TMD Pass to MECS Team to install Equipment or include on Telephone Service Add to Saturn database Injured? Injured? Uninjured? GP Contacted or other Primary Care staff visit requested Fall recorded and included in Falkirk Falls Management Project Provision of up to 3 days Crisis Care Inclusion in Falls Management project Discharge home with Follow-Up check Telephone call, plus or minus a home check visit Refer to CCT Duty Worker for further assessments No concerns Close Case