By Elizabeth George
It was the middle of the night when a resident in a memory care unit awakened. She slowly lowered herself from her bed and scooted cautiously across the floor to the bathroom. Having reached her destination, however, she found herself unable to raise up. When care staff arrived to her room moments after receiving the resident’s call for assistance, they found her on the floor, distressed, and unable to explain what happened.
What would your care team do in this situation?
Based on current protocols, your actions would probably land the resident in the Emergency Room – confused, upset, and unhurt.
Every 11 seconds an older adult is treated in the Emergency Room for a fall.* And while little is known about the risk factors that are particular to those with dementia, we do know that these individuals visit Emergency Departments more frequently, are hospitalized more often, incur higher charges, and have higher mortality after an ER visit than patients without dementia.**
As Henry Ford once said, “If you always do what you’ve always done, you’ll always get what you’ve always got”.
Has the Industry Been Overreacting?
For the first time, the industry has the benefit of data from direct observations of over 2500 falls in memory care units. A slice of this data shows that ER visits should not be the common occurrence that they are:
- 1 out of 3 incidents reported as a “fall” are not a fall but the result of intentional self-lowering
- 85% of falls are without serious injury
This data comes from SafelyYou, a Senior Living Foresight partner, and a spinoff of the Berkeley Artificial Intelligence Research Laboratory. SafelyYou has developed a system for detecting and reducing falls that has the industry’s biggest players reimagining how they address falls with their dementia care residents.
There are a variety of traditional interventions related to fall prevention that have been around for years. What’s more encouraging is the entrance in this space of tech companies who are introducing innovations like sensors and wearables that aim to detect changes in gait and predict falls before they happen.
The bad news is that these strategies are rarely effective for those with dementia.
A Disruptive Strategy Is Needed to Help Those Living With Dementia
“All residents living with dementia are a high fall risk”, explains Shirley Nickels, COO of SafelyYou, “and since they can’t always explain what happened, tell you what they need, or even if they are experiencing pain, it’s extremely difficult to understand how they fell or if they fell. Solutions, including the most promising tech innovations that are emerging, may work for many but they aren’t usually effective in dementia care. Changes in gait, for example, are unpredictable in this population and wearables see a low adherence rate because residents remove or don’t wear them and care staff forget to place them on the resident.”
SafelyYou is dedicated to serving the dementia care community. Their system, powered by AI-enabled video technology, allows organizations to:
- detect a fall in real-time and alert onsite staff to respond quickly with 1000x higher accuracy than with currently available systems
- see immediate video of the event to understand what happened – video is only kept of the 30-minute period before and after a fall detection
- assess a fall and evaluate its particular characteristics
- develop a precise and personalized plan to reduce falls in the future with the help and expertise of the SafelyYou team, which currently supports approximately 15 falls per day
Results from a recent study were highlighted in July’s edition of The American Journal of Managed Care (click here to get the report). It showed that use of SafelyYou’s system resulted in a decrease in ER visits by 80%. Another study documented a reduction in falls by 30%.
Video has been seen by the industry as a double-edged sword with some concerns that what might be captured on camera may be a source of trouble down the road.
Shirley understands the perception. “We get a lot of questions about the use of video. The reason every attorney, consultant, and risk management personnel we’ve spoken to has supported our program is that it allows organizations to be proactive about risk management. We identify how residents are going to the ground before they result in injuries, where staff can use more coaching before improper transfer technique results in worker’s compensation claims, and protect our clients against false accusations of abuse.”
Shirley continues, “With the ability to observe falls and care team responses, organizations are better equipped to discover care gaps early and educate staff before issues escalate while also documenting all the instances of good care where resident falls were uncovered and the care plan was updated to provide better support.
“The required opt-in process means everything is transparent and collaborative with families, and we take tremendous pride that the average opt-in rate to use the program is 85%,” she concludes.
SafelyYou sees trends in the approximately 2500 falls it’s analyzed to date. “We see patterns emerging in the data across our client organizations”, Shirley says, “and we find that most interventions needed to reduce falls are environmental and may not be clinical. It’s easy and common to assume the worst but often, it’s a simple solution that is needed.”
For instance, one resident in a community was repeatedly found on the ground by his closet. When the community used SafelyYou’s system, staff were able to observe that he was attempting to retrieve his luggage from the open closet. He had a long career in sales and traveled frequently, so he wanted to pack up his things to go to work.
When the care staff realized this through video, they considered how they might remove the cues that put him at greater risk of falling. This insight prompted them to remove the luggage and close the closet door while trying to engage the resident in other ways. That simple change alone reduced his falls.
Finding solutions is what motivates the team at SafelyYou. “Families are relieved to get clarity into how to help their loved ones and it gives them peace of mind while reducing medical expenses that are often unnecessary,” Shirley sums up.
*U.S. Senate Special Committee on Aging 2019 Annual Report
** “Risk Factors Associated with Falls in Older Adults with Dementia: a Systematic Review” by Physiotherapy Canada published by NIH