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PTA Blog Talk

Falls and Staffing Issues

Published March 6, 2014 11:00 PM by Jason Marketti

Reducing falls in a facility is about quick response times to answer call lights and having adequate staffing ratios to ensure the patients' needs are being met. To save money, some facilities will decrease staff to a minimum level and those who are working will have to simply pick up the pace to meet the demands of care.

As reimbursements continue to decrease, limited staffing may now be the norm even though every indicator tells us the quality of care decreases and higher fall incidences occur with fewer staff to attend to patient care. To reduce falls at night, floor lighting of different hues has been used. The soft yellow glow seems to work best, and does not disrupt the circadian rhythm as much in certain patients. But this doesn't resolve the dilemma of staffing issues as a whole.

I'm certain if patients and family members would sue a facility every time a fall occurs, changes in staffing would happen. If family members would then bring a class-action suit against their insurance carrier for being the responsible party directly related to a fall, reimbursements may go back to prior levels where adequate staffing could ensure safety to the high-risk patients. Of course, all this legal maneuvering could be avoided if insurance carriers would stop decreasing reimbursements and facilities would staff appropriately based on the needs of the patients, not the needs of the bottom line. There is finger-pointing about who is responsible every time a patient falls, but little is done to resolve the larger issues.

There have been times when a patient will have a fall and no therapy is recommended. Therapy can play an instrumental role in staffing education and patient safety to reduce the risk of falls, but some facilities underutilize the best resources that are available to ensure patient safety. Front-end staff, the CNAs, should be used at every opportunity to glean ideas from a patient-safety perspective and about how to appropriately staff any given facility. If facilities are concerned enough about patient care, they need to take steps to ensure every resident is safe and has the care required before reducing staffing levels.

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Great comment Tom.

Jason, if we are just out to have nursing homes spend more money that they don't have to stay open, then just build Nursing homes all with padded rooms and hallways and floors. I just read an Article about saving NASCAR drivers lives. It said, "every racetrack should have Padded Walls." Some tracks stated we can't afford that! So, what's the answer? Get padded walls or go out of business or both due to the recovery costs? It's a Business and Nursing Home owners are going to do their best to stay open. I don't expect that they will take my advice on the Padded rooms, hallways and floors. :)

I like the "Working smarter with a team approach is a better resolution." (TOM)

Donald Meadows, PTA March 29, 2014 9:10 AM
Robertsdale AL

Hi Jason,

A few suggestions that may help your cause in helping your facility and falls. Initiate a multi disciplinary falls team include social service, nursing/CNA, maintenance etc. "everyone" is responsible.  Review each fall in detail and come up with sound interventions and appropriately assign. Look and address risk factors that places your resident at risk, why wait until they fall to have interventions in place. Utilize your activity dept, I can bet the majority of falls are un witnessed, if they are engaged falls will reduce. Lastly, increase staff rounding time including the leadership team, most SNF falls occur in their room usually involving the washroom. You can not prevent a fall unless you live in a gravity eliminated environment, however you can reduce the risks of falls, suing( unless proving negligence) is not the answer. Working smarter with a team approach is a better resolution. Good Luck

Tom March 7, 2014 2:15 PM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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