Elizabeth Peterson, MPH, OTRL, FAOTA

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The Role of the Professional in Home Safety
Assessment and Intervention for Fall Prevention

• Presented by
• Elizabeth Peterson, MPH, OTR/L, FAOTA
• Clinical Associate Professor
• UIC Dept. of Occupational Therapy
• AOTA representative, Falls Free Coalition

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Introduction

• Evidence supports professional involvement in
  home safety assessment and intervention for fall
  prevention.
• Home hazard assessment and mitigation, carried
  out by a health care professional, should be part
  of a multi-component intervention for
  community-dwelling older persons who have fallen
  or who have risk factors.
• AGS/BGS Panel RecommendationsDRAFT
  form-presented by E. Peterson, 5/06
• Likely to be beneficial Home hazard assessment
  and modification that is professionally
  prescribed for older people with a h/o falling.
• Gillespie et al., 2005

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Introduction

• Evidence supports home safety assessment and
  intervention as one part of a comprehensive fall
  prevention program.
• Recommended components of fall prevention
  programs for community-dwelling seniors
• Environmental modification carried out by a
  health care professional
• Balance, resistive exercises for strengthening,
  gait training
• Decrease psychoactive and other medications
• Manage vision problems
• Manage postural hypotension
• Address other CV/medical problems
• AGS/BGS Panel Recommendations DRAFT
  form-presented by Mary Tinetti, 5/06

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Factors Influencing Home Safety Practice

• Accreditation requirements
• e.g. JCAHO, CARF
• Internal (system-specific policies

• Context of service delivery
• Type of health care professional involved
• State Practice Acts
• Requirements for reimbursement

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Factors Influencing Home Safety PracticeContext
Within traditional health care systems

• Home health
• Long term care
• Hospice

• ER
• Acute care
• Inpatient rehabilitation
• Outpatient rehabilitation

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Factors Influencing Home Safety PracticeContext
Outside traditional health care systems

• Services provided via
• Consultants (private pay)
• Area Agencies on Aging
• Congregate senior housing
• Departments on Aging
• PACE programs
• Grant-funded initiatives/studies

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Home Safety for Fall Prevention Target
Audience(s)

• Older adult
• Supports identified by the client
• e.g. spouse/significant other, children, members
  of extended family, friends, neighbors
• Direct care providers
• e.g. PCA, home health aid
• Other
• ALF staff

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Intervention Process Overview

• Evaluation
• Intervention
• Outcomes

Overall goal To optimize the fit between the
individual and their environment to reduce fall
risk.
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Home Safety for Fall Prevention Evaluation

• Needs assessment includes consideration of
• the client
• their environment
• their performance in the environment

Evaluation goal To identify the causes of
difficulties with ADLs/IADLs that place the older
adult at increased risk for a fall.
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Evaluation

• Are the clients needs

Outside scope of services/ expertise?
Within scope of services/ expertise?
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Evaluation Resources

• Evaluation instruments required by insurer
• e.g. OASIS
• Home safety-specific evaluation tools
• Westmead Home Safety Assessment
• Clemson et al.1996
• Home Fast
• Mackenzie et al., 2000
• Safety Assessment of Function and the
  Environment for Rehabilitation (SAFER)
• Oliver et al., 1993

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Intervention Challenges

• of real or potential hazards
• without adequate coping skills, knowledge of
  hazards could lead to fear of falling, activity
  restriction, deconditioning and increased fall
  risk
• Individual differences (physical, cognitive)
  influence whether or not a hazard exists
• Range in associated costs
• Facilitating behavior change
• Need for proactive problem solving

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Intervention

• This presentation Examples of client centered
  practices

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Intervention

• Client-centered active involvement of the older
  adult in
• deciding priorities for home safety
• identifying barriers and supports to action
• addressing the problem
• evaluating the outcome
• identifying next steps if outcome is not
  satisfactory

Key message You are not alone in your efforts
to live safely in your home.
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Intervention

• Compensatory
• strategies
• e.g.
• adaptive equip.
• home mods
• activity mod

• Client-centered teaching the older adult to
  assess the match between

• Remediative
• strategies
• e.g.
• ?strength
• ? balance
• ? endurance

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Intervention

• Client-centered devising an individualized fall
  management plan

• Components include
• Practicing how to get up from the floor
• Developing a plan to access help
• Developing a plan to avoid a long

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Outcomes

• Use outcomes to inform program improvement!

• Nature of outcomes evaluated is often driven by
  context of service delivery
• Types
• Client-specific
• Process
• Impact

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Summary

• Professionals have important roles in supporting
  older adults efforts to reduce fall risk in the
  home.
• Partnerships are needed to link seniors to needed
  services.
• In order to evaluate abilities and needs,
  observation of performance in the home is
  essential.
• Many interventions are intended to empower the
  older adult to
• assess abilities activity/environmental demands
  
• be active problem solvers
• Evaluating outcomes key to building better home
  safety programs.

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Special thank you to

• Lisa Fagan
• Joy Hammel
• Jon Pynoos
• Dory Sabata
• Jon Sanford
• AOTA GSIS Leadership