Falls and Best Intentions

Tuesday, May 16, 2017
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Balance and Best Intentions: Timely Fall Prevention (Intervention 1)

There is a ton written on balance and falls in the elderly. But what’s most important is recognizing the signs that a fall is imminent and safeguarding your loved one before it happens. Like so many issues with the elderly timing is everything. How do you as a son or daughter bring up your concern without causing angst?

Let’s take the scenario of a son noticing his mom’s declining balance and mobility decides to show up at her home with a walker. She doesn’t want to use it. What to do? Clearly, this son has the best of intentions.

One proven approach is to get an expert to help assess and advance the cause. Mom might need more than a walker or other assisted device. She might need caregiving a few hours a week or or maybe even several hours a day.

Care Managers with Home Health licenses can perform assessments and with knowledge and objectivity; they can evaluate the home environment for needed changes that would make for a safer environment; and they can pay attention to other needs and provide recommendations. These are private pay services and at this time are not included in the Medicare benefit.

If dollars are tight, move directly to what is offered through insurance. A physical therapist (PT) can conduct a functional assessment on strength, balance and gait (how she walks and how far), so that next steps and conversations can take shape. A functional assessment will also include pivot and transfer, getting up from a chair or couch and moving to the next place.

More importantly, PT can make sure she has the right fit and can work with her on using the device properly. If not, it could be worse than not device at all. There are several types of walkers and some are geared for those whose lower body is weak, requiring more support with upper body.

So how do you get the conversation started? All it takes is noticing and caring.

A dialog might start with an observation: “Mom I noticed your balance has changed.” Now it’s your turn to listen. If she says, “Yes, I’m a little unsteady, and I can’t walk as long or as well as I use to.” If she’s frank with you, this is your chance to start exploring a solution.

All she needs is an order (a prescription) from her provider. Ideally Medicare home health where PT and occupational therapy (OT for performing daily activities, bathing, dressing, grooming, preparing foods), come to home for 30 mins, 2 visits/week with RN case mgr over course of 10 weeks or so depending on need and progress made. Further, they can see how mom’s functioning in the home and make suggestions for follow up by the RN case manager assigned.

If this seems like more than mom wants at this point, at a minimum, she could have access to a PT visit in clinic. Again, this usually requires a doctor’s referral. And with a PT visit, most likely your mom will get an overview and handout, but she won’t have anyone alongside to make sure she’s moving safely – the most important aspect of in-home visits.

We suggest you accompany your loved on at the doctor’s visit. Doctors are trained to diagnose, treat and prescribe and some of the best doctors overlook the essential needs of elders in their daily life, needs outside the clinic. That’s where you come in to advocate for your loved one. In your absence, care managers can perform this function.

All should be covered Medicare insurance Part B. Some PPOs ad HMOs offer Home Health within their healthcare organization, Sutter and Kaiser come to mind but might also contract with outside agencies. While others always contract with licensed agencies. Different Home Health agencies take different insurances, and cost depends on policy and co-pay. Again, your provider or hired care manager can provide trusted options.

In summary, here are the tips to motivate change in your loved one:

  • Speak frankly and compassionately; you have your parent’s best interests in mind.
  • Bring up an event you noticed and try not to judge it. Leave the observation open-ended. Give your parent time to reflect and respond. Sometimes the silence tells you everything you need to know.
  • Educate yourselves on insurance benefits, including the Home Health Medicare benefit.
  • Make sure mom’s home environment is safe for her stage of life. Rugs, dimly lit rooms and halls, cords, clutter, unmarked steps, loose railings are all tripping and fall hazards. Please refer to our Care Solutions for Elders Toolkit for improving home environments for the elderly.
  • Make sure your loved one has invest sturdy, comfortable shoes with a reasonable sole; too thick and it’s likely to be a liability. Slippers without a back to secure the heel are not recommended. Properly fitted athletic shoes and well fitting socks can be ideal.
  • Have difficulty motivating change? Home Health agencies often have a medical social worker assigned to your loved one’s case and they are excellent resources to move the needle and get care on track.
  • Practice patience. Change does not happen overnight, gets harder as we age and may take several conversations over weeks and even months before your mom or dad are will to take a step. That step might be stating they are willing to explore; or they may even want to make an appointment with their provider. Praise the positive.