Healthcare providers are wrestling to reconcile high re-hospitalization rates with health care reform initiatives, prompting senior care providers to consider ways to reduce hospitalization-inducing falls within their communities.
Falls can be debilitating for seniors, both physically and emotionally, and can result in injuries that require higher levels of care—including hospitalizations or long-term skilled nursing, both at higher costs compared to community-based settings.
From 2001 to 2010, the number of deadly falls among seniors 85 and older skyrocketed, more than doubling from 5,350 to 11,412, according to data from the Centers for Disease Control and Prevention (CDC).
In 2009 alone, CDC reported that emergency departments treated 2.4 million nonfatal fall injuries among older adults, more than 662,000 of which required hospitalization.
One way several senior living communities have been able to both improve the quality-of-life among their residents while also cutting costs is by implementing health and wellness programs, specifically ones focused on fall prevention.
The most common programs concentrate on balance classes that educate residents on everything from exercises and gait evaluation, to learning how to get out of a chair or get up off the floor in the event of a fall.
The Terraces at San Joaquin Gardens, a continuing care retirement community (CCRC) in Fresno, Calif., implements a balance program called “Vertical” that has been gaining popularity among its residents.
Implemented less than a year ago, Vertical garners a full room of participants each session, where community’s Executive Director Jessica Lopez recalls the need for a second class sign-up sheet to accommodate resident demand.
“Because our residents want to remain as independent as possible, they realized [Vertical] was important to them,” says Lopez. “They realize that their bodies are not what they used to be, so they want to do everything in their power to keep their strengths up.”
Falls not only impact the physical health of residents, but the operations of the senior living community as a whole.
Since The Terraces uses its own staff of nurses and physical therapists to lead its balance class, the costs of implementing the program do not so much rely on monetary value as they do on allocating time.
“Falls require additional care given to residents, which means that for our folks living in residential living, our staff has to go out and respond,” says Lopez. “This takes time, which correlates to money as well.”
Before implementing its “Vertical” class, Terraces reported about 3-4 falls a month among its residents. Now, Lopez says they have yet to see one in the eight months the course has been around.
Erickson Living, provider of senior living communities across the U.S., has seen significant results from its extensive health and wellness system. By incorporating on-campus medical and fitness centers along with rehabilitation services for occupational, physical and speech therapies, Erickson has been able to track factors related to falls.
One of the main aspects Erickson looks at are hip fractures, according to Chief Medical Officer Dr. Matt Narrett.
“A hip fracture is public enemy #1 among our octogenarians,” says Narrett.
About 95% of hip fractures occur within the context of a fall. The average cost to treat a hip fracture totalled $18,000 in 2005, according to data collected by the CDC, but that figure has risen considerably since then and ranges anywhere between $20,000-$40,000, says Narrett.
Medicare spending reached $555 billion last year, according to a Congressional Budget Office (CBO) report, and reducing costly patient re-hospitalizations is at the forefront of healthcare reform initiatives.
The direct costs of falls vary across a number of factors, including fees associated with hospital and nursing home care, doctors, rehabilitation, use of medical equipment, prescription drugs, and even changes made to the home to make it more fall-preventative.
Because Medicare assumes many of these costs, seniors are required to spend at least three days in the hospital before receiving Part A benefits of nursing rehabilitation. Erickson, however, has been able to reduce hospitalization rates among its residents through its own health care plan called the Erickson Advantage Plan.
What began as a pilot insurance program in 2005 has since enabled Erickson to decrease its readmission rates by as much as half of Medicare’s plan member rates.
For 1,000 residents, Erickson Advantage sees 300 of its health plan members readmitted to the hospital, says Narrett, well below Medicare’s average rate of 370 members.
“Typically, we have rates of about 10% of our seniors readmitted post-discharge,” says Narrett. “The national average for a population similar to ours is roughly 20%-24%.”
By taking a comprehensive approach to implementing wellness programs, senior living providers have been able to not only reduce costs, but also guarantee the well-being of their residents by promoting physical activity.
“Individuals who are 83 or 84 years old want to find out how to preserve their cognitive function,” says Narrett. “And it takes a thoughtful, integrated approach.”
Written by Jason Oliva