Fall Reduction Interview With Prestige’s Karen Marin and Michael Gonzalez

At Prestige, fall prevention is at the heart of what we do. Our fitness programming and classes help provide residents with the tools they need to reduce the chance of falling.

In this interview we speak with two members of the leadership team at Prestige Assisted Living at Lancaster: Karen Marin, the Executive Director, and Michael Gonzalez, the Health Services Director, about how they handle fall risk in their community.

As you talk to families about senior living, how often is the risk of falling a concern?

Karen Marin: “I would say about 50% or so. We get half of our residents coming in looking for the socialization part of assisted living and having additional support as needed. And then the other 50% come in once they need that fall assistance; they’re having falls at home, they’re looking for a safer place.”

What are some of the most common risk factors for falling that you see in new residents?

Michael Gonzalez: “A lot of people we’ve had at least recently have been post-stroke residents. So they still have some gait issues, as well as some strength, mobility and flexibility challenges… They’re a little bit higher fall risk.”

KM: “And at times it could be medication too. Just recently we had a resident in memory care who was having behaviors, but most medications that the doctor would prescribe for those behaviors would cause some type of dizziness and unsteadiness. And then sometimes when we go out to their homes to do the assessment prior to moving in, one of the first things that I do is look around and they have rugs in their living room or in the bedroom or the bathroom. And those are potential risk factors too. Or it’s over-cluttered and they don’t have a clear pathway to get to the bathroom or to the kitchen for instance.”

Michael, as the Health Services Director, can you tell us about your role and how you contribute to fall reduction?

MG: “Well, I’m the nurse for the community, so I take care of all their health needs from appointments to medications, to patient education, family education, things like that. So for me, for falls, it’s really just educating the resident to build that trust to let us know and admit, ‘You know, I’m feeling a little weak today, can the staff come and help me out?’ So it’s building that rapport, educating the families and the residents themselves, like for instance why the doctor put them on physical therapy. Why do they need to use a walker? Because sometimes they, usually the men, they don’t want to use the cane, they don’t want to use the walker. They think it makes them weak or fragile. Which I tell them no, it makes you stronger and as you get stronger, maybe you won’t have to use assisted devices anymore. So it’s a lot of education. And then of course we do our hourly checking on all the residents that are a fall risk.”

What happens if a resident does sustain a fall?

KM: “If there is a fall, Michael goes through the root cause analysis where he goes in to investigate what caused the fall, and what can we put in place to prevent those falls? Did they start new medication? Do they have new symptoms that need to be reported to the doctor? Are the cords tucked away where they need to be? Is there anything on the floor? Things like that that he goes in and analyzes so that we can prevent those falls.

And if we see that it’s a resident who’s having reoccurring falls, then that’s when we reach out to doctors and start requesting physical therapy, occupational therapy and any additional services that are needed to help that resident. Sometimes we have to make adjustments in the apartments, clear things out. Maybe it’s time for a hospital bed or an electric bed where they can lower it to a lower position so it’s easier for them to get in and out of bed. Maybe they need to make that transition from a cane to a walker or things like that, that we look at to help the residents prevent those falls.”

What are some of the safety measures in the residents’ apartments?

KM: “We have walk-in showers in all of our apartments. We have a lot of lighting and night lights for the night, so nothing’s too dark. Our microwaves are at a lower level. Our refrigerators are standard size for the residents to have easier access.”

MG: “Our call light system is phenomenal. We have one in the living room, one in the bedroom, one in the bathroom, and it’s a two-way system. They have a button or a pull cord and it’s almost instant to our new system that we have. So if the resident feels, ‘Hey, I feel a little wobbly today’, they can just press that little button and our staff comes as soon as possible. They also come off the wall and the residents can walk with them.”

Fall risk can be particularly acute for memory care residents. What are some of the safety measures you have in place for them?

KM: “We encourage most of our residents to always stay in a common area versus their apartment. Yes, some of them have a routine where they go back to bed, take a small nap but the staff there is always checking in on them. And by having them in common areas and in an activity, it keeps them more active and instead of wandering on their own. They also have a little patio in the memory care area that’s enclosed that they have access to as well, where they have a small little walking paths that they could take.”

MG: “And the staff is really good about, for instance, at meal times they’ll take one resident at a time, so there’s not a blockage of wheelchairs or any kind of mobility devices. So they walk with them and then they go sit them down and get another resident.”

Are there any residents who are a success story, in that their fall risk has been significantly reduced since they moved in?

MG: “We have a resident who was a firefighter, very self-motivating. He was a captain, a strong leader. He came in with a walker and really worked with physical therapy. He did his own strength and conditioning in his apartment. Just a strong work ethic. And because of that, because of his will, he’s actually not using an assisted device anymore. He’s walking around the community without it.”

KM: “He came in needing full assistance – dressing, grooming, bathing, showers. And just this morning Michael reported that he had to update his care plan because now he doesn’t need any assistance at all. There’s times where we’re like, okay, you need to slow down.”

MG: “We have another gentleman who used a walker. Now he still uses it from time to time, maybe in the evening time, but he even wants to push his wife around in her wheelchair as he’s gained strength.”

It’s not unusual for older adults to be reluctant to admit to being at risk of falling. What do you tell new residents in that situation?

MG: “I sit down with them, I’ll put my arm around them, I’ll talk with them. I ask them what they’re concerned about, why they don’t want to use assisted devices. A lot of it is just that they’re embarrassed and I reassure them that we’re here for them. We’re here to support them in any way we can. And most of the time that tends to work. Sometimes they’re still a little more scared because in the past they’ve fallen and they got really hurt, or it took them a while before the fire department came and got them. So it’s just reassuring that we’re here to support them. That’s the biggest thing. And that’s why I always recommend Prestige, because our staff is so caring. We’re always there for them. We answer any questions truthfully and honestly with the families and with the individual person. So I think that program has worked out a lot for us.”