Increased Falls in LTC-EMS concerned

[paramed401]

Hello Everyone,

I am new to the forum, seeking some insight from experienced long term care nurses. I am a paramedic and an administrator with a local volunteer EMS agency. Our agency is an all volunteer service which is responsible for providing 911 response and emergency transport for the town. We do occasionally get some back up from the county who have a paid staff, but we are the primary provider of emergency medical services in this district.

A new long term care facility has just opened in our city. They are an assisted living facility, not skilled nursing. They specialize in memory care, dementia patient populations. The problem that we are seeing is that, despite a relatively low census, we are responding to disturbingly high number of falls at this facility. I have worked for many years in other districts, and our facilities with much higher patient census generate far less 911 calls than this new facility, which has only been open a few months. There have been a couple of emergency calls for other categories, such as chest pain and seizure. But the overwhelming majority is for falls.

I am concerned about this for two reasons:

1. I have serious concerns for resident safety if this continues. As an assisted living facility with an LPN administrator, who is responsible for providing oversight? We do not know if there is a consulting RN. I fear that if the local EMS agency does not take notice of this trend, who will? Does this seemingly disproportionate number of falls point to larger issues in this facility, such as staffing or other resident safety issues?

2. It is severely straining our agency's resources. We are being called to this facility several times per shift and our neighboring agencies are having to respond to emergency calls in our district with an extended response time. Most of the time the person has just fallen down, has no complaints, no bleeding, no abnormal vital signs, but they are still required to send them out to the ER. This is happening multiple times per day even. While I understand their liability concerns, they have almost overnight become our single largest caller and their census continues to grow. We asked them in writing before they opened to notify us when they began accepting patients, which they did not do.

We are considering several possibilities in dealing with this situation, but don't want to step on toes or go about it the wrong way. We are not out to accuse anyone of anything or get anyone in trouble. Our single overriding objective is the health and safety of all our district's citizen, including those in the LTC facility. So far we see the following options:

1. Set up a meeting with the administrator and express our concerns diplomatically. Request that they create a plan of action to reduce the number of falls in their facility and reevaluate in 90 days. How do you think this would be received?

2. Contact a local regulatory agency for help and ask them to investigate our concerns.

The third option, is technically to do nothing. This doesn't seem like the correct or safe option for any of the parties involved

What do you guys think? Have you dealt with this type of problem before and are you able offer any other suggestions?

[Mn nurse 22]

I was an RN case manager for an AL facility. I was on call every other week. Since a lot of our population was pretty high functioning they were able to self report injuries after a fall. No different than if they were living at home, fell down but had no injuries.

if our non-licensed staff suspected ANY kind of injury I was required to go in for an assessment (yes, sometimes several times per day) and as an RN I would help make the decision about sending the patient to the hospital. I would call their families and let them also weigh in if they wanted their loved one to be hospitalized.

I would definitely set up a meeting with them. Are they a for-profit or non-profit? Why would they send everyone who falls to ER? If I fall I usually don't go to ER and if I hear my mom or dad has fallen at home I don't insist they go by ambulance.

What is the nurses' role if not to assess a patient before just calling 911? As a family member I would be upset to have every fall result in a trip to ER. Our protocol said that if we EVER found someone unresponsive to call 911 but most other things they called their on-call nurse.

[ktwlpn, LPN]

Why would they send everyone who falls to ER? If I fall I usually don't go to ER and if I hear my mom or dad has fallen at home I don't insist they go by ambulance.

.

True but in my area the culture is changing. Family members are

so eager to" lawyer up" that many facilities in this area are sending residents out for evaluation out more and more frequently. My facility has a contract with a transport service we can use if it's not a true emergency. It's really frustrating for everyone involved but in our facility often a fall is just the first symptom. These folks can decompensate pretty fast. However on our dementia units we have many residents who routinely put themselves on the floor and for a time we had to treat every occurrence as a fall.

I think a meeting with the administrator is appropriate. They need to know they are taxing the resources badly.

[blessedmomma247]

I agree with the comments above. I think it would be a good idea to sit down with them and dicuss your findings. I do not understand calling 911 for every single fall. Does the patient have the right to refuse to go to the ER? I have been an LPN for years and I have learned to work with my EMS crew. Calling 911 for every single fall is crazy. Do you have a non emergency transport in your area? We have Medics or AMR and if a patient is stable and needs to be seen, I either have a staff memeber take them or I call a non emergency transport. If the patients are falling that much..there is reason and they need to be more supervised (time to move them to LTC). If you are going to every single "FALL CALL" then it may appear that neglect or abuse is going on when there really isnt.

[TheCommuter, BSN, RN]

I have worked in several different LTC facilities in recent years, and no, we did not call 911 for resident falls unless we suspected head injury or fracture.

However, due to the litigious sue-happy society in which we live, some LTC facilities and ALFs have policies requiring that all residents be sent to the ER if a fall occurs, even if no injury is suspected. This policy shields the LTC facility / ALF from liability if the resident were to die or sustain irreparable injury as a result of the fall because, after all, the ER doctor at the local hospital affirmed that everything was alright before approving the resident for return to the facility.

Most of the LTC facilities where I've worked had a contract with one or more small, privately owned EMS companies who transported residents to the ER for less emergent issues such as falls, suspected fractures, etc. 911 calls were reserved for truly emergent issues such as chest pain, impending CVA, respiratory distress, unresponsiveness, and so forth.

So perhaps you could suggest that the new ALF consider establishing a contract with a private EMS service who will transport to the ER for routine falls if it is indeed their policy to transport all fallen residents to the local ER.