Health care reform is driving the health care community to reexamine how fall prevention is addressed in older adults. These older adults include those living in the community who experience a fall and visit the emergency department, as well as individuals who experience a fall while receiving care during a hospitalization. Specifically, bundled payment, a reimbursement method based on the expected cost of a clinically defined episode of care, is motivating health care providers to examine transitions of care plans to and from different settings to ensure that falls are prevented during the episode of care, which currently is defined as a 90-day period for certain health conditions such as lower extremity total joint replacements. Therefore, bundled payment has the potential to facilitate communication across providers and potentially improve the quality of care delivered across care settings.
Improving the quality of care for older adults at risk for falls is of paramount importance in Florida. We live and work in a state where over 17% of the population is over the age of 651, a number that only continues to increase as baby boomers age. The risk of falling for every one of these individuals is 30% simply because they are an older adult2. In 2013, over 145,000 falls led to emergency department visits in those over the age of 653. In 2012, there were 45,935 hospital admissions due to non-fatal fall related injuries4. What is unknown is how many of those individuals not admitted to the hospital after an emergency department visit went on to fall again only to experience an injury requiring hosptialization. Preliminary anecdotal data collected via conversations with emergency response personnel and hospital administrators in Florida reveal a lack of fall prevention education provided in the emergency departments as well as lack of communication among practitioners across care settings regarding the care of an individual who has experienced a fall.
A 2013 study designed by a Medicare Quality Improvement Organization (QIO) reviewed Medicare claims information for institutional services covered by Medicare fee-for-service Parts A and B for services provided in North Carolina and South Carolina.5 Of 55,980 fee-for-service Medicare beneficiaries who were hospitalized and then subsequently transferred a skilled nursing facility and then ultimately discharged home, 22.1% (12,349 participants) experienced their first emergency department visit (without hospitalization or rehospitalization) within 30 days and 7.5% (20,966 participants) within 90 days.5 Overall, 12% of participants had emergency visits without hospitalization or were rehospitalized 10 days after the skilled nursing facility discharge.5
Given that reformed reimbursement methods are tied to quality of care and injury prevention specifically aimed at reducing hospital readmissions, it behooves us a health care professionals to establish care plans for older adults transitioning home or to a skilled nursing facility after a hospitalization or returning home after an emergency department visit.
The Florida Physical Therapy Association (FPTA), Florida Health Networks (FHN), and Area Agencies on Aging (AAA) are committed to facilitating transitions of care that ensure that older adults leaving hospitals have access to evidence-based fall prevention programs such as Otago, A Matter of Balance, Stepping On and Tai Chi, and to ultimately prevent hospital readmissions due to falls. The FPTA has recently established a Fall Prevention Task Force whose mission is to sustain fall prevention efforts across our state beyond Fall Prevention Awareness Day in September. Specifically, the FPTA wants to relay the message to all health care providers that physical therapists and physical therapist assistants are the practitioners of choice regarding fall prevention. Earlier this month, the FPTA was awarded a $4000 Community Awareness grant by the American Physical Therapy Association to continue this effort via a public relations and advertising campaign targeting older adults and their caregivers who visit the emergency department either for a fall related event or a non-fall related event; and emergency department personnel and other health care providers in the hospital-based setting who care for older adults presenting to the emergency room for a fall related event or an non-fall related event
Physical therapists possess the clinical decision making skills to quantify fall risk via screening methods, to perform multifactorial fall risk assessments, to make referrals to members of interdisciplinary care teams, and to prescribe exercise to prevent falls. All of these skills can be delivered in the emergency department, in an intensive care unit, in acute care facility, in an inpatient rehabilitation facility, or in a skilled nursing facility. All of these skills can be implemented as part of an older adult’s transition of care plan upon discharge from any setting. For more information please visit www.fpta.org.
1. US Census Bureau. People QuickFacts. Accessed September 17, 2015
2. Centers for Disease Control and Prevention. The Cost of Falls Among Older Adults. 2012. Available at: Accessed September 17, 2015.
3. Emergency Department Discharge Data, Florida Center for Health Information and Policy Analysis, Florida Agency for Health Care Administration; 2013 Accessed September 17,2015.
4. Unintentional Fall-Related Injury Deaths: Florida Department of Health, Office of Vital Statistics, Death Certificates; Underlying Cause of Death ICD-10 W00–W19; 2012 Accessed September 17, 2015.
5. Toles M, Anderson RA, Massing, M et al. Restarting the Cycle: incidence and predictors of first acute care use after nursing home discharge. J Am Geriatr Soc 62:79–85, 2014.