Post on 30-Apr-2020
Julie Schrader
The Fountains
4451 Stack Blvd. Melbourne FL
Stacey Clark
Abstract
The following is a personal review of the practicum that I did at The Fountains. Below
you will find the public health issue of falls in older adults and how the program Matter of
Balance (MOB) was implemented into the facility. Research, Implementation and evaluation
methods are described below in detail. You will find matrixes in the appendix from the research
done in the beginning stages. There are also personal recommendations for the program as it
continues in the future.
Introduction:
Older adults are classified as age 65 and older and one of the leading causes of death for
them is accidents. Falls are leading cause of accident deaths for this population. The CDC states
that one out of three older adults fall each year (CDC, 2015). Most of the leading causes of death
are chronic diseases such as Heart disease and Cancer; however, falls are a preventable leading
cause of death for older adults.
Several factors can lead to a fall; therefore it’s not simply to decrease the risk of falls for
older adult. The CDC states four key factors of preventing falls: Exercise regularly focusing on
leg strength and improving balance, Review medicines to identify any side effects that cause
dizziness or drowsiness, Have eye checkups to be sure vision is up to date, and make the home as
safe as possible by reducing tripping hazards and adding grab bars (CDC, 2015).
Falls cost an estimated $34 billion dollars in 2013 from direct costs. The cost of falls for
older adults is substantial for our health care system from the hospital to the rehab and drugs.
Older adults are hospitalized for fall related injuries five times more often than they are for any
other injury (CDC, 2015). On Average the cost of one fall injury is $35,000 per person (CDC,
2015).
The Fountains Principals, Values and Beliefs are: We are committed to exemplary
service delivered with integrity, dignity and compassion. Our communities for seniors are
distinguished by warm, secure and friendly environments.
We will enhance each resident's lifestyle by:
Responding immediately to residents' needs and concerns
Offering high quality creatively designed programs
Encouraging independence
Promoting a sense of community and friendship
A fall prevention program fits into their purpose in each of the bullet points. Falls prevention
can encourage independence by increasing strength and quality of life. The CDC agrees that fall
injuries can make it hard to get around or live independently and increase the risk of early death
(CDC, 2015). A fall prevention program would also be a creatively designed program that can
promote community and friendship.
The Fountains is a for profit organization so the funding for the program came from the
revenue sources within their organization. It is a private pay facility where the residents pay a
community fee and rental fee each month to live in the facility. These fees covered the cost of
the program from supplies to staffing. The Fountains believes in the ‘Art of Living Well’ which
is comprised of six dimensions of wellness. These beliefs allow programs like this fall
prevention program to be fully funded and backed by the organization. It is the Fountains
purpose to increase the quality of life in their population of older adults as long as they can.
Discussion:
The Fountains as an organization wanted to focus on fall prevention and have a program
called Stand Strong that they kicked off in 2014 to help residents reduce falls. This program is
meant to be a proactive approach to reducing falls in our communities. The program included a
fall mobility testing tool and follow-up to ensure we are addressing a plan to help residents avoid
re-occurrence of falls and employ preventative practices. Stand Strong used Senior Fitness
Assessment to test the resident’s functional ability and then they could join a fitness class or
balance class.
With this in place for the Fountains they were not seeing a decline in falls and wanted to
have a more substantial program for the at risk population. My role in this project was to create a
more in depth Stand Strong Program that would include an educational piece along with a
measurable impact for The Fountains. The first step understood what the need for the population
at The Fountains was with what the Director wanted to see. I put together a matrix that you can
see in the Appendix of several ways to measure Quality of life and fall reduction programs that
could be beneficial to the Fountains. This project took a lot of research and organization; there
are quite a few measures of QOL from various levels. The programs for fall prevention vary
quite a bit and I only included ones that were of interest to The Fountains, there are many
program for fall reduction.
Tracking falls is not easy but The Fountains has been tracking falls since January of
2015where they found that anywhere from 56%-90% of falls occurred in the home each month.
With this data and the knowledge the staff had they chose to go with Matter of Balance for a fall
reduction program to supplement what was already being done. Matter of Balance had key
pieces on the fear of falling and fall reduction in the home with very detailed educational pieces.
It’s also available for no cost to the organization. The only requirement is to attend a two day
training to become certified in teaching the class.
After the decision was made to go with Matter of Balance Senior fitness assessments
needed to be done on participants to be sure to have a physical baseline on each individual. They
also decided to hold off on the QOL measurement until a phase 2 because of the resource
commitment it would take to implement a measurement. It is a requirement for their stand
strong program to have an assessment done so starting those took a lot of time considering the
facility has 300 residents in total at its facility.
Following the baseline data collection I went to the Matter of Balance training to become
certified to teach the class. I created flyers and marketing for the program to start and get
participants to sign up for the class. Matter of Balance has all of the materials that are needed to
teach the class all I had to do was make copies for everyone to follow along.
Twenty participants signed up for the class and the class started. It is a two hour class that
is twice a week so it is a big commitment from each resident. The course is already set so there is
no lesson planning or changing from the course that needed to be done.
Unfortunately 75 hours was not enough time to finish this project but I will continue the
project at the Fountains and share the results with the organization when it’s finished. I am
unable to share them at this point because the sessions are still in place.
The goals and objectives were very appropriate address the problem of fall reduction.
Falls are hard to reduce and take a culture to change over a period of time so seeing results in six
weeks is hard to achieve for a community. Another barrier for this program was communication;
the target population is hard to communicate because they are not in the digital era. After putting
flyers out many still had no idea of the program because they don’t read the flyers. One
recommendation would be to email the family members to help encourage the resident to attend.
Family members are great resources for this generation because they can connect at a deeper
level than the staff that works with them. Family member also help when you give the resident
recommendations from the class. For example, attending fitness classes or helping to clear the
apartment of trip hazards.
Personal Assessment:
Most of my time for this project was spent on research and data collection in order to
help make the best decision for the target population. This industry needs to have a better
understanding of the resources that are already out there because if it took me hours to collect
this data it can take others as long as well. The data should be put out for health practitioners to
easily find and implement in their community. There is also no gold standard for testing QOL or
falls which was difficult then to know which is best without trying them all. I hope the research
will continue to grow and develop in this area for older adults.
This practicum helped me understand the commitment it takes to implement programs
and why it takes so long for the field to make changes. This small program took over 75 hours to
research, implement, and evaluate. If we really want to make a change in fall reduction it will
take many people with many hours to create a culture change in older adults.
The core competencies of the following were all applied during this program:
Analytic/Assessment Skills
Policy Development/Program Planning Skills
Communication Skills
Cultural Competency Skills
Community Dimensions of Practice Skills
Basic Public Health Sciences Skills
Financial Planning and Management Skills
Leadership and Systems Thinking Skills
I would say that I mostly used Assessment and Program Planning Competencies in this
practicum experience. I spent most of the time on these two competences in order to have a
successful program for the Fountains.
Public health practices are not easy to follow and is very time consuming but for ethical
reasons I now understand the importance of taking the time to plan and assess programs. This
journey has allowed me to see the importance that all the time of research took in order to make
an informed decision. Without the research background you are starting from the bottom and it’s
not necessary in order to help the public field grow it is very helpful to use what worked well and
keep improving on that.
Conclusion and Recommendations:
I have not gotten all of the results from the class since it is still ongoing but I have seen
the difference in commodore between the participants in class and the confidence level grow
with in them. I am very hopeful that there is an increase in strength and coordination along with
the reduction in falls. Even if the reduction of one fall each month occurs that is $35,000 dollars
saved for health care. It also would mean that one person would be able to stay in independently
living longer in their apartment which in return is more revenue for the Fountains.
My recommendation would be to continue a support group for the first 20 weekly so that
they stay engaged in fall reduction and start a new class with twenty new participants after the
first pilot session is done. The hope would be to get every resident to participate in the program
so they have the educational awareness in order to reduce falls in their home.
I would suggest that they continue to get families involved in the program in order to help
create behavior changes in the residents. This will allow them to hold them accountable because
there is not enough staff to hold 300 residents accountable each day in their home.
References:
CDC. Cost of Falls. (2015, March 19). Retrieved June 28, 2015.
CDC. Falls Among Older Adults: An Overview. (2015, March 19). Retrieved June 28, 2015.
Appendices:
Name of Assessment
Areas of Well-being Measured
Target Demo
Benchmarks Length Pros Cons Cost Links to Resources
1. Gallup-Healthways Well-being Index
Life Evaluation Emotional Health Physical Health Healthy Behaviors Work Environment Basic Access
18+ National data, requires Gallup subscription ($8,500/year)
31 items Valid, reliable Heavily tested
Length Work & Access
not relevant? Not tested for
OAs Access to
benchmark data requires membership
? Click here
WHO-5 (1998) Psychological well-being(i.e. depression)
18+ National data 5 items Short Tested for
validity in OAs
Short = harder to see where differences lie
Free Click here
WHOQOL-OLD Physical health Psychological Social Environment
65+ International & National data
24 items Tested in 22 different WHOQOL centers in world
Must provide annual update
Must provide WHO with raw data
Free Click here
PWI-A(incorporates QOL and Sub. Well-being)
Standard of living Personal health Achieving in life Personal relationships Personal safety Community-
connectedness
18+ Not tested in OAs, but in other age populations
7-8 items Additional question regarding spirituality
Valid (.78 correlation)
Reliable
Not yet tested in OAs
Tested in Australia
Free Click here
Future security (.70-.85 Cronbach alpha)
SCL/PRB Index Material well-being Physical and cognitive Social engagement Emotional
65+ 12 countries(overall country data)
? Internal research, no outside studies found
National level data
Access to index
? Click here
Diener, Life Sats, subjective
Name of Assessment
Areas of Wellness Measured
Target Demo
Benchmarks Length Pros Cons Cost Links to Resources
Vitalize360 (formerly COLLAGE)
Health Nutrition physical & mental
fitness community links lifelong learning spirituality
65+
IL & AL
Non available, can compare to other sites potentially?
6 sections ~60 items
total
Known site in Iowa, Methwick
Collects needs, preferences, and interests
Creates personal goals
Provides snapshot
Not research based
Questionable validity and reliability
Lengthy More wellness
based
Pay for service (waiting to hear back on
estimate)
Click hereAnd here
MatherLifeways WPWA
6 dimensions of WPW
Self-efficacy Wellness behaviors Readiness to Change Self-responsibility Relationships
Staff/resident Organizational
wellness culture
65+ No current database for benchmarks
Internal benchmarking only
Can compare community reports (?)
49 items 20-30 mins
Online or paper versions
Developed with nationally recognized expert on WPW
Can add 5 addt’l ?’s
Not been tested/researched outside of the company
Small pilot sample sizes
Piloted in only 3 states
MLIA owns data
~$15,000 Click here
Link to email
estimate
WellCoaches Well-being assessment
Life Satisfaction Readiness to Change Engergy Weight Exercise Nutrition Health Stress & mental
18+ None known 75 items, plus demographics
Plentiful information
Know more for 1:1
Wellness based
Need to have contact with coach online?
? Click here
health Mental & emotional
fitness
WellCoaches Quickie Well-being Assessment (short form)
15 areas (purpose, eating, exercise, resilience, energy, mindset, weight, gratitude, finances, obsessions, medical, recharge, relationships, life issues, best self, overall)
18+ None known 25 items, paper form
15 items, online
Covers many areas, many addressed by residents
Online set up is not good survey design
Online different from paper form
? Click here for online version
Name of Fall Areas of Well-being Benchmarks Length Cost Links to
Reduction Program
Measured Resources
2. Matter of Balance
Fear exercise
survey 6 weeks Free Click
3. STEADI tools and educational materials
TUG, Chair stand, BP, Balance Test
Optional Free Click
4. Fall Proof exercises battery of tests
24 weeks Cost of book & training
Click
5. FallScape Videos Measurable tests
Optional ? Click
6. SAIL Fitness class N/A Optional three times/week
Free Click
Apartment
Hallway
Bathroom
Common Area
Dining Rm
OutdoorsOther
Not Completed
0%10%20%30%40%50%60%70%80%90%
100%
Where Falls are Happening
Jan Feb Mar
Evaluation: