If you don’t support a loved one living at home or work in a healthcare environment, such as a care home or hospital where you interact regularly with people over the age of 65, then it’s unlikely you’ve had to consider what happens when someone has a fall.
It’s common to find that after a certain age many people will struggle to get back on their feet after a fall and may require assistance. Often, the first action carers will take is to call an ambulance for help and this is true for residents living in care homes too.
Now you may be thinking that that seems like a sensible precaution, however consider this…a third of people aged over 65 (a statistic which rises to 50% in people aged over 80) will fall at least once a year; that equates to 2,000 people every day.
Over 45% will be uninjured and do not require an ambulance or any hospital treatment. This means that when the care home calls for an ambulance and lets them know the resident is uninjured but just needs help standing they’ll be automatically categorized as a ‘class C’ call, which is a low priority. In these situations, it can mean a wait time of anywhere between one and four hours, (we’ve even heard anecdotal stories of some residents waiting up to eight hours!)
This means the person who’s fallen will have to lie on the floor, probably in quite a bit of discomfort, whilst they wait for the ambulance to help them back up. In a care home environment, a staff member from the care home will be also be assigned to sit with them during the wait.
Can you imagine how’d you’d feel being forced to wait on the floor as people walk past you, or worse, how you’d feel if you were the care home worker, not allowed to help the person up?
20% of care home residents admitted to hospital after such a fall will have been on the floor for over an hour and perhaps most shocking is the statistic that of those, 50% will then die within six months from related complications, even if they were uninjured! Making the problem even worse is the fact that after you’ve fallen once, there’s a 60% chance of having another fall, which in a lot of people leads to loss of confidence and a reduction in activity which in turn leads to loss of muscle strength which then makes future falls even more likely, a self-fulfilling, vicious circle.
So why aren’t care homes lifting their residents?
Well there’s a variety of reasons.
Whatever the reason, we’re sure everyone can agree that it’s not nice to be left on the floor for extended periods of time, no matter your age especially as there are a wide range of both physical and psychological implications to consider:
Pressure ulcers, also known as ‘pressure sores’ or ‘bedsores’ are an injury that breaks down the skin and underlying tissue when an area of skin is placed under increased pressure (sure as lying on the floor for long periods) and can form within half an hour of falling. The extra pressure causes a lack of blood to the affected region which causes it to become starved of oxygen and nutrients. Depending on the time spent on the floor, recumbent, in the same position, these sores can range from uncomfortable, to painful, right through to life threatening.
One of the more obvious and least dignified consequences of a resident being left on the floor for extended periods is incontinence which will come with a whole host of medical issues if the resident can’t easily be cleaned, not to mention the psychological embarrassment it causes people.
Again, ask yourself how you’d feel in that situation…
Whilst the risk of dehydration is greatly reduced in a care home situation it remains a fact that most people who do fall are at risk of suffering this if left for long periods. Being supine on the floor isn’t the most pleasant place to have a drink and many residents will prefer to wait till their back up on their feet; which can be a dangerously long time to go without any liquids at all.
One of the more serious consequences of being left on the floor for long periods after a fall is hypothermia or the increased risk of contracting illnesses like pneumonia. In an ideal world a care home resident would fall over in a warm, heavily carpeted room, however life is rarely that fair. A lot of falls take place in corridors or walkways with cold tiles underfoot or even outside. This obviously makes things a lot harder when trying to keep the resident warm during the long wait for an ambulance.
Research by the American Journal of Epidemiology shows the fear of falling in the elderly will subsequently have a massive impact in reducing their ongoing quality of life. The fear of falling amongst older people occurs in approximately 30% of those who have never fallen and 60% for those who have fallen previously.
The person then becomes more dependent on others and less mobile and begins to cut their daily activities. As the fear of falling increases and activity diminishes, muscle strength weakens causing more and more falls.
In fact, frequent falls are often considered the main contributing reason for first admissions to a care home.
In addition, healthcare professionals who have been injured through manual handling tasks may also become reluctant to lift or move people going forward, becoming much more likely to call 999.
This can then directly impact the health of patients and increase the prevalence of pressure ulcers and other associated issues.
Finally, 20% of people over 65 admitted to hospital as a result of a fall have been on the ground for over an hour. 50% of these will die within six months as found in the study by Vellas et al.
So, what can be done about this? Clearly the easiest answer is to empower care homes to lift fallen residents safely and only call ambulances in emergency cases. Unnecessarily admitting residents to hospital impacts services and it’s estimated that bed blocking costs the NHS and the UK taxpayer over £900 million every year (with some sources putting that figure a lot higher).
Now clearly we here at Mangar Health feel the right equipment to use would be our Camel or ELK lifting devices. They’re safe, dignified and are perfectly suited to single handed care however, we’d also be more than happy if care homes were using any other suitable lifting devices as well. We understand care homes are committed to providing quality, dignified care for their residents but we’d like to see less pressure on an already overstretched ambulance service.
Every ambulance trust in the UK uses our ELK lifting cushions and when the paramedic arrives at a care home they are likely to use the ELK to perform the lift; all we’re suggesting is that care homes reconsider their falls policies and create care pathways that best protect the health of their residents. It’s worth checking out the Scottish Care Inspectorate falls pathways and the recommended action for residents that fall.
Also, take a look at IStumble, created by West Midlands Ambulance Service and a great guide for carers wanting to check if their resident if injured.
If you want to learn more about how health and adult social care is regulated in the UK then there’s a lot of resources available on the CQC website here; the CQC (Care Quality Commission) being the regulatory body for the industry, or if you want to speak to them about this or any other issue you might have then you can reach them here.
Mangar Health is a member of the Winncare Group