Falls are a concern at assisted living facilities

State collects information but lacks analysis for root causes

NEW STATE DATA suggest falls are a major problem at assisted living facilities across Massachusetts, with roughly two of every five residents ending up down on the floor over the course of a year.

Falls among elders are a serious public health problem. Each year, 2.5 million older people are treated in emergency departments for broken hips and head injuries that result from falling down, according to the Centers for Disease Control and Prevention. The agency says fall injuries are among the 20 most expensive medical conditions to treat—the average hospital cost is $35,000. Medicare pays about 78 percent of the tab.

The data on falls in Massachusetts come from adverse incident reports filed by assisted living facilities over a seven-month period from January 1, 2015, to July 31, 2015. The reports have always been filed with the state, but this is the first time the Office of Elder Affairs has ever tabulated them. The data were obtained under a public records request.

For the seven-month period, a total of 4,847 adverse incident reports were filed, with 75 percent, or 3,590 of them, involving falls. That works out to an average of 513 falls a month at the state’s 227 assisted living facilities. Projected out over an entire year, that amounts to 6,154 falls, or roughly two falls for every five of the 14,452 elders living in the facilities.

In addition to the 3,590 falls, there were 821 episodes of serious health and behavioral emergencies; 202 unanticipated deaths, including suicides; 139 episodes of abuse, neglect, and exploitation perpetrated by employees and other parties; 48 bad medication reactions; and 47 elopements, where residents with dementia got out of their locked units and wandered outside the building.

The abuse/exploitation reports generally involve employees physically abusing residents, verbally abusing them, or stealing their money and other possessions. State officials say any incident report that suggests residents are at risk or a violation of state regulations are flagged for follow-up.

Situated in apartment-style settings, assisted living facilities are designed for people who need help carrying out the daily activities of life such as dressing, bathing, and taking medication. Residents often need assistance, but not the level of care offered by skilled nursing facilities. The average age of assisted living residents is 86.

Martha Waldron, a spokeswoman for Elder Affairs, says in a statement that the office “regularly reviews the incident report data and analyzes the incidents as a regular part of the biannual certification review process. Incident data is reviewed to identify trends and flag concerns.”

Waldron says the agency, headed by Secretary of Elder Affairs Alice Bonner, does not try to address the root causes of the incident reports. “Developing programs to reduce the number of incidents is the responsibility of each assisted living residence,” she says.

A public records request for any written analyses of the incident report data indicates none has been done.

Darcy McMaughan, director of the Program on Long-Term Care, Aging, and Disability Policy at Texas A&M University, says health data should, whenever possible, be collected with a focus on developing policy. “But much of the data out there is not collected with an eye towards using it to inform practice,” she says. “It’s not gathered with the intent of developing an evidence base and then facilitating new practices.”

Rebecca Benson, an elder affairs attorney, says she is concerned about the hands-off approach of Elder Affairs. “The failure of Elder Affairs to enforce its own regulations is frustrating enough to elders and all those who are involved in caring for them and advocating on their behalf,” she says. “The fact that Elder Affairs is disregarding its own data in formulating policy is completely inexcusable.”

Laura Shufelt

Laura Shufelt

Laura Shufelt, whose mother died in 2013 under a cloud of mysterious circumstances while residing in an assisted living facility in Centerville on Cape Cod, says the agency is not being proactive.

“It seems like Elder Affairs looks at the data, but doesn’t do much else with it,” says Shufelt. “They need to go a lot further. They need to use the information as a basis for developing programs that will lead to safer conditions for the residents of assisted living facilities. Otherwise, the incidents will keep piling up.”

Other states not only collect and tabulate incident report data from assisted living facilities, they analyze the information and then use the results as a basis for developing programs to bring down the numbers. Wisconsin, for example, developed a webinar entitled “Fall Prevention Training: Strategies for Reducing Falls Among Residents in Assisted Living Facilities.”

In 2014, Wisconsin received 3,645 incident reports from its 3,600 assisted living facilities, of which 1,976, or 54 percent, were for falls.

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Wisconsin also produced a 70-page report on medication management issues at assisted living facilities and holds bimonthly forums at which topics such as best practices, regulations, and statistics and trends are discussed by the many stakeholders involved in assisted living.

Otis Woods, the head of quality assurance at Wisconsin’s Department of Health Services, says in a statement that his agency regularly reviews and analyzes data “to identify patterns and trends in resident care and the provision of services. We post this data to our website to share it with facilities, advocates, industry organizations, and consumers to identify problems, promote provider responsibility, and foster a better quality of life for residents.”