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: