By Rosemary Kennedy, PhD, RN, MBA, FAAN
Many older adults’ main wish is to be able to live in their own home for as long as possible, but major safety issues have long been an understandable concern. In fact, every 19 minutes an older adult in the U.S. dies from a fall, and one in four U.S. adults will fall each year, according to data from the National Council for Aging Care. It’s no surprise, then, that falls are the leading cause of injury and death among elderly Americans.
Data from the Centers for Disease Control and Prevention (CDC) also paints a troubling picture:
- About 36 million elderly adults fall each year—resulting in more than 32,000 deaths
- Death rates from falls are up 30% over the past decade
- Each year, roughly 3 million older adults are treated in emergency departments for a fall-related injury
- More than 300,000 older people are hospitalized for hip fractures annually
The cost of these falls to the healthcare system is significant. According to the CDC, $50 billion is spent each year on medical costs related to non-fatal fall injuries (fatal falls cost another $754 million). That’s a huge financial burden on the U.S. healthcare system, not to mention the families of fall victims paying huge medical bills as they struggle with the emotional toll of a loved one’s disabling or life-threatening injury.
Even worse, as the number of Americans ages 65 and older grows, the number of fall injuries and the cost to treat these injuries are likely to soar. Sometimes fall injuries aren’t treated immediately, which can lead to other health issues that decrease an elderly person’s independence while increasing healthcare costs. The CDC forecasts that falls will increase to 73 million annually in 2030 (from 52 million in 2018) and that injuries will reach 12 million in 2030 (from 8 million in 2018). If these estimates are accurate, that means more cost to our healthcare system and more pain for elderly Americans, often decreasing their likelihood of living independently at home.
Yet while common and costly, falls do not have to be an inevitable part of aging. Education, technology, planning, and a strong safety net of caregivers in the home can help prevent falls that devastate lives and exact a huge financial cost on our healthcare system. With prevention and early intervention, we can dramatically reduce unnecessary utilization of care delivery services and still keep patients safe, which aligns perfectly with value-based care principles.
Safe in the home
The first step in keeping patients safe in their homes is prevention. CDC has a brochure with a checklist for home fall prevention that includes helpful tips about removing clutter and other trip hazards.
But elderly people also fall in the absence of trip hazards. They may have joint pain, balance, or flexibility issues, or they simply may pass out from the effects of an illness or chronic condition. And that’s where early intervention, the second step in keeping vulnerable populations safe, can mean the difference between life and death.
Effective early intervention requires a care coordination team comprising caregivers living in or with access to an elderly person’s home and clinicians. If patients have a safety net—a family member or neighbor in their home to help triage—a health episode can be managed successfully without resorting to a 911 call and unnecessary utilization of care delivery services.
Early intervention and care coordination, however, are difficult without technology capable of issuing alerts in the event of a medical emergency, enabling clinicians to monitor patient vital signs and other health indicators, and providing a link between clinicians and caregivers. Thus, implementing in-home technology is the third important step providers and health plans can take to ensure patients are safe. Technology such as remote patient monitoring (RPM) of people with chronic conditions and personal emergency response systems (PERS) can help with early intervention, prevention, and maintaining independence.
A PERS keeps patients safe and independent, while reducing readmission costs for providers. A simple push of a button instantly connects subscribers in their homes (or wherever they are) with highly trained emergency response operators who can assess the situation and send help if needed.
Some PERS devices even can detect a fall and immediately contact an emergency operator. These are ideal in cases where the patient loses consciousness or is unable to initiate a call. In cases such as these, every minute can matter.
An RPM system allows clinicians to collect vitals, aggregate data from the patient portal as well as electronic medical records, monitor results, and update care plans. Aggregated data may include physiological and assessment data captured at home along with evidence-based risk factors such as social and physical determinants of health, past medical history, and recent healthcare utilization.
By bridging the gap between patients, caregivers, and clinicians, emergency response and early intervention tools such as PERS and RPM can reduce requests for emergency medical services. Early intervention keeps care delivery in a place where it can be effective. For example, patients who can be treated at home won’t need to make office visit appointments, which frees the office to see patients who really need an in-person visit or who can schedule an office visit only during certain hours.
Our seniors want to feel safe, particularly in their own homes. The pandemic has made an already isolated cohort feel even more alone and vulnerable. Knowing that they have a safety net of clinicians, caregivers, and technologies watching over them provides older adults with the confidence they need to fully live their lives.
Patient satisfaction scores have been an important measure to health plans for years and are becoming increasingly vital. Hospitals and health systems that make their patients feel safer will benefit from higher subscriber satisfaction scores. A Commonwealth Fund study from 2013 shows that RPM can increase patient satisfaction as much as 85% while reducing healthcare costs.
Treating elderly patients for fall-related injuries when tools are available to avert and minimize the damage done by these incidents is a classic—and all too common—example of unnecessary utilization of care delivery services. We can and must do better. The U.S. could save billions in unnecessary costs and thousands of lives each year if healthcare organizations adopted strategies and technologies to protect elderly Americans through prevention and early intervention. More importantly, this protection can enable our seniors to live as independently as possible while improving quality of life for themselves and their loved ones. When that happens, we all win.
Rosemary Kennedy, PhD, RN, MBA, FAAN, is chief health informatics officer of Connect America.