Hospital Continuum Presentation

Continuum of Care in
Fall Management
Mobile
Diagnostics
/Med Surg Home Care
Supp
Assisted &
Center of Independent
Excellence
Living
Hospital
Outpatient
Discharges Therapy
Hospitalists
Discharge Planners
Physicians
-Primary
-Specialists
Creating a “Culture of Safety” Paradigm in a

local community
Agenda
 Introductions  Continuum Overview
 Falls  Continuum Flow Chart
 Statistics  Center of Excellence
 Etiology Model
 Dizziness  Assisted & Independent
 Etiology of Dizziness Living Communities
 Systems Controlling
Balance
 Discussion
 Traditional Therapy
 Action Plan
Programs
Falls: Relevant Statistics
 Falls are not a normal part of aging
 Balance related falls are the leading cause of
deaths in elderly
 Annual fall rates:
 30% of those > 65
 50% of those > 80
 25% of patients > 50 who fx a hip die within

12 months, and 40% within 24 months
Etiology of Falls
 Dizziness is the #1 reason for falls
 Loss of protective sensation is #2
 50% of falls in elderly can be attributed to
vestibular dysfunction
Dizziness
 Lightheadedness: feeling faint
 Vertigo: Perception of movement, either self
or surroundings
 Oscillopsia: Experience of objects that are
known to stationary appear to be moving
 Disequilibrium: Unsteadiness, imbalance
Etiology of Dizziness
 Otologic: 50% (vestibular)
 CNS: 22% (TBI, CVA, Migraine, etc)
 Psychogenic: 15% anxiety, panic, depression)
 Medication: 5%
 Other
Systems Controlling Balance
 Vestibular
 Somatosensory
 Visual
 Musculo-Skeletal
 Cognitive
 70% of our balance is vestibular when our

head and body are in motion
Traditional Therapy Programs
 Historically reactive vs. proactive
 Research shows traditional therapy programs
have little to no effect on fall risk
 Strengthening and increasing functional endurance
does not impact balance systems
Continuum Model
 Screening of all Geriatric Patients
 Physician Marketplace
 Home Care Marketplace (as part of Oasis)
 Community Screening Programs
 Residents in Assisted Living and Independent

Living Facilities
 Geriatric Patients prior to D/C from acute care
facilities
 With a positive screen, patient enters continuum
Hospital Is Ideal Platform
 Has a large discharge geriatric population who can be
screened by hospitalist prior to D/C for potential for falls
 Also may have home care agency who can screen all
traditional home care patients for falls
 Secondary opportunity for extended care marketplace
 If hospital has captured medical practices, then they can screen
all geriatric patients for fall risks
 Secondary opportunity to develop a Center of Excellence
 All home care and outpatient therapists are trained in high
level evaluative, treatment and education in falls
Continuum Flow Chart
Center of Excellence In Fall
Management
 Continuum of Care Philosophy:
 A screening, diagnostic and treatment center “with
and without walls”
 It has a physical location, however, is a true continuum.
It, therefore, can address the needs of patients who are:
 Ambulatory
 Home bound
 Facility based
 Assisted Living Facilities
 Independent Living Facilities

Center Offerings
 Continuum of consultative services for Primary
Physician to assess fall risk for their patients including
a screening tool that can be implemented in the
primary’s office
 Full diagnostic testing including:
 ENT
 Neurology
 Podiatry
 Diagnostic services including VNG, Posturography
 Specialized therapeutic evaluative and treatment
services on an ambulatory, home care and extended
care facility basis
Center Structure
Potential Team Members
ENT
Other
(Psychologist,
Physiatrist, Neurologist
Etc)
Center of
Excellence
Home Care
Podiatry
Therapy
Outpatient
Therapy
Client Populations
Primary
Primary
Physicians
Physicians
Assisted
Assisted &&
End Users
End Users Center ofof
Center Independent
Independent
(Ambulatory)
(Ambulatory) Excellence
Excellence Living
Living
Facility
Facility
End Users
End Users
(Home
(HomeBound)
Bound)
Primary Physician Middle User
 Program is marketed “physician to physician” as a
diagnostic and treatment center that acts as an
extension of the primary physician
 Primary physician is given a screening tool to identify
population of his patients who are at high risk of falls
 Advised of the specialized capabilities of, and
prudency of referring all home care patients because
of screening process and specialized training
 Advised of specialized capabilities of part B therapy
provider vs. generic therapy
Assisted/Independent Living
Facilities
 Primary concern is “opening the front door
and closing the back door”
 Marketed via the proactive foundation of
program, and that it is activated by the DON,
not outside consultants who will have a
tendency to over utilize.
 Cross marketing (viral) of all services to the
general and professional community
Outpatient Part B Opportunity
 There will be significant referrals to part A &
B outpatient therapy from the Center
 Part B therapy centers can be developed in
selected Assisted Living and Independent
Living Facilities which increases Hospitals
outpatient network and is a perceived benefit
from the perspective of the AL/IL
Conclusion
 Falls are an inevitable risk to aging populations
 Historic medical and therapeutic model are
reactive vs. proactive
 A seamless continuum of care model can be
successful instituted in any community which has
a foundation of a “Culture of Safety” and extends
from the hospital to the ambulatory marketplace,
home care marketplace and extended care
marketplace

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Continuum of Care in

Creating a “Culture of Safety” Paradigm in a

 25% of patients > 50 who fx a hip die within

 70% of our balance is vestibular when our

 Community Screening Programs

 Residents in Assisted Living and Independent

 Independent Living Facilities

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