How Home Health Can Improve Fall Rates and Readmissions

Home health can play a significant role in reducing the number of emergency room readmissions among seniors after a fall, according to a new study focused on why older adults end up back at the hospital after an initial fall. The report determined that older adults who experience head trauma and visit the hospital as a result of a fall are much more likely to return to the emergency department soon after.

The Ohio State University (OSU) Wexner Medical Center looked at the medical records over 250 seniors who were treated and evaluated at its trauma center. The study came up with some surprising results, with nearly one-third of this patient group returning to the emergency department (ED) within 90 days after they were discharged.

“We have a lot of older adults that fall and we see them in the ER,” Lauren Southerland, MD, an emergency physician with OSU who specializes in geriatric care, told Home Health Care News. “We studied who had come to the ED, and found that if they had hit their heads, a lot of them were coming back. Head trauma made a person 2.5 times more likely to come back to the ED. It’s not at all what we expected to see.”

The biggest problem was what happened to patients after they returned home from an ED visit related to a fall.

“When we looked a reasons why people were returning [to the hospital], a lot of the problems were related to the initial fall,” Southerland said. “A lot of them fell again within the next few months.”

Reducing the number of readmissions of fall patients became a priority for the OSU staff, as falls are considered a leading cause of injury among older adults. While some seniors are typically admitted for further medical monitoring, about half will be discharged after visiting the emergency department, according to OSU.

One way to lower the risk of another fall after a discharge is home health, according to Southerland.

“There are a lot of little things that a home health care aide can do that might prevent the next fall,” Southerland said. “The role of a home health care use or aide is vital. They have to watch an older person very carefully [after head trauma]. They need to look for any signs of any unusual behavior, like being extra sleep or confused. Those could be caused by new medications or a concussion. Home health people know patients the best.”

One of the best resources to impact the rate of readmissions is a case manager, according to Southerland. While many ERs aren’t able to afford one, coordinating care between the hospital and a home health care company for a patient can make a big difference in preventing readmissions.

“Having a case manager in the ED is an amazing resource for patients, and getting them set up with home health therapy is invaluable,” Southerland told HHCN.

The transition from the hospital to the home after a head trauma is crucial in the care continuum, but it’s not just home health care companies that shoulder the responsibilities of keeping patients from returning the ER. The current discharge process from an emergency room leaves a gap in the care continuum by not involving home health care coordination.

“Typically in the ED, it’s focused on acute injuries,” Southerland said. “You make sure they didn’t fall from a heart attack and make sure there are no other underlying conditions. We don’t talk about fall prevention and other experiences at home.”

Since deciphering why older adults may be returning the ER, OSU has worked to increase fall awareness among its staff to better coordinate follow-up care in the home, as well as be on the lookout for trauma symptoms that could lead to another fall in the near future, according to Southerland.

Written by Amy Baxter