Coming Soon! A Different Type of Assisted and Independent Living in Dover, NH

Your new home in Dover, NH with care as you need it!

Dover, NH now features a beautiful and brand new complex specifically designed to provide apartments for those 62+ with daily needs. This unique concept provides the option of in-home care provided by Abundant Blessings Homecare for those who need a helping hand. Mast Landing also offers dining services.

Abundant Blessings Homecare is partnering with Mast Landing Senior Care Housing to provide service enriched housing. 

Falls in the Elderly

GEORGE F. FULLER, COL, MC, USA, White House Medical Clinic, Washington, D.C.

Am Fam Physician. 2000 Apr 1;61(7):2159-2168.

See related patient information handout on the causes of falls and tips for prevention, written by the author of this article.

Falls are the leading cause of injury-related visits to emergency departments in the United States and the primary etiology of accidental deaths in persons over the age of 65 years. The mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic groups, with falls accounting for 70 percent of accidental deaths in persons 75 years of age and older. Falls can be markers of poor health and declining function, and they are often associated with significant morbidity. More than 90 percent of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age. One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year. Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits. Outpatient evaluation of a patient who has fallen includes a focused history with an emphasis on medications, a directed physical examination and simple tests of postural control and overall physical function. Treatment is directed at the underlying cause of the fall and can return the patient to baseline function.

Elderly patients who have fallen should undergo a thorough evaluation. Determining and treating the underlying cause of a fall can return patients to baseline function and reduce the risk of recurrent falls. These measures can have a substantial impact on the morbidity and mortality of falls. The resultant gains in quality of life for patients and their caregivers are significant.

Epidemiology of Falls in the Elderly

From 1992 through 1995, 147 million injury-related visits were made to emergency departments in the United States.1 Falls were the leading cause of external injury, accounting for 24 percent of these visits.1 Emergency department visits related to falls are more common in children less than five years of age and adults 65 years of age and older. Compared with children, elderly persons who fall are 10 times more likely to be hospitalized and eight times more likely to die as the result of a fall.2

Trauma is the fifth leading cause of death in persons more than 65 years of age,3 and falls are responsible for 70 percent of accidental deaths in persons 75 years of age and older. The elderly, who represent 12 percent of the population, account for 75 percent of deaths from falls.4 The number of falls increases progressively with age in both sexes and all racial and ethnic groups.5 The injury rate for falls is highest among persons 85 years of age and older (e.g., 171 deaths per 100,000 white men in this age group).6

Annually, 1,800 falls directly result in death.7 Approximately 9,500 deaths in older Americans are associated with falls each year.8

Elderly persons who survive a fall experience significant morbidity. Hospital stays are almost twice as long in elderly patients who are hospitalized after a fall than in elderly patients who are admitted for another reason.9 Compared with elderly persons who do not fall, those who fall experience greater functional decline in activities of daily living (ADLs) and in physical and social activities,10 and they are at greater risk for subsequent institutionalization.11

Falls and concomitant instability can be markers of poor health and declining function.12 In older patients, a fall may be a non-specific presenting sign of many acute illnesses, such as pneumonia, urinary tract infection or myocardial infarction, or it may be the sign of acute exacerbation of a chronic disease.13 About one third (range: 15 to 44.9 percent) of community-dwelling elderly persons and up to 60 percent of nursing home residents fall each year; one half of these “fallers” have multiple episodes.14 Major injuries, including head trauma, soft tissue injuries, fractures and dislocations, occur in 5 to 15 percent of falls in any given year.15 Fractures account for 75 percent of serious injuries, with hip fractures occurring in 1 to 2 percent of falls.15

In 1996, more than 250,000 older Americans suffered fractured hips, at a cost in excess of $10 billion. More than 90 percent of hip fractures are associated with falls, and most of these fractures occur in persons more than 70 years of age.8 Hip fracture is the leading fall-related injury that results in hospitalization, with these hospital stays being significantly prolonged and costly.16 It is projected that more than 340,000 hip fractures will occur in the year 2000, and this incidence is expected to double by the middle of the 21st century.17

One fourth of elderly persons who sustain a hip fracture die within six months of the injury. More than 50 percent of older patients who survive hip fractures are discharged to a nursing home, and nearly one half of these patients are still in a nursing home one year later.18 Hip fracture survivors experience a 10 to 15 percent decrease in life expectancy and a meaningful decline in overall quality of life.

Most falls do not end in death or result in significant physical injury. However, the psychologic impact of a fall or near fall often results in a fear of falling and increasing self-restriction of activities. The fear of future falls and subsequent institutionalization often leads to dependence and increasing immobility, followed by functional deficits and a greater risk of falling

Questions to Ask When Hiring Homecare Services

Providing care for a loved one can be stressful. Hiring homecare services should help relieve stress, not add to it. We made the following list to help make hiring a homecare service easier. 

Things to consider:

1.  Reputation:  Ask around. Ask your hospital discharge planner about any agency you are considering.  Rehabs or Nursing homes will usually provide you a list of agencies to consider. Senior centers and government services such as Service Link in New Hampshire are also great place to get information. Ask specifically about more than one agency for comparison purposes. 

2. Check out their website: The agency’s website should be thorough, informative and professional.

3. Ask to have a free in-home assessment. Any reputable agency should be willing and able to provide an assessment of your loved one’s needs. This meeting should be one that is not only for admission purposes, but also to answer the family’s questions or concerns. The homecare representative should be willing and able to answer and help guide the family toward the options they have, without pressure. They should be willing to be a resource for you whether you use their services or not. 

Questions to ask an agency:

1. Is your agency licensed by the state?

The states of Maine and New Hampshire require homecare agencies to be state licensed. New Hampshire also requires a state license for independent caregivers. If your family is considering hiring privately for care for your loved one please read our article on this topic "Use Caution When Hiring Independent Caregivers".

2. Will you take care of all required payroll paperwork for my loved one’s caregiver? Are your caregivers all employed by the agency?

The states of Maine and New Hampshire consider you an employer if you independently hire someone to work in your home. There is a large amount of paperwork involved in being an employer. This paperwork covers such matters as taxes, Social Security, workers compensation, disability, and liability insurance. One benefit of hiring an agency is that the agency normally does this for you. Even so, it is good to ask, as some agencies do use independent contractors as caregivers.

3. What kind of training do you provide for your caregivers?

To expect experienced and trained caregivers to work in homecare should be the minimum. However, it is important to ask if the hiring agency is training the caregiver themselves in addition to any formal training or schooling which the caregiver has had. What do they require for continuing education? Abundant Blessings Homecare’s new hire training and continuing education exceeds the state requirements in every area. Our RN is continuously adding and improving our training. We believe providing the very best training and continuing education will assure that our caregivers are the very best caregivers!

4. Do you conduct drug testing on your caregivers?

The states of Maine and New Hampshire do not require drug testing for home healthcare workers. Many homes in which home healthcare services are provided contain controlled substances, therefore we believe drug testing should be a vital part of the hiring process for any home care agency.

5. What kind of background check do you conduct on your caregivers?

Having peace of mind that your loved ones are in good hands is vital when hiring homecare services. The state of NH requires that homecare agencies in New Hampshire conduct only a State of New Hampshire criminal background check, not a Federal background check. They also do not require a motor vehicle driving record check. At Abundant Blessings Homecare we believe that State, Federal and Motor vehicle record checks are all essential when hiring homecare for a loved one. We run all three checks on all our caregivers. These additional checks are an added expense during the hiring process but we feel they are essential for peace of mind for your family. It is possible for someone to have a criminal record in another state which would show up on a Federal check and yet their New Hampshire background check would return "clear". We also believe motor vehicle background checks are imperative because often times home healthcare workers provide transportation for their clients.

6. Are your employees insured and bonded? 

The state of New Hampshire requires insurance of homecare agencies, but not bonding. However, insurance does not cover theft; bonding does. Also, not all liability insurance is the same. You could ask the agency for a copy of their policy or ask what their liability insurance covers. 

7. If at any time my loved one needs more hours of care (eg: 24 hour a day), or if a caregiver should call in sick, do you have the staff for coverage? 

Any agency you hire should have enough staff to cover these situations should they arise.

8. What is your policy regarding sending a caregiver to my loved one’s home whom my loved one has never met?  

It is not safe for an elderly person to be answering the door to total strangers. An agency should have a policy in place regarding the meeting of new caregivers. Abundant Blessings Homecare never sends new caregivers to a home blindly; we always conduct a “meet and greet”.

9. What kind of supervision do you provide? 

Once a caregiver is placed in the home of your loved one, ongoing supervision of that caregiver needs to be provided. How often can you expect a Care Manager/Supervisor to be available? Your family is assigned a Care Manager who you will get to know and trust as your go to person. At Abundant Blessings Homecare our phone number is always answered 24/7 by a real person and if your Care Manager is off when you call, you will be connected with whomever is providing coverage. In addition, we conduct drop in visits just to see how things are going on a regular basis. 

10. What kind of service agreement is required? What are your minimum number of hours?

All agencies have different policies. Find out what is required to be sure it will work for the needs of your loved one.

11. What is your method for tracking a caregiver’s arrival and departure from a clients home?

The agency should have a system in place for this that works for you and your family.

12. What are your hours of operation, and how are phone calls handled during odd hours? 

Abundant Blessings Homecare is available by phone 24/7, and is always answered by a real person!

13. Do you provide a written plan of care which clearly describes any rates and fees?

The state of New Hampshire has requirements which must be on the plan of care. The plan of care should be thorough and well    explained to your family.

14. How soon can you start services?

Your family may need homecare right away, yet the homecare agency may be too busy or too small to handle a quick start. They may need time to schedule services. This is a very important question to ask.

Family and Friends, Familiar Smells, Nana's Apple Pie....

...The Blessings of Home. 

Founded on a belief in old fashioned values, Abundant Blessings Homecare can help you or your aging loved one be blessed by remaining in the safety and comfort of home.

Watch for our "Blessings of Home" apple spice cards with a packet of apple pie spice mix inside. When you receive the card and packet of spice mix, why not bake up an apple pie and bring it to a senior in your life and take the time to reminisce with them about the "blessings of home".

If you would like to receive a free apple spice card and information about Abundant Blessings Homecare, call or email us today.

(603) 473 - 2510 

info@abundantblessingshomecare.com