State Policy Toolkit for Advancing Fall Prevention: Suggested Indicators* · 2019-02-04 · 2. Inventory of evidence-based programs and services offered in communities expands from

State Policy Toolkit for Advancing Fall Prevention: Suggested Indicators*

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General Leadership Goal: Committed Partnership between Department of Public Health (DPH), State Unit on Aging (SUA) and the Fall Prevention Coalition at state & local levels

Policy Change Indicators Year 1 Indicators Year 2-3 Indicators Year 4-5 Why could this be a priority?

State Health and Aging Plans include fall prevention as a priority area and acknowledge interdependency.

Memoranda of Understanding between the SUA and DPH outlining each organization’s goals and responsibilities in the fall prevention partnership- includes clearly stated priority to leverage and advance the grant activities to build and sustain a statewide fall prevention network of programs and services. In states where partnership is working well, a formal MOU may not be necessary.

Conduct annual progress review and apply quality improvement process to the implementation of the state plans.

Appropriate revisions of state plans enfold priorities and successes, and map out strategies for addressing shortfalls.

It is essential to have strong committed partners at the leadership level and is viewed as a prerequisite for an effective and sustainable fall prevention initiative.

1. Local technical assistance activities and funding priorities provided by the state leadership reflect fall prevention priorities.

2. Inventory has been conducted of programs and services currently offered in communities to be used as a baseline to measure change in years 2-5.

Local public health and AAA plans have been developed and activated to address gaps identified in the inventory.

1. Local public health and AAA working with DPH and SUA maintain a consumer and provider accessible inventory of fall prevention programs and services.

2. Inventory of evidence-based programs and services offered in communities expands from baseline.

Policy Change

State Coalition on Fall Prevention will commit to the vision and goals of the state effort (and as relevant to the CDC project and goals).

1. Coalition objectives and activities for PY1-3 reflect coalition commitment to state priorities and the Falls Free© logic model framework.

2. Policy opportunities, resources/assets are identified with a plan developed to address shortfalls including marshalling a committed stakeholder network.

A Partnership and Policy Plan is framed with outcomes clearly defined in concert with DPH and SUA vision.

1. Conduct an annual review of progress and apply quality improvement process.

2. Define, train and activate a committed Stakeholder Network.

3. Implement Partnership and Policy Plan with consistent messaging, one page tailored briefs and defined targets.

Measure progress of Partnership and Policy Plan implementation

An actively engaged Coalition that has aligned its goals and activities with the state efforts is a prerequisite for an effective and sustainable, state wide fall prevention initiative.

http://www.ncoa.org/improve-health/center-for-healthy-aging/falls-prevention/evaluation-guidelines/why-use-a-logic-model.html

http://www.ncoa.org/improve-health/center-for-healthy-aging/falls-prevention/evaluation-guidelines/why-use-a-logic-model.html


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Goal: Increase awareness of the issue and effective prevention strategies


DPH, in collaboration with the SUA, appoints and coordinates a broad-based, state FP Advisory Group or Implementation Team to advise leadership on how to facilitate targeted activities and to go statewide; how to leverage member's current investments and level of interest; identify and address barriers to broader implementation; promote FP awareness and awareness of the initiative. Members serve as advisors on the use of expanding technology.

Advisory Group/Implementation Team in place; guidelines and roles clearly identified; routine recurrent meetings schedule established.

In collaboration with the Coalition or Implementation Team, the state partners identify what should be accomplished, over what timeframe and how to track and leverage results

1. Meeting records available demonstrating well functioning team with outcomes clearly defined.

2. Feedback and quality improvement mechanisms activated.

3. Advisory Group/Implementation Team member organizations reflect fall prevention as a priority within their own parent organizations.

The Implementation Team is a requirement of the 3 state grantees and essential to the development of meaning partnerships and engagements – all states should strive for an Advisory Group at the state level, but alternately may find an active, broad-based Coalition serving that function.

A process for identifying and engaging key stakeholders, their organizations and networks – including consideration of resources, advocacy acumen and commitment to fall prevention activities-- has been developed by the Advisory Group/Implementation Team and monitored by DPH.

1. Process identifying and engaging key stakeholders is activated with clearly identified strategies and contact activities, and a follow up engagement and reporting back to Implementation Team strategy.

2. Process is implemented for conducting

an ongoing assessment of emerging stakeholders.

Representatives of Osteoporosis initiatives and other chronic conditions initiatives are thoughtfully enfolded into this effort; other nontraditional partners are engaged – measured by the number and breadth of the coalition partners.

Policy Change

Partnering state level departments and the Coalition co-lead the effort to launch a statewide awareness campaign.

1. Participation in Falls Prevention Awareness Day 2012:

Governor’s and local community leaders’ Proclamations obtained

Coalition and Advisory Group/Implementation Team begins efforts to make the case with the legislature for declaring in perpetuity

Issue joint DPH and SUA press releases

Leverage state wide activities

Increasing participation in the annual Fall Prevention Awareness Day (FPAD) as evidenced by increasing partner participation, geographic areas served and estimated reach from the baseline Falls Free 2011 FPAD survey

2. Promote empowering of consumers and caregivers

through awareness and education to dialogue with

1. Joint working group from the Advisory Group/Implementation Team and Coalition established to develop and launch statewide awareness campaign.

2. Other appropriate coalitions are included in the awareness campaign such as Osteoporosis and/or Healthy Aging Coalitions. Consider co-branding this effort.

3. Participation in Falls Prevention Awareness Days 2013-14:

Governor’s and increasing number of local community leaders’ Proclamations obtained

Issue joint DPH and SUA press releases

1. Measure progress on Healthy People

Objectives:

OA-1 Increase the proportion

of older adults who use the

Welcome to Medicare Benefit

because this benefit includes a

falls risk assessment

OA-11 Reduce the rate of emergency department visits due to falls among older adults

2. Increasing number of local businesses, healthcare facilities and group providers, faith-based organizations, retirement

Promoting awareness of the issue, the preventive nature of falls, and the states’ collaborative effort to make tools, resources and strategies available to consumers and to promoting dialogues between older adults, their families and caregivers, and providers is essential to affecting the falls rates. Consistent messaging is important, hence the need for collaborative activities enfolding the state leadership, Implementation Team and Coalition.

http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=31





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providers about FP strategies and bring awareness to caregivers/direct care work force/family members on steps they can take to promote fall prevention; link to awareness campaign.

Increasing participation in the annual Fall Prevention Awareness Day as evidenced by increasing partner participation, geographic areas served and estimated reach from the baseline Falls Free 2011 FPAD survey

State nursing home and long term care associations, local businesses, faith-based organizations, retirement homes & NORCs have been contacted to promote organizational commitment and to host events, distribute educational materials, promote local programming.

homes/NORCs, recognize fall prevention as a priority.

3. Increasing number of local businesses, healthcare facilities and group providers, faith-based organizations, retirement homes/NORCs, are committed to host awareness and education events, distribute educational materials, and promote/offer local programming.

46 States participated in FPAD; peers have shared tools and resources posted at www.ncoa.org/fpad. Each year; states are asked to compile activities and estimated reach to report to NCOA, such data can be a proxy for some of the indicators

DPH develops and maintains web site in collaboration with Implementation Team, State Coalition and state level partners; feedback mechanism created to enfold stakeholder needs and activities.

1. DPH develops and publishes an easy to read annual data report; feedback mechanism created to enfold stakeholder needs and activities, portraying data and impact of injury and cost to a variety of stakeholders and gather feedback on appropriate modifications and needs by stakeholders.

2. DPH tailors data to help communities and decision-makers understand and support public policies and practices.

1. Measure growth in DPH website content and usage rates.

2. Measure increase in requests for

data to support local and state policy decisions and funding requests.

States can leverage existing websites. The key piece of the awareness effort is the thoughtful communication of data that can be used to tell the story and is linked to the DPH priorities.

Plan and activate a media plan and awareness campaign in collaboration with the coalition members, the Advisory

Group/ Implementation Team and the state communications department. Plan should include timely, targeted follow up with testimonials and ongoing success stories to keep awareness level high throughout the year. In collaboration with the State Coalition Evaluation Workgroup begin to measure general awareness using consumer, family member and/or provider surveys.

1. Measure success of partnering activities undertaken to acquire underwriting, funding/donations/foundations support for the development of PSAs, videos, brochures, presentations, flyers with unified messaging to support awareness activities - measured by funding and in-kind contributions.

2. A process is activated for gathering testimonials from a broad constituency including older adults, family members, organizational leads, program deliverers, and health providers. Testimonials are enfolded into the awareness activities.

In collaboration with the State Coalition Evaluation Workgroup begin to measure behavior changes using consumer, family member and/or provider surveys.

Bringing greater awareness to all key stakeholders including older adults and their families is a key strategy of the National Action Plan and the Safety of Seniors Act, PL 110-202. It is recognized as a key strategy to affect behavior change.

http://www.ncoa.org/fpad


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3. In collaboration with the State Coalition Evaluation Workgroup begin to measure belief changes using consumer, family member and/or provider surveys.

Policy Change

Develop and activate a DPH internal policy for developing testimony; reviewing, and informing legislative actions and imminent regulatory or policy changes that would affect older adult falls risk; and providing timely information to organizations, state and local leaders to help inform regulations, policies and legislations.

Internal policy in place (for review and update current policy) targeting Fall Prevention efforts.

1. Measure number of reviews/requests for input by state & local policy makers.

2. Leverage local and state coalition partners and stakeholders; enfold testimonials and program feedback.

Measure number of reviews/requests for input by state & local policy makers.

Building the relationships with policy makers that facilitate the thoughtful input of DPH on pending policy and regulatory change can serve to promote the fall prevention agenda and avoid the potentially negative or unanticipated impact of some decisions.

The DPH review policy makes active use of the fall prevention web page, data sheets.

1. An easy to read annual data report is now available to support activities and to help communities and decision-makers understand and support public policies and practices.

2. Measure growth in DPH website content and usage rates.

3. Measure increase in requests for data to support state and local policy decisions.

1. Continue to measure growth in DPH website content and usage rates.

2. Continue to measure increase in requests for data to support state and local policy decisions.

Making the case for fall prevention through accessible easy to read annual reports is essential to maintaining momentum and measuring change over time


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Goal: Increase provider participation in fall prevention practices


Provider networks and health plans require providers to enfold fall prevention screening within the annual wellness visits; welcome to Medicare experiences; and adopt routine screening protocols for adults > age 65.

Identify key stakeholders and barriers to their participation; link to organizational incentives to encourage participation. Identify readily available champions or key access points to engage target populations.

Record list of contacts and identify needs of stakeholders; measure engagement of key stakeholders. Follow up with identified contacts and stakeholders. Partnering with the State Hospital Association brings access to the Partnership for Patients Hospital Engagement Networks and Transitions in Care investments.

Measure organizational uptake and appropriate quality indicators Measure progress on Healthy People Objectives:

OA-1 Increase the proportion of older adults who use the Welcome to Medicare Benefit / falls risk assessment.

This policy change is the foundation for moving forward with the STEADI implementation as the “how to.”

Policy Change

State and local health departments collaborate with all clinical delivery systems to promote appropriate, quality and effective fall prevention services and referrals.

DPH data is used to make the case for fall prevention with hospitals, Emergency and Trauma Centers, Fire departments and emergency medical services.

1. Older adults who present to the emergency room visits for fall related injuries but not admitted are scheduled for a home visit by an appropriate health care provider.

2. EMT training initiated with referral mechanisms in place.

3. Measure change in coalition and Advisory

Group/Implementation Team members organizational priorities.

Measure progress on Healthy People Objectives:

OA-1 Increase the proportion of older adults who use the Welcome to Medicare Benefit / falls risk assessment.

OA-11 Reduce the rate of emergency department visits due to falls among older adults.

Outreach by DPH and the Advisory Group/Implementation Team targeting key areas of access and linkage to the community is essential and will include a variety of targets that are relevant to the state profile and needs.

Partner organizations begin to educate select providers about available reimbursement for fall prevention assessments/activities, the STEADI tool and the availability of community programs.

1. Increase reach to providers – activate champions from early adopters.

2. Record contacts and follow up, needs of stakeholders.

3. Measure number of adopting organizations.

Measure change in number of adopting organizations.

If the state undertakes to affect clinical practice through the dissemination of the STEADI Toolkit it is essential to build partnerships and engage effective implementation strategies

Develop and implement education/awareness program for intake/referral staff. Develop referral process for accessing community programs through easily accessible resources including: web portal, and trained and knowledgeable Area Agency on Aging (AAA) intake staff/ADRCs/ State Health Insurance Counseling and Assistance Programs (SHIPs).

1. Link process to DPH website measure organizational uptake - apply quality improvement process to increase uptake and showcase champion adopters.

2. Provide TA and state/local data to professional associations to affect education and training opportunities for providers Measure use of TA and materials.

Measure organizational uptake and

referrals.

Measure use of TA and materials.

First line communicators within

provider offices, area agencies on

aging and other intake services are

critical to the operative referral of

those at risk. Implementing an

effective awareness and education

program for those staff is

essential






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Policy Change

Target professional associations to recognize and promote fall prevention intervention as a priority of professional practice.

Develop a process to identify champions/needs to activate engagement with targeted state chapters/affiliates of the American Medical Association (AMA); American Physical Therapy Association (APTA); American Occupational Therapy Association (AOTA), State Geriatrician Association, Geriatric Nurse Practitioners, EMS/Trauma

Approach state APTA chapters with 1-2 page marketing brief on Otago opportunities and reimbursement strategies

Approach state AOTA chapters with 1-2 page marketing brief on opportunities and reimbursement strategies

Educate providers about available reimbursement for fall prevention assessments/activities

1. Continue partnership engagement process, measure contacts made and how many key State Chapters/Affiliates cite fall prevention as a priority and include training opportunities in state conferences and meetings –engage newly identified champions.

2. Key State Chapters/Affiliates cite fall prevention as a priority and include training opportunities in state conferences and meetings.

3. Approach additional professional State Chapters/Affiliates.

4. Measure change in coalition and Advisory

Group/Implementation Team members organizational priorities.

Continue engagement process activating champions, measure contacts made and how many key State Chapters/Affiliates cite fall prevention as a priority and include training opportunities in state conferences and meetings.

Promoting the state’s effort with professional associations and raising their acknowledgement and participation is a key for sustainable systems change; link to national association priorities wherever possible.

Policy Change

Require fall prevention continuing education for professional license/certification renewal

1. Make the case for fall prevention with state professional associations, and leverage champions and members of the state coalition. Consider state chapters of the AMA, APTA, AOTA, Geriatric Nurse Practitioners, and others; enlist the collaboration of national Falls Free© partners where appropriate such as the APTA and AOTA.

2. Leverage the Advisory Group/Implementation Team

members and their organizations. Team members commit to influencing their own organizations and professional associations.

1. In collaboration with Coalition and Advisory Group/Implementation Team develop PowerPoint presentations for delivery at conferences, medical meetings, etc; tie to the National Associations continuing education offerings (activate the AZ, NC initiative of a speakers bureau with generic PPT developed to support speakers).

2. Provide TA and state/local data to professional associations to affect education and training opportunities for providers (could use a state developed/targeted PPT with relevant data).

Leverage relevant Healthy People 2020 Objectives:

OA-7 Increase the proportion of the health care workforce with geriatric certification (specifically citing physicians, registered nurses, and physical therapists.

Promoting the state’s effort with professional associations and licensing boards is a long range strategy but key to affecting practice change.

Leverage home health agency opportunities to bring greater awareness and training to home care providers (using Otago Certification marketing materials, NCOA-PHI Direct Care Worker Training Program).

1. Make the case with care managers and Home Care Agencies to implement a training/continuing education program.

2. Measure uptake of programs.

Monitor growth of programs and number of agencies adopting Fall Prevention as a priority.

http://www.ncoa.org/press-room/press-release/ncoa-and-phi-launch-falls.html

http://www.ncoa.org/press-room/press-release/ncoa-and-phi-launch-falls.html


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Policy Change

Require falls prevention training for medical students and other appropriate health care professionals, including entry level PT, OT, Nursing, EMT, and care managers

Leverage coalition and Advisory Group/Implementation Team members and their organizations. Members should make a commitment to influencing their own organization and networks, and educational affiliations.

1. Make the case for Fall Prevention with state professional associations, leverage champions and members of the state coalition.

2. Seek university training program stakeholders and champions. Employ best practice strategies used by other states; enlist the collaboration of national Falls Free© partners where appropriate such as the APTA and AOTA.

Leverage relevant Healthy People 2020 Objectives:

OA-7 Increase the proportion of the health care workforce with geriatric certification (specifically citing physicians, registered nurses, and physical therapists.

Working with a variety of medical and ancillary health professions to implement entry level training programs would serve to bring greater awareness and recognition to the next generation of providers.

Policy Change

Require EMT and other emergency medical services providers to report data to a state registry.

1. DPH identifies and activates EMT/Trauma champions.

2. Department Public Health has identified /developed/activated a falls data repository for emergency medical data that provides timely and user-friendly data and trends analysis to make the case for EMT participation.

1. Analysis of emergency medical data for falls is enfolded into the easy to read annual report and shared with key stakeholders/policy makers.

2. DPH data analysis to ramp up awareness with hospitals, Emergency and Trauma Centers, Fire departments and emergency medical services.



Understanding the magnitude of this growing problem across all states is essential to addressing recurrent falls in older adult homes and nursing homes.

Policy Change

Require EMT and other emergency medical services to link in home fallers (uninjured/not transported) to community services for follow up.

DPH data used to make the case for fall prevention with state EMS associations. Through NCOA Falls Free©, link to other state initiatives and share resources.

1. EMT training initiated with referral mechanisms in place.

2. Measure uptake of training.

3. Monitor number and quality of referrals and follow up.

4. If warranted by the data, implementing a process by which fall prevention services are made available to older adults falling in their homes without injury/transport would be an important contribution.

1. Measure progress on Healthy People Objectives: OA-11 Reduce the rate of emergency department visits due to falls among older adults.

2. Measure uptake of training.

3. Monitor number and quality of referrals and follow up.

An increasing number of older adults are falling in their homes, often without transport, and are therefore never offered fall prevention services; even if transported, they are infrequently assessed for falls risk. The research indicates a person who falls is 2-3 times more likely to fall again and should be a priority of any state effort to reduce falls and injuries.










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Policy Change

Require all state funded health clinics to conduct fall prevention screening and appropriate referral on all patients 65 years and older of age.

Identify the state oversight office/state lead for the state health clinics and the state contracting agencies.

1. Make the case for fall prevention services with state oversight office for the health clinics and with the state contracting agencies.

2. Leverage national initiatives with FQHC (See Tip Sheet: http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/NCOA-AoA-Flyer-FQHC.pdf).

Measure change in contracts, uptake in training – if feasible conduct records audit.

The percentage of older adult clients served by state funded health clinics varies from state to state, but where the clientele warrants, this is a meaningful way to affect clinical practice through renewable or revised contracts that could include this mandate. It should be tied to training and retrospective auditing.

Goal: Increase funding opportunities and investments for fall prevention

Policy Change

Indicators Year 1 Indicators Year 2-3 Indicators Year 4-5 Why could this be a priority?

All State Departments budget requests for aging services incorporate evidence-based programs including falls prevention.

1. DPH/SUA employs state and professional champions to make the case for including fall prevention considerations with state grant overseers and other state departments, including transportation, education, public works, etc.

2. State Unit on Aging will require Area Agencies on Aging budgets to include fall prevention programs and activities; and to include budget requests for Title III D funds to support evidence-based falls prevention programs.

3. State Public Health Departments will require local PH departments budgets include fall prevention programs and activities, and to link to AAAs and other community-based organizations reaching older adults.

Fall prevention efforts are linked to community development grants and revitalization funds. Activate intra and interstate initiatives to share training costs.

Track number of other departments including fall prevention in their considerations.

All state level and local departments serving older adults should consider the relevancy of fall prevention programs and services; aging organizations now have access to funding for evidence based programming that should be leveraged.

Policy Change:

The Advisory Group/ Implementation Team provide recommendations to the assessment of potential funding sources and strategies for pursuing that support.

1. Inventory available of funding opportunities with clearly identified targets of opportunity and strategies to engage in this work. Process for periodic updates in place.

2. In collaboration with the Coalition and Advisory Group/ Implementation Team, develop an awareness and education strategy/accompanying PowerPoint presentation including ROI to reach potential funding organizations including foundations, community boards, health care institutions, health plans, etc.

1. Track number of contacts made, barriers and opportunities realized. 2. Activate awareness and education strategy measure investments.

A variety of funding initiatives and champions are needed to affect state wide fall prevention. Inviting the broader advisory or implementation team members to brainstorm and pursue potential funding opportunities adds to the strength of proposals.

http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/NCOA-AoA-Flyer-FQHC.pdf




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Goal: Enhance data surveillance collection, analysis and system linkages


The DPH will identify key data resources within state level departments and partner with relevant data managers to improve the capture and quality of those data deemed important to fall prevention.

DPH prepares an inventory of databases and data managers. DPH works with department heads and data managers and employs state and professional champions to make the case for including fall prevention considerations

A variety of data management resources are available across departments which could prove valuable to the assessment of older adult falls. Taking stock of the available resources is an essential first step

Policy Change

The Department of Public Health gives priority to epidemiological/ surveillance services that can identify and address barriers and gaps/needs in fall data to produce annual or more frequent user-friendly profiles of the impact and cost of falls among older adults. Areas of high injury rates, EMT use, hospitalization rates and deaths are analyzed; timely, useful data and an analysis of trends are being provided to all key stakeholders that can influence state and local policymakers.

Inventory data sets are identified with consideration given to linking data sets in order to portray data and impact of injury and cost to a variety of stakeholders. Review completed of the national injury surveillance datasets put forth by CDC and considered for state application. http://www.cdc.gov/Injury/wisqars/InventoryInjuryDataSys.html

Links to annual data report in place; feedback mechanism created to enfold stakeholder needs and activities and to gather feedback on appropriate modifications and needs by stakeholders.

Review of users and stakeholders feedback activated.

Accurate and consistent collection of data is essential to making the case for fall prevention and planning efforts to address areas of high injury rates and gaps in service.

Policy Change

The state hospital association and trauma associations require accurate and timely coding of external cause of injury codes to better monitor data injury rates and follow up.

DPH makes the case with state hospital association and trauma associations to assess gaps in quantity/quality of data; Partner with associations to develop policy for accurate external cause of injury codes enfolding into the annual report.

Actively monitoring & quality of data, identify and pursue opportunities for data linkages, identify data gaps, strengthen e-code use, and promote accessible and user-friendly data systems and formats.

Measure and monitoring change in completion of data collected. Ongoing analysis of trends in place.

The collection of external source of injury codes remains difficult in some states. Where working well, state hospital associations have identified such data collection as a priority, investing in modifications of the charge forms and training of coding staff

http://www.cdc.gov/Injury/wisqars/InventoryInjuryDataSys.html

http://www.cdc.gov/Injury/wisqars/InventoryInjuryDataSys.html


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Policy Change

Accurate, timely Emergency Medical Services data for older adult falls are captured at a central state repository and analyzed for trends and gaps in services.

1. Partnering with state hospital associations, state trauma associations, and state EMT associations to promote accurate and timely data collection.

2. Develop and activate data collection and accountability system.

1. Update falls data (injury, hospitalization, EMS, death) on a timely basis; create useful benchmarks and post to an accessible web site; enfold within the annual report.

2. Actively monitoring trends, quality of data, identify and pursue opportunities for data linkages, identify data gaps, strengthen e-code use, and promote accessible and user-friendly data systems and formats.

Anecdotally states are struggling with a growing number of home related falls without transport or follow up. It is imperative to volume of this work that could drive a change in practice and referral.

Policy Change

Medicaid services promote the capture of utilization data and require the linkage of external cause of injury codes to hospital transfer records to more accurately assess the cost of falls among low income older adults.

DPH begins partnering with State Medicaid Office to bring issue to consideration and urgency for clarity of cost and impact.

1. Use data analysis to identify gaps in ability to estimate costs – collaborate with Medicaid Office to link data to emergency room and transfer data sets.

2. Link into CDC’s WISQARS (tool for classifying injury mortality and morbidity data) and HCUP Hospital stay database (AHRQ).

3. Medicaid is represented on the Advisory Group/Implementation Team.

Medicaid is able to assess the cost/impact of falls among recipients to inform policy decisions. Medicaid requires providers to assess for falls risk and link to community resources.

Opening a dialogue with Medicaid is essential – in most states the Medicaid Office is already referring clients to aging service programs. Using data and education re the high volume and cost of falls, and potential ROI among Medicaid clients can serve to enfold Medicaid (and legislators) in the process of reducing costs. Potential reimbursement and home support strategies could promote longer term sustainability of the effort.

Policy Change

An easy to read, annual report is submitted to the legislature portraying the impact and cost of falls within the state, including Medicaid share of the costs.

In collaboration with Coalition and the Advisory Group/Implementation Team engage interest of state legislators to set an annual reporting requirement of the impact and cost of falls within the state, including Medicaid costs.

DPH assesses available data sets and develops a template for an annual report to the State Medical Officer and state legislature and other key stakeholders.



Bringing greater awareness to the legislature of the impact of falls among its seniors is essential to any planned legislative policy initiatives, and over time a reflection of trends that will help to inform policy decisions.






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Policy Change

Emergency data systems are linked to provide more accurate reporting of fall-related injuries and deaths.

In collaboration with Coalition and Advisory Group/Implementation Team, make the case for linking data systems for more accurate reporting of fall-related incidents with state legislators, state hospital association, state trauma associations, state EMT associations, etc.

Emergency data systems demonstrate consistency of reporting to ease linkages.

Emergency data systems are linked to provide more accurate reporting of fall-related injuries and deaths. DPH monitors and analyzes trends.

Goal: Increase the availability and accessibility of community programs and services


State leadership in public health and aging collaboratively identify the array of resources that each community/county should have in place for essential fall prevention.

A catalog of current community resources and programs/services in fall prevention is developed. Recognition is given to the contributions of a healthy life style as promoted through other EB programs and how a menu of programs and services can promote Fall Prevention.

1. Through partnership with the Department of Public Health, identify areas of high fall concentration and leverage state guidance for giving priority to fall prevention services.

2. Local PH departments, in collaboration with AAA and the local coalitions target fall prevention efforts through culturally relevant programming to reach concentrations of high risk fallers (identified through DPH efforts).

3. Activate champions to make the case with other state departments, including transportation, Medicaid, Public Works.

DPH and SUA develop and implement community health and aging plans that can inform federal policies while meeting the growing needs of the adult population.

While this policy initiative is essential for a state wide implementation strategy, it will also be appropriate for supporting targeted community roll out of interventions. Cataloging programs can assess in gap analyses to ensure programs are available and targeting need, and can help in long range planning.

Advisory Team/Implementation Team promote and champion local and regional coalition/working group’s development in collaboration with the state fall prevention coalition.

1. Measure change in number of local coalitions and networks.

2. Develop an outreach strategy and accompanying PowerPoint presentation to reach potential funding organizations including foundations, community boards, health care institutions, health plans, etc.

3. Make the case with community transportation planners to ensure safe and accessible transportation services.

4. Activate champions to make the case for

including fall prevention in the Hospital Community Health Benefits Program.

Measure outreach and new funding opportunities realized. Track the number of presentations.


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Policy Change

In accordance with State Unit on Aging guidance, fall prevention is enfolded into program offerings and the delivery of Home and Community Based Services within the Area Aging Service Plans and activated locally.

A catalog is developed of current community resources, programs and services in fall prevention and other healthy aging programs.

1. SUA & AAAs promote a menu of programs to promote healthy aging and support ongoing behavior change strategies; link programs and services

2. Collaborate with DPH and SUA to enfold program information into a web accessible program and service directory for use by consumers, family members and providers

3. Develop tracking system for ensuring delivery of quality programs and services

4. Activate intra and interstate initiatives to share training costs.

5. Catalog of resources, programs and services is maintained in real time

Activate tracking system for ensuring delivery of quality programs and services.

Cataloging programs can assist in gap analyses; help in long range planning; and bring attention to the programs already available. It can encourage thoughtful leveraging of current investments.

Policy Change

Communities consider environmental impacts of funding and infrastructure decisions on falls.

Advisory Group/Implementation Team, in collaboration with the Coalition, frames a plan and educational presentation to target planning boards, city managers and public works officials. DPH and local public health offices provide local data to support addressing this issue.

Local planning boards, city managers and public works officials have been contacted in targeted communities to address injury prevention. DPH and local public health offices continue to provide local data to support this issue.

1. Activate partnership and stakeholder network and volunteers to conduct walkability audits.

2. Employ state and professional

champions to make the case with state grant overseers and other state departments, including transportation, education, public works, etc.

3. Use data report to support activities

and to help communities and decision-makers understand and support public policies and practices.


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Goal: Build and leverage an integrated, sustainable fall prevention network


The State Coalition leadership will set a priority to leverage and advance the grant activities to build and sustain a statewide fall prevention network.

The State Coalition actively seeks out opportunities to partner with other coalitions such as chronic disease, (esp. osteoporosis), healthy aging initiatives, safe community and activity community efforts, disability; professional associations, health care facilities, etc.

The State Coalition encourages the development/nurtures and provides TA to local and regional coalitions and working groups.

Other healthy aging and safe community initiatives and large provider groups such as the Veterans Administration Hospitals and Clinics are engaged in this effort.

Collaboration across coalitions that are working on common public health issues of older adults can enhance access and reach of interventions and reduce cost.

Policy Change

Fall prevention interventions are incorporated in appropriate state agency plans and budget requests, particularly Public Health and the State Unit on Aging.

Led by the DPH/SUA prioritizing fall prevention and enfolding burden and strategies within the state plans that will be included in the area service plans.

AAA will include fall prevention programming as part of its budget request.

All AAA will be funding evidence-based fall prevention programs within their respective service areas.

This serves as an important marker of state leadership, but will be dependent upon timing of the cyclic revision of the state aging and public health plans.

Policy Change

Department of Public Health commits to promoting new partnerships across the division and other state departments. Work with communities/counties to identify the array of resources for essential fall prevention.

Draft of recommended state and locally required resources for fall prevention available for use in measuring how communities fare.

Education and awareness activities, key messages are developed to bridge the understanding of public health issues, especially falls and older adults.

State level departments and local communities begin to consider environmental impacts of falls on funding and infrastructure decisions by enfolding city planners, transportation officials and others.

Policy Change

Activate the State Coalition strategic plan to broaden the base of the coalition to strengthen its goals and working group activities.

1. Encourage local/regional coalitions to align their efforts with the state leadership and coalition goals.

2. Empower consumers/caregivers through

awareness and education to dialogue with providers about FP strategies.

Identify and activate champions within the faith-based communities; measure uptake. Leverage previous investment in faith-based programming by the State Unit on Aging.

Measure of health ministers, faith based community nurses, etc., begin to address fall prevention.

Depending on the state, the faith based organizations may be essential to bringing greater awareness and programming to members. In MS, the CDSMP was most effectively rolled out through faith based organizations for very little funding, primarily through training support and ongoing TA.


14

Policy Change

Communities consider environmental impacts of funding and infrastructure decisions on falls.

Promote awareness and general education re the issue and activities within the community

1. Activate partnership and stakeholder networks and volunteers to conduct walkability audits linked to community public works and planners.

2. An easy to read annual data report available to support activities and to help communities and decision-makers understand and support public policies and practices.

3. Hospital Community health benefits program includes community fall prevention.

Goal: Improve fall prevention activities in places where older adults reside


Fall prevention is viewed as a priority across the continuum of care and in all transitions activities.

Outreach to State Nursing Home Association, Long Term Care Associations and others to raise awareness; tracking of contacts and adoption of priorities in fall prevention.

1. The state nursing home and long term care associations, local businesses, faith-based organizations, retirement homes/NORCs, promote organizational commitment, host events, distribute educational materials, promote local programming.

2. State activities/grant funded sites and other Transitions of Care opportunities enfold fall prevention.

3. The state nursing home and long term care associations bring awareness to the issue and cost-effective, implementable prevention strategies with members.

All association member nursing homes and long term care facilities monitor and address falls among residents.

Targeting such organizations is not a priority for grantee states, but will be important in a state wide approach to affecting falls. Over time, the changing national focus on quality, transitions of care and resident safety will help to achieve these outcomes - states & coalitions may serve as valuable resources for these facilities.

Policy Change

Nursing homes under state license or accepting state funding routinely include Vitamin D supplements for residents.

The state nursing home and long term care associations bring awareness to the issue and cost-effective, implementable prevention strategies with members.

Quality Improvement Organization and Advancing Excellence Campaign fall prevention goals adopted in nursing homes.

Routine Vitamin D distribution within nursing homes has been found to significantly reduce falls.


15

Policy Change

Long term care facilities under state license and/or receiving state funds show evidence of a fall prevention program subjected to ongoing internal evaluation and quality improvement.

Partners have developed and offer culturally competent and appropriate TA/education and training for staff.

1. Track number of presentations.

2. The state nursing home and long term care associations bring awareness to the issue and cost-effective, implementable prevention strategies with members.

All association member nursing homes and long term care facilities monitor and address falls among residents.

Goal: Institute ongoing evaluation of state efforts and outcomes


Department of Public Health/Injury Prevention Section develops, implements and monitors an evaluation of the overall efforts as an expanded function of its epidemiological activities.

1. In partnership with the Advisory Group/ Implementation Team, establish goals and benchmarks for the broader, statewide initiative.

2. Develop and activate a communications strategy to keep stakeholders apprised.

Collaborate with the State Coalition’s Evaluation Initiative to measure impact.

Documents

State Policy Toolkit for Advancing Fall Prevention: Suggested Indicators* · 2019-02-04 · 2. Inventory of evidence-based programs and services offered in communities expands from