Implementation of a Fall Prevention Program in Nursing Homes: Facilitators and Barriers

Abstract

Falls in nursing homes are a serious health problem and the consequences of falling can have far-reaching effects on the health and independence of older adults. There is evidence that exercise and balance training can reduce an older adult’s risk for falls. The purpose of this project is to identify the barriers and facilitators that may impact the success in implementing a balance and exercise program for nursing home residents in a nursing home with the intent to reduce the prevalence of falls. This program, Fit4Life, was funded under the Minnesota Performance-Incentive Based Payment Program (PIPP). As part of an evaluation of the PIPP program, interviews were completed with staff in 15 nursing homes about their program. The type of staff interviewed were project leaders, Directors of Nursing and administrators, RNs, CNAs, activities and therapy staff, quality improvement and clinical coordinators, exercise technicians and case managers. Thirty-eight (38) interview transcripts were reviewed to identify the barriers and facilitators to implementing the program. The responses to these questions were then coded by identifying themes of barriers and facilitators and the results were quantified. The results indicate that buy in from staff, families, and residents are both a strong facilitator and barrier. Other effective strategies for facilitation were clear and consistent communication, strong leadership that fosters open dialogue between staff members, interdisciplinary teamwork and seeing positive results. A few of the most common challenges were time constraints, the health of residents, resources including staff, space and equipment, and communication. The results of this study suggest that there are a number of essential strategies that nursing homes can focus on to increase the effectiveness of a fall prevention program and to decrease the challenges that occur during implementation.