In the arena of medical care, there are times when good intentions produce bad outcomes. That was our reaction when we read this important article published recently on the Kaiser Health News website. It’s called “‘Fear Of Falling’: How Hospitals Do Even More Harm By Keeping Patients In Bed,” and the premise is straightforward: in an overzealous effort to make certain seniors don’t accidentally fall while in the hospital’s care, medical institutions are taking radical steps in fall prevention that end up doing patients more harm than good. If you’re a senior facing hospitalization, or the spouse or adult child of a hospitalized senior, this article, written by Kaiser reporter Melissa Bailey, is a must-read.
Hospital’s Fear of Falling Leaves Healthy Woman Bed-Ridden and Needing Rehab
Bailey’s report describes an Ohio woman in her 80s named Dorothy Twigg, who was living independently until a dizzy spell sent her to the local ER. In order to prevent a fall, Twigg was “stuck in a bed with side rails and a motion sensor alarm,” a situation that left her “livid,” in the words of her cousin and caretaker. After just a few days of hospitalization during which she received neither occupational nor physical therapy, “Twigg grew so weak that it took three months of rehab to regain the ability to walk and take care of herself,” according to the Kaiser Health News report. Over the next two years this once-independent woman would repeat the same pattern – three days confined to a hospital bed, then three months of rehabilitative care – no fewer than five times.
As Melissa Bailey points out in the Kaiser report, the concern about seniors falling while hospitalized is legitimate. “Falls remain the leading cause of fatal and nonfatal injuries for older Americans,” said Bailey. “Hospitals face financial penalties when they occur. Nurses and aides get blamed or reprimanded if a patient under their supervision hits the ground.” However, the problem is made far worse when the preventive treatment creates ill effects of its own. “Hospitals have become so overzealous in fall prevention that they are producing an ‘epidemic of immobility,’ experts say. To ensure that patients will never fall, hospitalized patients who could benefit from activity are told not to get up on their own.” Instead they remain stuck in a bed with siderails and bed alarms, and with no nursing staff available to help them move.
Fear of Falling: Long-Term Muscle Weakness After Only a Few Days in Bed
Being stuck in bed is especially dangerous for older patients who are often weak to begin with, says the report. “After just a few days of bed rest, their muscles can deteriorate enough to bring severe long-term consequences.” One geriatrician and researcher from San Francisco studied hospitalized patients age 70 and older and discovered that one-third of them “leave the hospital more disabled than when they arrived.” He called the rate of disabilities arising from hospitalization “staggering.” Immobility is often a major contributor.
The hyper-caution about seniors and falls goes back to 2008, Bailey writes, when CMS (the Centers for Medicare and Medicaid Services) “declared that falls in hospitals should never happen.” CMS instituted a series of penalties levied against offending hospitals, which, though not especially severe, helped create “a climate of fear of falling,” where nurses began to feel they’d be blamed and reprimanded if an elderly patient fell while they were on duty. The result is that patients were told not to move and were required to stay bed-bound, a practice which continues to trigger a vicious cycle of weakness and, ironically, a greater risk of falling. When Congress passed the Affordable Care Act, penalties levied against hospitals with large numbers of falls actually grew more severe, sending a signal to hospitals that they needed to be even more diligent in preventing falls. Sadly, in their zeal, many hospitals overlooked the need for patients to get up – safely – and get moving. Adding to the irony, hospitals are required by federal law to report falls, but are not required to track how often patients get up and move.
Fear of Falling: Getting Patients Up and About Requires a New Mindset
As Kaiser reports, there are many reasons why older patients tend to stay in bed while hospitalized. It could be due to pain, fatigue or weakness. They may have intravenous lines or other apparatus that make it awkward to move. There’s often a shortage of staff to help them, and they may feel embarrassed walking down the hallway in a flimsy gown with messy hair. “Yet,” says the article, “walking even a little can pay off. Older patients who walk just 275 steps a day in the hospital show lower rates of readmission after 30 days, research has found.” That’s why some hospitals are changing their protocols to emphasize patient mobility and improve independence. But many hospitals still face barriers including staff shortages, inadequate equipment, and inability to record ambulation in electronic medical records. Above all, says Kaiser, “Getting more patients out of bed will also take a significant change in mindset.” We think it’s a shift that patients and their families should help encourage.
It’s Time for a New Mindset in Retirement Planning
As we said at the start of this article, good intentions can at times produce bad outcomes – an axiom which is certainly true in the area of retirement planning. No one sets out intentionally to fail in their retirement planning, but the vast majority of retirees do fail: they are unable to protect their assets, they become a burden to their loved ones, and they too often end up in institutional care against their wishes. It doesn’t have to be that way. When retirement planning is done thoroughly and well, retirees can find that their financial, medical, housing and legal plans all mesh together, and that their family members are fully informed and supportive concerning mom or dad’s retirement wishes. In order to accomplish this kind of successful retirement for his clients, Rajiv Nagaich of AgingOptions has pioneered the LifePlan, a truly comprehensive strategy for retirement success.
We invite you to come and hear what Rajiv has to say. Join him for a free LifePlanning Seminar at a location that’s most convenient for you. It will open your eyes to a better way to map out a fruitful and secure future for you and those you love. For a complete calendar of upcoming seminars, visit our Live Events page and register there for the seminar of your choice (or feel free to call us during the week). Bring your questions and prepare to have your eyes opened at a LifePlanning Seminar with Rajiv Nagaich. Age on!
(originally reported at www.khn.org)