In the realm of aged care, ensuring the safety and well-being of residents is paramount. Yet, a significant grey area persists around the issue of low-low beds and whether or not falls onto crash mats should be considered a ‘fall’, and therefore be reported as an incident and or included in Qi reporting.
After further consultation, thoughts on this issue appeared to vary substantially from one aged care home to another, with some homes considering a fall from a low-low bed as an incident and others simply not.
A fall from a low-low bed can occur in different ways: sometimes, bed setups have a disparity of close to 15cm, which, despite being a minor distance to fall for most people, can result in serious injury for frail aged care residents. In other cases, the bed is level with the mat, meaning the resident simply rolls out of bed onto the mat.
This begs the question, should falls from low-low beds onto crash mats be reported as a fall?
Currently, the answer varies depending on which aged care organisation you talk to. And it appears to be a question that the Department of Health and Aged Care has yet to consider.
This grey area not only confuses staff but also has potential implications for the collection of Quality Indicator (QI) data and the overall quality of care.
The root of this issue lies in the vague guidelines provided by the Department of Health and Aged Care.
According to the Department, “a fall is an event that results in a person coming to rest inadvertently on the ground or floor or other lower level.”A fall resulting in major injury is a fall that meets this definition and results in one or more of the following: bone fractures, joint dislocations, closed head injuries with altered consciousness, and/or subdural haematoma.”
The Department’s definitions could easily be misinterpreted; which has led to some aged care providers choosing to report falls from a low-low bed while others do not.
The Department’s responses to this publication’s requests for clarification on the categorisation of falls continue to leave things on murky ground, by failing to provide definitive answers.
The Department emphasises the general responsibilities of aged care providers and the role of the Aged Care Quality and Safety Commission in monitoring compliance.
This lack of specificity leaves each aged care provider to develop its own protocols, leading to a wide variation in what constitutes a reportable fall.
In fact, discussion regarding what should and shouldn’t be reported has quietly grown so contentious that a physiotherapist with extensive aged care experience would only agree to share their thoughts on this issue under the condition of anonymity.
“Depending on which organisation you’re working for, they all have different rules around it,” the physiotherapist explained. “Some organisations certainly don’t report rolls out of bed onto crash mats as falls,” they said.
While some might perceive falls from low beds onto crash mats as minor, the physiotherapist stressed that even small falls can result in significant injuries, particularly for elderly residents with conditions like osteoporosis.
“Older residents can sustain fractures spontaneously,” the physiotherapist noted. “I’ve seen an older resident fracture her hip just by sitting down gently into a chair. So, it is possible for injuries to occur even with small, low-velocity falls.”
This underlines the importance of accurately documenting all incidents to ensure comprehensive care and risk management.
Additionally, recording these falls can serve as an early warning sign of more severe falls in the future, allowing for preventative measures to be taken. However, the current grey area means that some facilities might underreport such incidents, potentially compromising resident safety.
The inconsistency in reporting falls has broader implications for the collection of QI data.
The National Aged Care Mandatory Quality Indicator Programme requires residential aged care services to report quality indicator data to the Aged Care Quality and Safety Commission quarterly.
This data includes the percentage of care recipients who experienced one or more falls and those who sustained major injuries from falls. If some aged care providers do not report falls from low beds onto crash mats while others do, it can skew the data.
The physiotherapist echoed these sentiments: “If there’s this grey area across this one particular thing, then it’s a problem. When I go into homes, and they’re not reporting these falls, but I know other homes are, we’re looking at skewed data, and we’re not playing on an even field.”
This inconsistency can misrepresent the safety records of different providers, affecting their quality ratings and potentially influencing the choices of prospective residents and their families.
The lack of uniform reporting standards not only creates confusion among staff but also hampers efforts to improve care quality across the sector.
Accurate and consistent reporting of all falls, regardless of their perceived severity, is crucial for effective risk management and quality improvement. As the physiotherapist pointed out, “The whole concept of reporting incidents is because they’re early warning signs, like near misses, to prevent future incidents.”
Despite the challenges, the physiotherapist believes that there is a place for low beds in managing fall risks, but their use should be carefully considered. “We need to go through a process of ensuring who’s appropriate to have them put in place,” they said.
“We don’t want to be putting people in a position where we take away their ability to have independence and stay up and move.”
To address this grey area, the Department of Health and Aged Care must establish clear, uniform guidelines for reporting falls from low beds onto crash mats. By doing so, aged care providers can operate with consistent standards, leading to better outcomes for all residents.
Clear policies will also ensure that QI data accurately reflects the safety and quality of care provided, enabling continuous improvement across the sector.
In the meantime, aged care providers must strive to develop and implement best practices for fall reporting, guided by the principles of transparency and resident safety.
The physiotherapist aptly noted, “Injuries can occur even with small falls. It’s about ensuring we’re providing the best care and maintaining the safety and dignity of residents.”
The ambiguity surrounding current falls reporting protocols raises crucial questions about the accuracy of current data being processed by regulatory bodies to form star ratings and gauge compliance.
Simply put, how can we use data to inform decision-making when not everything being measured is the same?
This ‘data consistency capture ‘ has been an issue for a long long time- with the understanding now very clear about avoiding restraints and the need for safety to be balanced with supporting resident freedom and the residents right to make choices that incur risk.
The resident who rolls from a mattress to an adjacent mat, without any injury seems to me to be more an “anticipated outcome” where the measures put in place to protect their safety- whilst supporting their freedom and independence- have been effective.
I have seen a resident with osteoporosis fracture their hip whilst walking normally on it (Audible crack) with staff they were with at the time gently lowering them to the ground in response- is an incident – a medical one- but was not a fall. I have seen residents who had been hobbling for a few days be found to have a fractured hip- without a history of a fall-(I could not believe it!)
It is complex but we need to remember the intention of capturing falls is to monitor residents wellbeing, investigate any incident for what we can learn from it, ID trends and anticipate issues and put in measures to try to increase safety. The data collection surely is to support resident safety and care…one has to be very careful one is not trying to compare apples with oranges if you want to use it for whole of service accountability!
We as Carers report it to the RN on duty and He/She does a head to toe to check. When accepting one Person for Respite We were asked why We don’t have bed rails. It’s not all that long ago they were on beds in Aged Care Facilities but they are considered a form of restraint! They were helpful in stopping rolls/falls out bed!