In healthcare, we often talk about people in cohorts - populations of individuals grouped together by clinical, social, financial and other general demographics.
Most frequently, health plans lump members into disease states and chronic conditions- high-risk, complex, catastrophic, the top 20%. Though I learned early on in my career that referring to people by their risk profile or chronic condition will get you some side eyes from the clinicians in the room, and rightfully so.
Here at Jukebox, our care recipients and families come to us in a variety of different situations. Some are adult children looking for ways to keep their parents safe and at home. Some spouses and friends struggling to care for their loved ones. Others proactively modifying their homes so “aging in place” is a reality and not a dream. However, regardless of how/why they find us, when we look at the people we help, there are always common themes and characteristics.
Chief among them, they are living with, or caring for someone with chronic conditions.
In the following article we’ll explain the link between chronic conditions and fall risk, highlighting the chronic conditions that put people at the greatest risk of falling and why it’s imperative for health plans to reevaluate how they address home safety.
The Link Between Chronic Illness and Fall Risk
While it may not look like it on the surface, the relationship between chronic conditions and fall risks is undeniable. According to the NCOA Center for Healthy Aging Falls Database, “over 67% of falls prevention program participants indicate that they have multiple chronic conditions.” And here at Jukebox Health, we can confirm that statistic - nearly 67% of the home safety evaluations that our network of occupational therapists conduct are for someone who’s reported living with, or caring for someone with at least one chronic condition.
But why do chronic conditions correlate with fall risk?
Simply put, the condition impacts a person physically, cognitively and emotionally. Depending on the specific diagnosis, those living with a chronic condition will experience a range of physical changes to their body. Many of these physical changes include frailty, increased muscle weakness, impaired vision and shuffling gait - which are all factors that have been proven to increase fall risk.
- Parkinson's or Multiple Sclerosis can disrupt coordination and movement control.
- Peripheral neuropathy, often seen in diabetes, can lead to reduced sensation in the feet, making it harder to detect changes in surfaces.
- The cognitive challenges brought on by conditions like Alzheimer's or dementia can impact judgment and spatial awareness, making everyday navigation a potential hazard.
Changes in functional status and mobility, compounded by instances of cognitive decline cause enough problems on their own. Layer in environmental risks found in the home, and you have a recipe for a fall that could lead to serious injury, or even premature death.
It’s also important for health plans and providers to realize that chronic conditions aren’t just a predictor of a fall, but can also be a predictor of limited movement and impediments to accessibility around the home. For those that are experiencing noticeable changes to their mobility and function, it’s not uncommon for many to become fearful and hesitant to ambulate, leading to a decline in strength, balance, independence and confidence in their movement.
So often we see care recipients decompensate due to this fear of falling, especially when they start to see the impact that their chronic conditions are having on their bodies and minds. They stop doing things for themselves and the need for additional support from a caregiver or a personal care aide becomes a must have rather than a last resort.
This inactivity and fear can cause social isolation, exacerbate pre-existing conditions and ultimately lead to a decline in ADLs, IADLs, physical function, confidence and self-sufficiency.
The Chronic Conditions Most At Risk
Although all chronic conditions can increase one’s risk of falling there are some that represent a greater risk that health plans need to note.For example, at Jukebox Health the top chronic conditions our clients report are:
- Alzheimer’s Disease and Related Dementias
And the frequency in which we see these conditions is not just by chance. In fact there are a variety of studies that show a direct correlation between specific conditions and the likelihood of experiencing a fall. For example, it’s been reported that over 50% of those living with PD will fall within the next year.
Further, those with arthritis are 2.5 times more likely to report two or more falls and suffer a fall-related injury than those without arthritis. And similar studies show that people living with Alzheimer's Disease and related dementias are 8x more likely to fall.
However, it’s not just these conditions that pose a fall risk.
There are even conditions that greatly increase fall risk that plans are often overlooking. This includes Type 2 Diabetes, Glaucoma and cancer. In fact, the American Cancer Society reported that cancer survivors have a 25%-30% higher rate of falls than the general population. And patients with Chemotherapy-induced peripheral neuropathy (CIPN) have a 41% higher risk of falling.
Today, health plans throw personal care services and OTC product catalogs at members to solve these problems. However, labor is scarce, quality is an issue and at a time when stability and independence is already being questioned and stripped away from members, the interventions only create higher levels of dependency and increase the risk of falling.
Plans have a role to play in addressing these conditions and how it may indicate an increased risk of falling. If your plan isn’t already, we encourage all care management departments to revisit the questions they’re asking members and ensure they are highly targeted to their specific situation. Home safety and falls risk questions should be asked regularly and at the point of sale. Understanding the needs of your members during AEP and after enrollment will help put people into the appropriate benefit plan and will put them on the right path during every open enrollment period.
By gaining a better understanding of the progression of conditions, changes in mobility and other concerns, plans can determine the best ways to get their members the resources they need before an incident occurs. Don’t wait until someone falls to deploy an intervention. Use the analytics and research you have access to and think of Home Safety, Modifications and Falls Risk programs as preventative screenings that are covered by the plan.
The Importance of Addressing Life at Home
For individuals with chronic conditions, the home environment plays a significant role in their overall well-being and safety. And when they don’t feel safe in their own home this can lead to a major decline in health. Plans need to ensure they aren't just educating members, but are taking actionable steps to ensure that members with a chronic condition are living in a home environment that is safe and accessible- priorities that CMS has outlined in their roadmaps for Social Determinants of Health and Health Equity.
So let's talk about the solution and where home modifications come in.
Home modifications can create a supportive space that not only reduces fall risks but fosters independent living. By improving accessibility, minimizing hazards, and incorporating assistive devices, health plans can empower their members to lead safer, more comfortable lives at home.
And a solution doesn’t just have to be putting grab bars on an OTC flex card. They can be real clinical intervention because home modifications are not nearly as impactful without the guidance from a clinician.
It’s why we recommend that plans always leverage a full care management program or benefit approach to home safety that includes an in-home evaluation, risk identification, product procurement and most importantly, installation - all led by a licensed occupational therapist.
While all home modifications can make an impact, studies show that OT-led recommendations can decrease the risk of falling by 50%.
With their knowledge and training, OTs are able to address condition-specific symptoms that a member is experiencing. An OT is able to specify recommendations that go beyond just a standard 18” grab bar. For example, an OT might recommend:
- Lowering the doorway thresholds to minimize fall risk because during the initial OT evaluation it was discovered that the member is experiencing shuffling gait
- Comfort grip grab bars that are warmer to the touch and easier to grasp because the member expressed concern about her hand arthritis
- Toilet seat risers for the member with painful knee arthritis
- Caregiver alarms for the member that is balancing her own accessibility needs while caring for her aging father who has a tendency of night wandering
Building Highly-Targeted Benefits and Care Management Programs for Specific Populations
As the needs of individuals with chronic conditions differ, health plans must tailor their benefits and programs to cater to specific populations effectively. Developing highly-targeted benefits and programs allows health plans to:
Promote Preventive Care
Historically health plans have taken a reactive model to home safety, often only providing intervention after a member has experienced a fall or even worse a hospitalization due to a fall. By building a targeted benefit, plans have the ability to address fall risk proactively and pin-point hazards that are shown to pose a risk to a member’s specific condition.
Increase Member Satisfaction and Retention
90% of people over the age of 65 want to remain in their homes as long as possible. What better way to honor their wishes than by offering benefits that will actually let them “Age in Place?” A specialized home safety benefit with products that are aimed at specific symptoms demonstrates a plan’s commitment to member well-being. This is a great way to not only improve health outcomes but increase satisfaction and retention.
Improve Population Health Management
While everyone is in need of some level of home modifications, members with an apparent pain-point are the most likely to take action. A targeted benefit helps identify high-risk populations, provide focused support and ensure a higher utilization rate. CMS has given plans the green light to offer these benefits and programs to their beneficiaries. Design SSBCIs and Care Management programs that enable independence and keep people in their homes.
Next Steps to Safety
For people over the age of 65, one fall is a matter of life or death. And for plans this is a billion dollar problem.
Addressing fall risk and enhancing home safety for individuals with chronic conditions is a crucial responsibility for health plans, financially and ethically. By understanding the impact of chronic illnesses on fall risk and recognizing the importance of creating highly-targeted benefits, health plans can promote preventive care, improve member satisfaction, and achieve cost savings. Partnering with a home modification provider is key to ensuring that a home safety benefit is effective from beginning to end.
That’s why at Jukebox Health we’re proud to work with plans to build highly targeted care management programs and benefits that help specific populations.
If you’re interested in receiving a demo of our Home Safety technology or want to learn more about how we can help your plan build a more robust home safety program/benefit please contact us at (212) 321-5113 or email us at firstname.lastname@example.org.
Our fully integrated service manages the process from evaluation to installation. We provide competitive product pricing, a national network of trained occupational therapists and vetted installers that make deploying a home safety intervention scalable, efficient and affordable.