Falls are always a concern in long term care facilities. In light of this, Jefferson County Nursing Home in Dandridge, Tenn., identified through its Quality Assurance/Performance Improvement (QAPI) process that improvement was needed in the area of falls management. As a result, we began considering a performance improvement project (PIP) by looking for an innovative way to reduce or eliminate the occurrence of falls.
As a result of a learning circle from among our interdisciplinary team, The Balancing Act was proposed. The intention was to strengthen some of the deficits our elders have that may contribute to falls. After the first time of doing the program, the team was in agreement that The Balancing Act was the appropriate PIP.

The Balancing Act Is Born

The goals of Jefferson County’s Balancing Act are to actively engage elders who are at risk for falls, promote endurance and balance for gait stability, and enhance socialization and quality of life. The interdisciplinary team includes the activities department; therapy, including occupational, physical, and speech; housekeeping; and restorative certified nurse assistants.

In addition to the team, the group is also joined by students from the local high school who are a part of a program known as the Service Learning Project. Additionally, family members of the elders take part.
The group of elders includes those who have been identified as a fall risk or who have had a recent fall; however, any elder who wishes is invited to participate. The location of The Balancing Act may vary, but the program is usually held in the home’s main dining room due to its size. The length of the program is typically one hour.

“Elders who participate in The Balancing Act have more minutes in therapy than elders who do not,” says Lori Toney, physical therapy assistant for Functional Pathways, the facility’s therapy provider.

Therapy The Fun Way

The program usually begins with the traditional activity of gathering around a colorful parachute and using it to develop arm strength and range of motion as the elders get “warmed up.” Once the elders have warmed up, the sky is the limit on the types of nontraditional games used as exercises.

“The Balancing Act has turned into both a fun and functional program,” says Debbie Thacker, clinical manager for Functional Pathways.

Baseball is one popular game, with the elders hitting the ball and team members running the bases for them. They also play games that include balancing plates on their heads; throwing water balloons outside during the summer heat; volleyball, bowling, kickball, soccer; reminiscing with questions; passing a ball; and taking a turn with a stick while standing and swinging at a piñata.

The goal is to maximize elders’ standing time by utilizing staff members or volunteers while the games are taking place. The games and activities are all approached by thinking with a “culture change” mindset.
How It’s Working

Over the past quarter, falls have been reduced up to 15 percent. The Balancing Act is used as a possible intervention when an elder falls and the program has potential to strengthen them. The program is growing not only in terms of elders who are participating, but with the number of volunteers and family members. The activity continues to generate a great deal of staff and visitor interest.

One specific example of a resident who has benefited is Myrtle Reidell. She had a fall but no serious injuries soon after coming into the nursing home.

Reidell also completed a round of therapy at the nursing home and was somewhat active within the building.

After starting The Balancing Act, Reidell has been attending more outings with the use of her walker. She recently attended a 90-and-over potluck luncheon at her church and was reunited with all of her friends from church, which meant so much to her.

“The Balancing Act has proven to be a fun and social activity that the elders truly enjoy,” says Rich Henderson, occupational therapist with Functional Pathways. “It has been wonderful to see the elders improve their safety awareness and functional progression toward their therapy goals as a result of this program.”

Roger Mynatt has been administrator of Jefferson County Nursing Home, Dandridge, Tenn., for 22 years. He is married and the father of three daughters, two cats, and one dog.