Solano County Senior Fall Prevention Survey

1. Solano County Senior Fall Prevention Survey

Falls and/or the injuries that result from them are, by and large, preventable. With proper measures and education, seniors should be able to reduce the risk of falls and safely maintain their independence longer.

Fall Prevention efforts have shown success reducing the frequency and severity of falls among older adults. One study conducted by the Yale School of Medicine found that education coupled with other interventions effectively reduced falls among older adults by 11%. The Solano County Fall Prevention Partnership, a collaborative group of professionals and community members, is working on county-wide fall prevention efforts for community dwelling older adults in Solano County. In order to design effective fall prevention efforts the Fall Prevention Partnership is conducting an assessment on fall prevention efforts and programs in Solano County.

We appreciate you taking the time to inform us of your organization's fall related programs and services.

If you have any questions or would like to join the Fall Prevention Partnership please contact Rochelle Sherlock at 707-864-3984 or rochelle_sherlock@comcast.net.

Thank you!

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1. Please provide us with the following information.

Please provide us with the following information. Name:
Organization:
Department:
Address:
City/Town:
ZIP/Postal Code:
Email Address:
Phone Number:

2. Please indicate the category that best describes you and/or your organization (check all that apply):

Please indicate the category that best describes you and/or your organization (check all that apply): Medical Clinic

Doctor's Office/Physician

Hospital/staff

Physical Therapist

Home Health Care Services (e.g., Visiting Nurses Association)

Public Health

In-Home Supportive Services

Hospice

In-Home Care Agency

Senior Apartments/Community

Assisted Living Facility

Board and Care Home

Skilled Nursing Facility

Nursing and Rehabilitation Center

Adult Day Health Care

Adult Day Care

Senior Advocate

Senior Center

Resource and Referral agency

Meal Preparation/Food/Basic Needs (e.g., Meals on Wheels)

Education and Training

Recreation/physical fitness

Emergency Response (e.g., Fire Department)

Dispatch

Medical transportation

Mental health

Housing and Development

Home Repair Services

Other (please specify)

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3. Of the total client population you serve, what percentage, would you estimate, are seniors (65+)?

Of the total client population you serve, what percentage, would you estimate, are seniors (65+)? 95-100%

80-95%

60-80%

40-60%

20-40%

10-20%

Less than 10%

Comment/Other (please specify)

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4. What proportion of your services (e.g., intervention, treatment) are related to senior falls? Please estimate the proportion based on the senior population you serve and not on the overall population you serve.

What proportion of your services (e.g., intervention, treatment) are related to senior falls? Please estimate the proportion based on the senior population you serve and not on the overall population you serve. Less than 5%

5-10%

10-15%

15-20%

20-40%

40-60%

60-80%

80% or more

Other (please specify)

5. A fall resulting in a hospitalization cost, on average, $37,000 in Solano County in 2004 (EPIC Branch, California Office of Statewide Planning and Development, Patient Discharge Data). These costs do not take into account additional expenses related to the fall such as emergency response without hospital admission, physical therapy and rehabilitation, home care, or cost to the community. The following question is an attempt to quantify some of the other costs related to falls that are not captured in Hospital Patient Discharge data. How much does it cost (estimate) to provide fall related intervention and/or treatment services to seniors?

A fall resulting in a hospitalization cost, on average, $37,000 in Solano County in 2004 (EPIC Branch, California Office of Statewide Planning and Development, Patient Discharge Data). These costs do not take into account additional expenses related to the fall such as emergency response without hospital admission, physical therapy and rehabilitation, home care, or cost to the community. The following question is an attempt to quantify some of the other costs related to falls that are not captured in Hospital Patient Discharge data. How much does it cost (estimate) to provide fall related intervention and/or treatment services to seniors?

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6. Many organizations are heavily impacted by the growing senior population resulting in insufficient expertise, staffing, and resources to meet the growing demand. Please indicate the degree to which your organization is impacted by senior falls?

	Demand exceeds capacity	Significantly impacted	Impacted	Slightly impacted	Not impacted	NA	Other
Expertise (e.g., geriatrically trained professionals)	*Many organizations are heavily impacted by the growing senior population resulting in insufficient expertise, staffing, and resources to meet the growing demand. Please indicate the degree to which your organization is impacted by senior falls? Expertise (e.g., geriatrically trained professionals) Demand exceeds capacity	Expertise (e.g., geriatrically trained professionals) Significantly impacted	Expertise (e.g., geriatrically trained professionals) Impacted	Expertise (e.g., geriatrically trained professionals) Slightly impacted	Expertise (e.g., geriatrically trained professionals) Not impacted	Expertise (e.g., geriatrically trained professionals) NA	Expertise (e.g., geriatrically trained professionals) Other
Staffing (e.g., time providing services related to senior falls)	Staffing (e.g., time providing services related to senior falls) Demand exceeds capacity	Staffing (e.g., time providing services related to senior falls) Significantly impacted	Staffing (e.g., time providing services related to senior falls) Impacted	Staffing (e.g., time providing services related to senior falls) Slightly impacted	Staffing (e.g., time providing services related to senior falls) Not impacted	Staffing (e.g., time providing services related to senior falls) NA	Staffing (e.g., time providing services related to senior falls) Other
Resources (funding, space, equipment)	Resources (funding, space, equipment) Demand exceeds capacity	Resources (funding, space, equipment) Significantly impacted	Resources (funding, space, equipment) Impacted	Resources (funding, space, equipment) Slightly impacted	Resources (funding, space, equipment) Not impacted	Resources (funding, space, equipment) NA	Resources (funding, space, equipment) Other

Comment/Other (please specify)

7. Which of the following fall prevention practices (e.g., programs/services) does your organization offer to seniors (check all that apply)?

Which of the following fall prevention practices (e.g., programs/services) does your organization offer to seniors (check all that apply)? Reporting unsafe conditions

Education and awareness

Home safety assessments

Nutrition counseling/food access

Gait and balance assessments

Multifactoral risk assessments (combines assessment of gait, balance, nutrition, medications, home/environmental assessment, medical conditions)

Referral for assessment due to fragility or following a fall

Follow-up or case management following a fall that does not result in a debilitating fracture or injury

Fall prevention mitigation in senior’s home or at your site

Balance and mobility training

Exercise classes

Fall reporting

Fall prevention counseling to address risk factors

Other (please specify)

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8. Is there an eligibility requirement for the fall prevention services you provide ? If so, please describe.

Is there an eligibility requirement for the fall prevention services you provide ? If so, please describe. Yes

Other

If yes or other (please specify)

9. What is the fee structure for the fall prevention related services that your organization provides?

What is the fee structure for the fall prevention related services that your organization provides? Free

Sliding scale

Medicare covered

Medi-cal covered

Veteran's Benefits

Fee for service

Other (please specify)

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10. Do you have fall prevention policies and procedures in place?

Do you have fall prevention policies and procedures in place? Yes

In development (please describe)

Other (please specify)

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11. What percentage of the older adult population do you think experience falls?

What percentage of the older adult population do you think experience falls? Less than 10%

10-20%

20-30%

30-40%

40-50%

More than 50%

Comment:

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12. What are the consequences of falls for the older adults you serve(check all that apply)?

What are the consequences of falls for the older adults you serve(check all that apply)? Compromised mobility

Fear and reduced activity

Depression or other mental/emotional health issues

Cuts, bruises, laserations

Fractures

Broken hips

Head trauma

Hospitalization

Loss of independence

Long term care placement

Mortality or shortened lifespan

Non-injury fall

Don’t know

Other (please specify)

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13. What services do you believe older adults would use if provided (check all that apply)?

What services do you believe older adults would use if provided (check all that apply)? Risk factor assessment

Free in-home information

Balance and mobility training

Assisted living devices

Public Education

Counseling

Home Assessment

Mitigation

Case Management

Nutritional Assessment

Medication Assessment

Chemical Dependency Assessment

Vision Assessment

Hearing Assessment

Free Exercise Classes

Regular Eye Exams

Home Modification

Help to Decrease Clutter in Home

Other (please specify)

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14. Please indicate how important you think the following programs and services are for addressing fall prevention in Solano County?

	Very important	Important	Somewhat important	Not important	N/A
Community education and awareness	*Please indicate how important you think the following programs and services are for addressing fall prevention in Solano County? Community education and awareness Very important	Community education and awareness Important	Community education and awareness Somewhat important	Community education and awareness Not important	Community education and awareness N/A
Coordination among health care and other providers	Coordination among health care and other providers Very important	Coordination among health care and other providers Important	Coordination among health care and other providers Somewhat important	Coordination among health care and other providers Not important	Coordination among health care and other providers N/A
Provider education/training	Provider education/training Very important	Provider education/training Important	Provider education/training Somewhat important	Provider education/training Not important	Provider education/training N/A
Centralized resource and referral	Centralized resource and referral Very important	Centralized resource and referral Important	Centralized resource and referral Somewhat important	Centralized resource and referral Not important	Centralized resource and referral N/A
Fall surveillance data collection and reporting	Fall surveillance data collection and reporting Very important	Fall surveillance data collection and reporting Important	Fall surveillance data collection and reporting Somewhat important	Fall surveillance data collection and reporting Not important	Fall surveillance data collection and reporting N/A
Public Education/Advocacy for policies and community fall safety	Public Education/Advocacy for policies and community fall safety Very important	Public Education/Advocacy for policies and community fall safety Important	Public Education/Advocacy for policies and community fall safety Somewhat important	Public Education/Advocacy for policies and community fall safety Not important	Public Education/Advocacy for policies and community fall safety N/A
Organizational policies regarding reporting and follow-up	Organizational policies regarding reporting and follow-up Very important	Organizational policies regarding reporting and follow-up Important	Organizational policies regarding reporting and follow-up Somewhat important	Organizational policies regarding reporting and follow-up Not important	Organizational policies regarding reporting and follow-up N/A
Securing funds to support fall prevention efforts	Securing funds to support fall prevention efforts Very important	Securing funds to support fall prevention efforts Important	Securing funds to support fall prevention efforts Somewhat important	Securing funds to support fall prevention efforts Not important	Securing funds to support fall prevention efforts N/A

Comment:

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15. What geographic area do you serve?

What geographic area do you serve? All of Solano County

City of Vallejo

City of Benicia

City of Fairfield

City of Suisun

City of Vacaville

City of Rio Vista

City of Dixon

Other (please specify)

16. Are you interested in staying apprised of our fall prevention efforts?

Are you interested in staying apprised of our fall prevention efforts? Yes

Not at this time, thank you

Other (please specify)

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17. Coordination and collaboration are key to the success of any large (e.g.,county-wide) initiative such as fall prevention. Are you willing to partner with us to implement fall prevention efforts for community-dwelling older adults in Solano County? If so, please indicate the ways you might be willing and able to help in fall prevention efforts (check all that apply).

Coordination and collaboration are key to the success of any large (e.g.,county-wide) initiative such as fall prevention. Are you willing to partner with us to implement fall prevention efforts for community-dwelling older adults in Solano County? If so, please indicate the ways you might be willing and able to help in fall prevention efforts (check all that apply). Join the Solano County Fall Prevention Partnership

Coordinate services with other providers

Disseminate fall prevention information

Write articles and/or publish articles in newsletters and publications

Share resources (e.g., make photo copies of flyers, provide food at classes/events)

Provide staff to educate seniors and/or professionals at health fairs, events, and classes (e.g., Gait and Balance assessments, give a training)

Host a training/workshop on fall prevention (e.g., invite co-workers to a luncheon and/or gather a group of seniors for a presentation on fall prevention)

Provide conference room space for meetings and/or trainings

Become trained in evidence-based fall prevention practices

Funding

Other

We are not able to participate or contribute at this time. Thank you.

Comment/Other (please specify)

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18. Who should we contact to follow-up on your interest and potential involvement with the Solano County Fall Prevention Partnership and it's initiatives?

Who should we contact to follow-up on your interest and potential involvement with the Solano County Fall Prevention Partnership and it's initiatives? I am already involved

Myself (my contact information is provided in this survey)

A staff or volunteer other than myself (please fill in the person's name, phone number, and email address below)

Other

Please include the name, phone number and email of the contact person for follow-up.

19. Our intention is to gather enough data to inform our planning and development process for fall prevention in Solano County. With that in mind, is there anything else we should know that we have not already asked about in this survey?

Our intention is to gather enough data to inform our planning and development process for fall prevention in Solano County. With that in mind, is there anything else we should know that we have not already asked about in this survey?

20. Comments/Suggestions/Questions:

Comments/Suggestions/Questions:

Thank you for taking the time to complete this survey and for your support in providing critical services to older adults in Solano County.

Solano County Senior Fall Prevention SurveyExit this survey

1. Solano County Senior Fall Prevention Survey

*1. Please provide us with the following information.

2. Please indicate the category that best describes you and/or your organization (check all that apply):

*3. Of the total client population you serve, what percentage, would you estimate, are seniors (65+)?

*4. What proportion of your services (e.g., intervention, treatment) are related to senior falls? Please estimate the proportion based on the senior population you serve and not on the overall population you serve.

*6. Many organizations are heavily impacted by the growing senior population resulting in insufficient expertise, staffing, and resources to meet the growing demand. Please indicate the degree to which your organization is impacted by senior falls?

7. Which of the following fall prevention practices (e.g., programs/services) does your organization offer to seniors (check all that apply)?

*8. Is there an eligibility requirement for the fall prevention services you provide ? If so, please describe.

9. What is the fee structure for the fall prevention related services that your organization provides?

*10. Do you have fall prevention policies and procedures in place?

*11. What percentage of the older adult population do you think experience falls?

*12. What are the consequences of falls for the older adults you serve(check all that apply)?

*13. What services do you believe older adults would use if provided (check all that apply)?

*14. Please indicate how important you think the following programs and services are for addressing fall prevention in Solano County?

*15. What geographic area do you serve?

16. Are you interested in staying apprised of our fall prevention efforts?

*18. Who should we contact to follow-up on your interest and potential involvement with the Solano County Fall Prevention Partnership and it's initiatives?

19. Our intention is to gather enough data to inform our planning and development process for fall prevention in Solano County. With that in mind, is there anything else we should know that we have not already asked about in this survey?

20. Comments/Suggestions/Questions:

Solano County Senior Fall Prevention Survey
Exit this survey

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1. Please provide us with the following information.

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3. Of the total client population you serve, what percentage, would you estimate, are seniors (65+)?

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4. What proportion of your services (e.g., intervention, treatment) are related to senior falls? Please estimate the proportion based on the senior population you serve and not on the overall population you serve.

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6. Many organizations are heavily impacted by the growing senior population resulting in insufficient expertise, staffing, and resources to meet the growing demand. Please indicate the degree to which your organization is impacted by senior falls?

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8. Is there an eligibility requirement for the fall prevention services you provide ? If so, please describe.

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10. Do you have fall prevention policies and procedures in place?

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11. What percentage of the older adult population do you think experience falls?

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12. What are the consequences of falls for the older adults you serve(check all that apply)?

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13. What services do you believe older adults would use if provided (check all that apply)?

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14. Please indicate how important you think the following programs and services are for addressing fall prevention in Solano County?

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15. What geographic area do you serve?

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18. Who should we contact to follow-up on your interest and potential involvement with the Solano County Fall Prevention Partnership and it's initiatives?