Preventing Falls: A Holistic Approach for Older Adults and Health Plans

Edna, 74, had always been independent and active. Lately, though, she’d noticed her balance worsening and avoided activities she once loved for fear of falling – convinced it was just part of aging. One afternoon, she received a call from Sharon, a social care advocate who worked with her Medicare Advantage plan. After Edna shared her concerns, Sharon explained that her plan offered a fully covered balance program with fun classes, instructional videos, and a balance training device to help improve her strength and confidence. 

Within weeks of enrolling, Edna saw remarkable progress. Guided by her instructor and using the program’s resources, she regained the strength and stability to return to her walks and even visit the park on her own. Grateful for her advocate's timely call, Edna felt empowered and confident again, realizing that the right support could make all the difference and that imbalance and falling are not an unavoidable part of aging. 

The Facts about Falls

Falls are a leading cause of injury among adults aged 65 and older, yet they’re far from inevitable. Every year, over 14 million older adults report a fall—making fall prevention a critical health priority. Fall-related healthcare expenses reached $80 billion in 2020 and are projected to exceed $101 billion by 2030. Contrary to popular belief, falling isn’t just a natural part of aging. Many falls stem from modifiable risks like unsafe home environments, medication side effects, and physical inactivity. Addressing these risks can save lives, improve independence, and enhance health plan outcomes such as Star Ratings via Health Outcomes Survey (HOS) measures, which will be triple-weighted in 2025.

Fall Prevention Strategies

Preventing falls in older adults requires a multifaceted approach that addresses both physical and environmental risk factors. Here are several proven strategies that Medicare Advantage plans and healthcare providers can implement to reduce fall risk.

1. Exercise Programs: Strength and balance training, such as Tai Chi or resistance exercises, helps improve muscle strength, coordination, and flexibility. Regular physical activity is one of the most effective ways to prevent falls.
2. Home Safety Modifications: Simple home modifications like improving lighting, removing clutter, installing bathroom grab bars, and securing loose rugs can make living spaces safer.
3. Medication Reviews: Regular reviews of a member’s medications by healthcare providers can help identify those that may cause dizziness, drowsiness, or balance issues, which are common contributors to falls.
4. Vision and Hearing Care: Routine vision and hearing exams ensure that individuals can better detect environmental hazards. Corrective lenses, hearing aids,     and other interventions can help minimize sensory deficits contributing to falls.
5. Footwear and Mobility Aids: Wearing appropriate, non-slip footwear and using mobility aids like walkers or canes can provide additional support and stability.
6. Fall Risk Assessments: Regular fall risk assessments by healthcare providers should include examining factors such as gait, balance, medications, and medical history to identify individuals at higher risk and allow for early intervention.
7. Education and Awareness: Offering resources on exercise, home safety, and recognizing fall risks can empower individuals to take proactive steps to avoid falls.

Fall Prevention with Community Lynk

Social care advocates play a vital role in preventing falls by addressing factors contributing to fall risk. With Community Lynk, advocates can assess members' living conditions, identify risk factors, and connect them with community resources such as home safety modifications, vision and hearing aids, exercise programs, transportation, and nutrition support to help prevent falls.  Additionally, advocates can educate members about fall prevention strategies and document a member's history of falling using Z codes (Z91.81), allowing advocates and healthcare providers to track past falls, tailor interventions, and manage risk. Through continuous support and follow-up, advocates help create safer environments and reduce falls for Medicare Advantage members. If a health plan has already partnered with a CDC-approved Evidence-Based Falls Prevention Program such as A Matter of Balance, Stepping On, or YMCA Moving for Better Balance, BeneLynk can promote these programs, ensuring our services best meet health plan and member needs.

Fall Documentation with Veteran Lynk

The Department of Veterans Affairs (VA) does an excellent job documenting fall risk in veterans’ medical records, often capturing comprehensive details about previous falls, mobility issues, and related risk factors. Because this information is not shared with the veteran member’s Medicare Advantage plan, there is often a gap in understanding the full scope of the veteran’s health risks, including fall risk. This can result in missed opportunities for early intervention, preventive care, and proper care coordination. Veteran Lynk bridges this gap by ensuring that crucial fall risk documentation and other medical details from the VA are shared with the Medicare Advantage plan, enabling more comprehensive care management and reducing the likelihood of fall-related complications.

Final Thoughts

Through a combination of exercise programs, home safety modifications, and regular healthcare reviews, falls can be prevented. Social care advocates play a vital role in identifying risk factors, providing education, and coordinating resources to support fall prevention while documenting fall history and risk. Because reducing the risk of falling affects Health Outcomes Survey (HOS) results, documenting and addressing fall risk directly impacts plan reimbursement, performance metrics, and health plan costs.

To learn more about how social care can improve HOS measures, reach out to us at sales@benelynk.com! We would love to hear from you!

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