Indicator Metadata

Falls in the Last 30 Days in Long-Term Care

Percentage of Residents Who Fell in the Last 30 Days

This indicator looks at how many long-term care residents fell in the 30 days leading up to the date of their quarterly clinical assessment. Falls are the leading cause of injury for seniors and contribute to a significant burden on the health care system. Residents are at a higher risk of falling if they have a history of falls or are taking certain medications. Preventing falls increases the safety and quality of care of residents.

This indicator examines the percentage of residents who fell in the 30 days leading up to the date of their quarterly clinical assessment. It is calculated by dividing the number of residents who had a fall in those 30 days by the number of all residents with valid assessments within the applicable time period.

Unit of Analysis: Resident

Place of service

Percentage or proportion

The following covariates are used in risk adjustment:
Individual covariates: Not totally dependent in transferring; locomotion problem; Personal Severity Index subset 2 (non-diagnoses); any wandering; unsteady gait/cognitive impairment; age younger than 65

Facility-level stratification: Case Mix Index (CMI)

Stratification, direct standardization, indirect standardization ;

Standard Population:
3,000 facilities in 6 U.S. states and 92 residential care facilities and continuing care hospitals in Ontario and Nova Scotia

Description:
Residents with valid assessments

Inclusions:

1. Residents with valid assessments. To be considered valid, the target assessment must
   1. Be the latest assessment in the quarter
   2. Be carried out more than 92 days after the Admission Date
   3. Not be an Admission Full Assessment

Description:
Residents who had a fall in the last 30 days recorded on their target assessment (J4a = 1)

Inclusions:

1. Residents with valid assessments. To be considered valid, the target assessment must
   1. Be the latest assessment in the quarter
   2. Be carried out more than 92 days after the Admission Date
   3. Not be an Admission Full Assessment

Exclusions:
None

CCRS quality indicators were developed by interRAI (www.interrai.org), an international research network, to provide organizations with measures of quality across key domains, including physical and cognitive function, safety and quality of life. Each indicator is adjusted for resident characteristics that are related to the outcome and independent of quality of care. The indicators can be used by quality leaders to drive continuous improvement efforts. They are also used to communicate with key stakeholders through report cards and accountability agreements.

Lower is better. It means that a lower percentage of long-term care residents had a fall in the month leading up to their quarterly assessment.

Health System Outputs: Safe

Living With Illness, Disability or Reduced Function

CIHI: None

Health Quality Ontario (external): 9% for long-term care

Canadian Institute for Health Information. CCRS Quality Indicators Risk Adjustment Methodology (PDF). 2013.

Canadian Institute for Health Information. When a Nursing Home Is Home: How Do Canadian Nursing Homes Measure Up on Quality? (PDF) 2013.

Health Quality Ontario. Long-Term Care Benchmarking Resource Guide (PDF). 2013.

Health Quality Ontario. Results From Health Quality Ontario's Benchmark Setting for Long-Term Care Indicators (PDF). 2017.

Health Quality Ontario. Health Quality Ontario Indicator Library. Accessed October 4, 2017.

Hirdes JP, Mitchell L, Maxwell CJ, White N. Beyond the "iron lungs of gerontology": Using evidence to shape the future of nursing homes in Canada. Canadian Journal on Aging. 2011.

Hirdes JP, Poss JW, Caldarelli H, et al. An evaluation of data quality in Canada's Continuing Care Reporting System (CCRS): Secondary analyses of Ontario data submitted between 1996 and 2011. BMC Medical Informatics and Decision Making. 2013.

Jones RN, Hirdes JP, Poss JW, et al. Adjustment of nursing home quality indicators. BMC Health Services Research. 2010.

CCRS

Type of Year:
Fiscal
First Available Year:
2010
Last Available Year:
2019

Newfoundland and Labrador, New Brunswick, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Yukon

Province/Territory, Region, Facility, Corporation, Sector (residential and hospital-based continuing care)

Every year

Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Not applicable

This measure uses data collected by long-term care facilities using the Resident Assessment Instrument–Minimum Data Set 2.0 (RAI-MDS 2.0) and submitted to the Continuing Care Reporting System (CCRS). Users should be cautious when interpreting results from CCRS because the CCRS frame does not currently contain all facilities in all provinces and territories that make up the CCRS population of interest; thus the population covered by CCRS may not be representative of all continuing care facilities across Canada.

Some jurisdictions have implemented or are in the process of implementing the new interRAI Long-Term Care Facilities (LTCF), the next-generation clinical assessment instrument for long-term care. Data collected using this assessment instrument will be submitted to the Integrated interRAI Reporting System (IRRS). Results for these jurisdictions as of the fiscal year of interRAI LTCF implementation are not available at this time. Historical results based on the RAI-MDS 2.0 are available.

Coverage is incomplete for some fiscal years in the following jurisdictions:

• Saskatchewan (implemented and started collecting data using the interRAI LTCF in 2019–2020)
• Manitoba (includes all facilities in Winnipeg Regional Health Authority only)
• New Brunswick (implemented and started collecting data using the interRAI LTCF in 2017–2018)
• Nova Scotia

Indicators are risk-adjusted to control for potential confounding factors.

Since 2003, the number of facilities and jurisdictions submitting to CCRS has been increasing. With the addition of new jurisdictions, it is possible that differences in care practices may affect indicator rates; however, changes to the underlying population would be controlled for using risk adjustment. There is also evidence to suggest that trending and use of data from the entire time series is not an issue and that data quality is consistent over time (Hirdes et al., 2013).

The CCRS quality indicators use 4 rolling quarters of data for calculations in order to have a sufficient number of assessments for risk adjustment. Since residents are assessed on a quarterly basis, each resident can contribute to the indicator up to 4 times.

Data for this indicator is also available in the Quick Stats tool, which includes results for both the residential and hospital-based continuing care sectors: https://www.cihi.ca/en/quick-stats.