Falls reduction and mobility within nursing homes: An innovative, collaborative, state-sponsored approach

Minnesota's Nursing Home Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving the quality of nursing home care. Projects lasting 1-3 years are selected through a competitive process and funded for up to 5% of the daily per diem rate. Through PIPP funding, a Minnesota nursing home collaborative comprised of 13 facilities developed and implemented an innovative exercise and falls prevention program targeting both nursing home residents and community members. During on-site visits to three participating facilities, we conducted 34 in-depth interviews with project leaders, direct caregivers, quality coordinators, and other staff. Interview questions focused on project successes, challenges, and processes of implementation such as leadership, communication and allocation of time, space, and personnel. Qualitative data were analyzed using the Consolidated Framework for Implementation Research (CFIR). Project leaders noted that success was about more than the financial incentive; there was reward in observing the positive changes in resident mobility, mood, and socialization. Key challenges revolved around managing changes in staff and resident work and life routines. However, direct care staff felt empowered to make positive changes in the lives of residents. Unique aspects of this project included facilities working within the collaborative to share data and problem solve, and integration of community members into the program as a means to promote physical activity, foster social ties between residents and community members, and encourage project sustainability. Respondents identified lessons learned including the need to educate staff early, attain interdisciplinary involvement, and taking time to implement lasting change.