Grant: Partnerships for Health System Improvement (PHSI)

Home care clients are at particularly high risk for falls and related injuries by virtue of their degree of frailty, lack of independent mobility and presence of multiple chronic conditions. The objective of this study is to determine the impact, cost effectiveness and sustainability of the Strategies and Actions for Independent Living (SAIL) program, and the sub component of the SAIL program - the Home Activity Program (HAP), as strategies for reducing falls and their consequences among home care clients. The SAIL interventions include staff training, fall and injury surveillance, individualized client prevention plans and a Home Activity Program. The study design is a three-arm, non-randomized intervention conducted over 12 months, with over 1,200 clients. One arm will receive the full SAIL program, another arm will receive the SAIL Home Activity Program (HAP) alone, and a third arm will serve as the control with routine home support service delivery. The impact of the full SAIL program and the HAP component alone will be determined through the use of a fall surveillance system linked to the Inter-RAI Home Case (RAI-HC) Assessment toot and through analysis of data from validated mobility assessment tools commonly used among older adults (the Time-up-and-Go, Life-space assessment, Sit-to-Stand and the Tandem Stance). An economic evaluation will determine the incremental improvement of the HAP program alone compared to the full SAIL program, and both compared to routine home support delivery. Economic measures include a quality of life measures (EQ-5D), relevant RAI-HC data on health service utilization and key informant interviews. The sustainability of implementing the SAIL will be determined through a qualitative analysis of semi-structured key informant interviews with Home Care management, staff, clients and family members.