Action Falls is a programme that helps older adults avoid falls and injuries. It finds out why someone might fall and suggests ways to help, like checking their medication and encouraging them to stay active. It was created to try and prevent falls in care homes. It includes training for care home staff, a manual, and a checklist of what to look out for and what to do. Home care providers, local care groups, and older adults who live in the community think Action Falls could be useful too, to help reduce the number of falls in older adults who live at home. The investigators have identified that the programme could be particularly useful for older people who are supported by home care services.

The goal of this project is to develop ways to deliver and keep the programme running for older people supported by home care services. A future study will then try it out and see it helps people manage falls in home care.

The first part aims to plan and make changes to the current Action Falls programme to make sure it is suitable for use in home care settings. The investigators will do this by

• observing what happens on home care visits
• asking people who are supported by and who deliver home care how the programme needs to be changed.

In a future study the investigators will then deliver the programme across home care in Nottinghamshire and Lincolnshire and evaluate how well it has worked. The study will focus on coastal and rural areas.

Action Falls is a falls management programme for older people living in a care home that proactively identifies risk factors for falling and promotes actions to reduce these risks. This can include things such as reviewing medications, checking footwear is appropriate and supporting more activity. It has been collaboratively developed with care home staff, clinicians and researchers. The programme includes a training programme for care home staff, a manual, and a checklist of risk factors and actions. In the course of the work with the care home sector, domiciliary care providers, care organisations and social care practitioners have raised that Action Falls would be beneficial for domiciliary care. Areas where it would need to be adapted have been identified by these groups which include an increased focus on older people and their relatives who support with care needs. It is the push from the sector that has led to this collaborative grant.

Aims and objectives:

The aim is to adapt Action Falls for domiciliary care settings. The work will meet the following objectives:

• To explore the context of delivering Action Falls in domiciliary care
• To adapt the Action Falls materials to meet the needs of people accessing domiciliary care
• To develop a logic model of the adapted intervention

Evaluation plan:

Action Falls will be adapted, implemented and evaluated using the Adapt framework:

• Step One: To identify Action Falls as a potential intervention for domiciliary care. This has already been completed with Action Falls being identified as a potential intervention.
• Step Two: To plan for and undertake adaptations to Action Falls for domiciliary care. This will be done by exploring the context of domiciliary care by observing domiciliary care visits and carrying out interviews with older people, domiciliary care workers and owners and commissioners. The Action Falls materials will then be adapted using co-design workshops.

The final step (step 3) will be to evaluate the delivery of Action Falls. This will be done in a future study

Inclusion Criteria:

Observations:

• Domiciliary care workers working in the settings and localities in the sample and providing support to older people
• Social care practitioners working in the settings and localities in the sample

Interviews:

• Older people (65 years and over) supported by domiciliary care and providing support to older people
• Relatives of older people supported by domiciliary care
• Social care practitioners
• Owners of domiciliary care
• Commissioners and senior decision makers in Lincolnshire County Council and Nottinghamshire County Council

Co-design workshops:

• Domiciliary care workers working in BelleVie Care
• Older people (65 years and over) supported by domiciliary care
• Relatives of older people supported by domiciliary care
• Social care practitioners
• Owners of domiciliary care
• Commissioners and senior decision makers in Lincolnshire County Council and Nottinghamshire County Council

Exclusion Criteria:

• Lack of capacity to give informed consent

Observations: staff working in one reablement service in Nottinghamshire County Council and one in Lincolnshire County Council and one private provider in each site.

Interviews: older people receiving domiciliary care and their relatives from the sites in the observations, social care staff from County Council and one in Lincolnshire County Council

Co-design workshops: older people receiving domiciliary care and their relatives from the sites in the observations, and social care staff from Nottinghamshire County Council and Lincolnshire County Council and BelleVie Care

The analysis spreadsheet for which consent to share has been obtained will be shared via the University of Nottingham data archive under a CC-BY license. Any data which is deemed to be personally or commercially sensitive will assessed on a case-by-case basis to determine whether it can be shared. There will be no need to update the data past the project period. All published outputs will contain a Data Availability Statement including the datacite DOI that directs to the relevant data set. Data will be released at the same time as any published outputs underpinned by the data or by one year from the end of the project.

Individual field notes and interview transcript will not be shared due to the small number in one locality to maintain anonymity.