Project Profile: Standing Strong

A community-led initiative to improve care for our aging population

Community Connection
Why Quail Hollow?
Desired Outcomes
Contact Info

Part of an ongoing effort to improve care coordination between community services and health systems, by creating a communication process between Emergency Medical Services and Primary Care Physicians that will reduce unnecessary Emergency Department visits, this pilot project is aimed at preventing falls-related injuries and death in people over age 65 in our communities and reducing falls related 911 calls.  

Funding Source(s):

  • DH-Population Health
  • Endowment for Health Grant
  • Public Health Council of the Upper Valley (PHC)
  • Lake Sunapee Regional Visiting Nurses Association (LSRVNA)
  • Dartmouth Center for Health & Aging (ACL Grant)

Goals of the intervention:

  • Increase # of Home Safety Visits made by LSRVNA
  • Increase # of seniors connecting with DCHA to participate in falls prevention programs.
  • Reduce # of falls-related 911 calls
  • Reduce # of ED visits or hospitalizations due to falls

Project Lead:
Dartmouth-Hitchcock Population Health is the lead on this collaborative project with Lebanon Police/Emergency/Fire Department, Quail Hollow management, Lake Sunapee Regional Visiting Nurse Association, Falls Prevention team at Dartmouth Centers for Health and Aging, residents at Quail Hollow, and many volunteers.

Co-leads or Co-PIs of the project:
Dawna Pidgeon, Laleh Talebian, Alice Ely, James Culhane, Andrew White

Community Connection

“I was feeling very tired and wobbly, walking like a drunken person. I saw a bench up ahead and decided to sit down and rest. ….. It was for an instant. I saw myself falling to the sidewalk, and when I hit the concrete, my glasses fell off.”

– John J, resident of Quail Hollow

“ 5 years ago, I fell twice with ice and got a concussion one time and a shoulder injury the other time.”

– Bonnie V, 67 years old, resident of Quail Hollow

In late 2016, representatives from a broad spectrum of community and health sectors came together to improve our region’s health and wellbeing. They formed a coalition of coalitions called Healthy Communities Alliance and used community input guided by Community Health Needs Assessments (CHNA’s) to determine top 3 priorities and work together on one priority at a time. The first priority they chose to collaborate on was preventing falls in our aging population. Although this issue did not make it to the top of the list on the CHNA’s, it raised an important issue concerning our region demographics; NH and VT have the 2nd oldest population in the U.S.

Furthermore, more than one third of adults age 65 and older have a fall every year, with one out of five falls causing a serious injury. Many of those injured are disabled and even if they are not injured, become afraid of falling again. Research indicates that people who fall are 2-3 times more likely to fall again, and each fall increases the likelihood of more serious injury or death.


Why Quail Hollow?

Quail Hollow is an independent living complex for seniors located in Lebanon, NH. The management at Quail Hollow is extremely engaged in the satisfaction and wellbeing of the residents and is constantly working to improve the lives of the residents. They all share a common goal; maintaining the residents’ independence and safety in their homes. Therefore, they have taken the lead to initiate a pilot to reduce falls-related 911 calls and falls-related injuries.

“I’ve been trying to improve my balance and I have had a very good PT, but it is only limited to certain aspects couple of times a week. You don’t get a full spectrum of exercises…. So I started to take Tai Chi Quang Movement for Better Balance. I am taking these classes so that I can walk again without worrying about collapsing.”

– Ernie V, 93 years old resident of Quail Hollow

This collaborative pilot project will identify some of the gaps to effective care coordination between providers and community resources. We hope that the preliminary results from this pilot will inform future collaborations and application of this model beyond the town of Lebanon.

Partners and stakeholders of the Healthy Communities Alliance will be able to use lessons learned from this pilot and use this model in their respective communities.

The following graph summarizes the data collected by the Lebanon EMS, demonstrating that a significant number of 911 calls in their service area originate from Quail Hollow. More importantly, a significant number of those calls in the last 2 years were made from The Ridge complex, which is the newest building within the Quail Hollow Complex.

  • Almost all fall transports go to DHMC.
  • Participation rates are low at the all wellness clinics that are offered at Quail Hollow.
  • 55% of calls that DON’T get transported may serve as a target for intervention (one fall is predictive of future falls).
  • It is not clear how the information about a non-transport falls are being communicated to Quail Hollow support organizations and PCP.


  1. Conduct a pilot project to test a Referral Sheet to better coordinate falls reduction & prevention activities.
  2. Test the work flow & the coordination process using the Referral Sheet for a period of 8-12 weeks
  3. Analyze & share the results with the Quail Hollow residents, partners & stakeholders involved in the pilot.

Desired Outcomes

  • Reduce/Remove barriers to aging with dignity and in the community
  • Establish an effective care coordination process between providers and community resources
  • Utilize our online platform to allow for easy & transparent data access & sharing


The immediate goal of this community-led collaboration is to create a more effective care coordination model that will result in reduced # of:

  • falls
  • falls-related 911 calls, ED use, and hospital admission.
  • falls-related injuries and death in our communities’ aging population.

Our ultimate goal is to identify and bridge the gaps that currently exist in care coordination between providers and EMS. We hope to achieve this by developing an effective communication system that results in better faster information sharing, care coordination, and care delivery between providers, EMS team, and community resources.

Contact Information

Joyce Neilsen-Lake Sunapee Region VNA

Dawna Pidgeon- Dartmouth Centers for Health & Aging