Four Falls, $1,500, and a Board That Says No

Triangulate before spending.

• Primary data: a five-question anonymous member survey (falls in the past year, fear of falling, home hazards, willingness to attend a class); key-informant interviews with ushers and greeters, who see exactly who struggles on the steps, the sexton, the retired PT, and the homebound visitors; review of the parish nurse log for context - time of day, footwear, medications, whether the fall was on church property.
• Secondary data: county BRFSS fall prevalence, EMS or hospital data the coalition will share, Area Agency on Aging materials.
• Asset map: eight volunteers, a PT, the van, the kitchen, the phone tree, and the coalition's free training - all of which change the cost side of every option.

Prioritize with a simple matrix: frequency × severity × feasibility. Ranked that way, the rail and grab bars come first: they are inexpensive (often a few hundred dollars, not thousands), they protect everyone including visitors, the evidence is strong, and they require no sustained attendance. The home-hazard checklist is second because volunteers can deliver it. The exercise class is third and best, but it lives or dies on attendance, so build it on the coalition's free training rather than a paid curriculum and start with the PT's existing relationships.

Ask the trustees for the building changes now, in writing, because that calendar moves slower than anything else you will do.

Outcome: "Within 12 months, self-reported falls among members aged 70 and older will fall by 25% from the baseline of four falls in four months (an annualized rate of about 12), as measured by a quarterly postcard-and-phone check-in and by review of the parish nurse log."

Why it works: it has a numerator, a denominator (the roughly 130 members over 70), a time frame, and a data source that will actually exist. Falls are under-reported, so pair self-report with log review and state that limitation when you report.

Process: "By the end of month three, 60% of members aged 70 and older (about 78 of 130) will have completed the home-hazard checklist with a volunteer or will have explicitly declined, documented on the volunteer tracking sheet."

Why it works: it measures whether the intervention actually reached people, which is the failure mode of most congregational programs. A decline is counted, not hidden, so the number is honest.

A third measure worth adding: at least 70% of exercise-class enrollees attend eight or more of twelve sessions - because an exercise program that people quit has an effect size of zero regardless of its design.

Do not treat "no" as final, and do not fundraise quietly in place of advocacy.

1. Reframe in their language. Trustees manage risk and money. One fall - an ED visit, a fracture, a lawsuit, a liability insurer's question - costs far more than the rail. Bring the actual quote, which is usually smaller than they assume.
2. Bring the right people. Two members who have fallen, the retired PT, and the church's insurer or property chair carry more weight at a board meeting than a nurse's memo. Put the request in writing with dates so it is in the minutes.
3. Find restricted money. Memorial gifts, a men's fellowship project, a cost-share with the county coalition, the trustees' contingency line. Offer options rather than a single demand.
4. Mitigate immediately, in parallel. Greeters at the door, a chair at the top of the steps, a lighting check, temporary signage, and volunteers to assist anyone who needs it. Your duty of care does not pause while fundraising happens.
5. Document. Record the hazard identified, the request made, the date, and the response. If a second member falls, that record matters - for the member's family, for the board, and for you.

Advocacy in a faith community is a lay-leadership process, not a clinical order. The skill is persistence across meetings, not winning the first one.