What can I do for my father who keeps falling, even while under 24-hour care?

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My 89-year-old dad keeps falling out of bed when he tries to get up to go to the bathroom himself at a skilled nursing facility. The staff have put a bed alarm on him and do all they can to keep him safe, but he keeps falliing. He plans to move to a lower level of care in two weeks, but I don't think its possible because of the constant falls.

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Bedside urinals are great. The bed and chair exit pads with remote alarm isn't quite quick enough for my needs. That 10 second delay can be the difference between home or ER visit. He's on coumadin which makes it that much more dangerous. He forgets to ring the bell he's had for years (dementia). A physical therapist told me about an alarm that alerts immediately as the feet go over the side of the bed and break a laser. His dog would set that off throughout the night. I purchased a belt that goes around his waist for me to hold onto, but find that his sturdy robe belt serves the same purpose. The bathroom scares me the most. We have sturdy grab bars and a sit down tub. I bought a slightly used Hoyer lift that's too difficult to use by myself. I would love a low bed except my dad could never get up unless the bed electronically lifts up. For some reason I can't bring myself to use any type of restraint. I know they're not harmful. It's my issue. Other than falling, I worry that he'll be scared or upset without letting me know (because of dementia & not knowing where he is, etc) 
I recently purchased a seat cushion with a slight slant towards the back of his chair. It's helped to reduce sliding out of his lounge chair. He has the television on too loud at night to effectively listen to him using a baby monitor. I walk behind him when he's up so he doesn't fall backwards (Parkinsons). I've decided to take a break from purchasing items in the hopes of avoiding a fall. I take care of two elderly parents with multiple medical issues as a 24/7 live in caregiver. I always hear that I must take care of myself in order to properly take care of them. It's not always that simple. When I saw the post above advising three full-time caretakers for 8 hour shifts it makes me think about my need for respite care. My parents insist they can stay by themselves because they don't want to spend the money.
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My 86 year old father flails his arms while sleeping. He has begun oxygen treatment. Are they related?
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Does your dad's bed have bars around it? If it does, it might be able to prevent him from gettng up by himself or from falling off the bed. Since he is on high level of care already, is it possible to communicate with the nurses to maybe wake him up at night to go to the washroom so at least when he does so he is under supervision? (Just as when potty-training a child you would wake the child up at night to go to the washroom.) What do you think?
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No restraints are allowed in an ALF. My mom kept getting up at night too, for years. And fell multiple times, even with help, railings and a walker. Now she is in a lower bed but it's too late as she had a stroke and can't get up anymore. I wish I had known about the bed earlier. Also, check the MEDS....my mom was taking something that made her restless and agitated at night and made it worse.
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Sorry you are in such a terrible situation but it sounds like you are going to have to have the care givers put some extra effort into their job and insist they do what they must even if your father doesn't like it. This is for his own safety since falls are at the top of the list for people his age going to the hospital and not coming out. Hopefully you can visit him as much as possible and give him support and love in his advanced age. You have been fortunate to have a father for a lot longer than many of us.
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Gait therapy. Sounds goofy but it has helped both my parents. Their doctor prescribed it for them to see a physical therapist for this. There is one available in hte home that they are in.
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Great posting, Angelhouse...... You are right on target! The smaller facilities where people get better care are punished and it's all about the $$$$$. The rules are all so crazy, I really do wonder if the people that make the rules have ever had a loved one in a facility, large or small. So much of it just doesn't make any common sense.

If I ever bring my mother to SE Florida, I'll be looking you up for sure! Sounds like you're doing a great job for your people!! God Bless!!
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Well there are some answers here that are well meaning but outside my experience with seniors. I have a small ALF in SE Florida; these small group homes have more attention than large ALFs or skilled nursing facilities. We are not allowed to restrain them in any way, and that's what makes it tough with someone like this. For example the bedrails (built onto hospital beds) are not allowed. Yes there are Some cases where they're physically Able and very determined but Quiet about it, where they Might climb Over the full bedrail and more chance of injury. But we also had a woman who could NOT climb over Anything, but could move around in bed to get below the tiny 2-ft long rail we are allowed to have in Assisted living and fell out of bed that way a couple of times. At which point, I referred her out to a bigger ALF with hoyer lift tracks in the ceiling, and they have a way around the regs like an LPN on staff or something. We are all CNAs and/or HHA's in most ALFs.
In fact right now, we have a man who also jumps up out of bed and just fell twice in a week. The first time no biggie but the 2nd time the nightstand cut his head... Then if we move it away, we are out of compliance for what each room must have - nightstand by bed with at least one drawer, can have shelves, doors...
You would think whatever someone can do in their Home, we can do More here, but actually Not - for example insulin injections etc... I've found a lot of times it's about the money for Drs, nurses, insurance companies. And the Big places, of Every kind, have far Fewer staff to Resident ratio and that's Allowed by Law, so it Favors the big places and Punishes small ones that already do a better job in many ways for those not needing skilled nursing care.
Nursing facilities simply medicate them so they stay in bed at night. I give a couple of melatonin/Valerian/Chamomile tabs at bedtime, and if they like tea, I give chamomile tea to relax after dinner. Also, keeping them well hydrated through the day and not giving liquids after dinner can help (unless they specifically ask)

You may want to consider a Urologist consult b/c if he's doing the typical elderly man thing, that's a few drops each time, maybe a tablespoon and not worth getting out of bed for but they Feel it as if it's a full 'event' they need to rush to the bathroom for. So maybe the Dr can give him something (increase flomax if there are not contraindications) to help him go More and Empty the bladder, that then coupled with mild herbal sleep aids & Technology*, he can sleep sounder for a few hours instead of tryng to get up every half hour to hour like our guy does.
The Technology is Amazing - one of those radios by the bed that plays Sounds, like surf, rain, crickets & other soothing natural sounds. I find I sleep much sounder and wake more refreshed when I use mine, and it's given great results with a few clients.
If I find out anything else as we go through this with our resident, I will let you know.
Doreen,
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As I said before Ann, Whew!

And you are doing a fantastic job. I probably would know some of these things from reading other posts, but I'm afraid I'm not very good at keeping people who post straight until I've interacted with them a few times. Sorry.

Hugs to your husband. He certainly deserves to be well. I hope the treatment plan is a success.

It sounds like you are doing a good job of learning to set boundaries. (Not easy for many of us.) I understand that the sons have to have peace in their homes, but it is too bad that turns you into the bad guy. Hang in there!

Some very fine people have fallen into the prescription drug trap. I sincerely hope your friend can get some help, without damage to her relationships in the process. Given your situation, it may be enough for you to refuse to enable her -- taking on a more direct intervention may be more than you should try to handle right now. When other aspects of your situation improve/conclude/change, then perhaps you can direct some of your energy toward her situation.

Don't let anybody tell you that any of this is your fault, or that you somehow should be doing a better job. I don't think that is what Ruth was doing, but I understand your defensiveness. Some people really do imply that, and you are right to reject such implications.
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Is his medicine making him dizzy or unstable? Sounds like I would check on that. does he have a walker or cane close by? Is there a rail near his bed to hold onto? Are there rails on the bed of some sort? Can he ring a bell so someone will come and help him? Just brainstorming here.
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