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Mom is 96 and is a right side leaner she has fallen 5 times in 90 days out the bed that’s as low as it can go to the floor. She’s gone to the ER twice with a scare on her forehead but no broken bones (yet).


The Nursing Home says they can’t put up bed rails I’ve asked about cushions bedside on the floor to ease the fall but they said they can’t do that either because it’s against the law. Each time she falls there no way of knowing how long she’s been lying on the cold floor. She’s always be high tolerance for pain and she can’t tell them if she’s hurt.


My fear is that they don’t see any thing wrong external but there will be something internal if she keeps falling on that hard cold floor.


Any suggestions on what they can do?

Have Hospice come in and assess her. My mom has Hospice and she is not near death. She is in Memory Care. She has a hospital bed pushed up against the wall. It has a rail that is put up at night. She cant roll out but if she sat up she would be able to get out of bed. Hospice also has a floor mat that is put down when she goes to bed at night. Also they have an alarm on the bed that goes off when she tries to sit up. Hospice is wonderful!!
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Reply to evander09
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DrBenshir Mar 2, 2021
Any SNF should be able to provide the same things. Saying they can't legally is fishy. Do you have medical POA? If soyou might have to ask for these things in writing, because Mom may have refused them.
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I can’t believe they can’t put a "fall mat " on the floor. Another option since she sleeps on the right side is to put the right side of the bed next to the wall, lower the bed and place a fall mat on the floor. Do they want to be liable for her injuries? Talk to the head nurse about this.
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Reply to Harpcat
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If allowed, placing a pool noodle under the fitted sheet near the edge of the mattress might help. Keeps my toddler grandchildren in the bed!
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Reply to Patrice2
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Most states have gone the direction of assuming that falls will happen instead of assigning blame for falls. However, most facilities have "fall risk" protocols for the clients most at risk of falls. Most fall protocols include: beds in the lowest position possible (some are almost on the floor), mats (similar to gym mats) on sides of beds, no side rails, call bell within reach, frequent checks by staff... Ask the NH for a copy of their "fall risk:" protocol. If she appears to be falling too much, you may want to consider another place since her facility may not have enough staff to monitor her frequently,
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Reply to Taarna
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There are wedges that can be used to make it more difficult to roll to one side or the other. Sometimes 2 wedges are used to keep someone in a particular position.
The bed should be lowered all the way down so it is less apt to cause an injury if the person rolls out of bed.
Bed rails are not permitted as they are considered a restraint or confinement.
Some facilities will use bed alarms or alarms on the floor that will indicate when a person has gotten out of bed. But the bed alarms can be disruptive.
As far as I know mattress on the floor by the bed is not illegal. You might want to ask to see the facilities policy on that. They should have a book that outlines general practices. You could also contact your States Ombudsman and ask what the regulations are in your particular state. (you might even get that with a Google search)
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Reply to Grandma1954
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My Mom spent her last 5 years in a county nursing home (sundowner's syndrome- a form of dementia). They lowered the bed, put a foam rubber long matte on the floor, and also put alarm for the bed, so every time she got up, it would beep. At times it was annoying, and since I was there visiting her, would shut it off, making sure to put it back on when I left. Later, when she was in the hospital, they also made sure the bars of bed were up when she slept. So can't understand why they said it's against the law. Check it out, and speak to the administrator of the nursing home.
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Waterspirit Mar 2, 2021
More severe falls occur from bed rails being up. We've spent all of our lives in beds without them, so the instinct is for people to try to go over them. Rarely do they try to scoot to the bottom of the bed to bypass the rails. That's why physical restraints are now outlawed. There are reports of patients actually hanging themselves in their attempts just to get out of bed. Many years ago, I had a patient in locked LEATHER restraints. One night he heard my colleague shout for help (her patient had clamped his teeth on her arm). The other got out of bed, dragging the locked leathers, with the broken glass IV bottles and tubing into the room she was stuck in. "Here, X, you need these" he said!!
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States do not allow rails or retraints anywhere due to strangulation risk. You might want to push the bed against the wall and purchase some of those extra long body pillows. The bed should be as low as possible. If the home allows and it is not a trip risk, you might be able to use some floor padding
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Reply to MACinCT
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A burrito mattress, is I think what you want. My mil had one while in NH for on respite. It is deeper in middle and sides higher. Bed low as possible and then put a mat next to open side, other open side was against wall. When at home I had the top rails and also bottom rails for her bed. And used swimming pool noodles on the rails for comfort. For a 75 pound woman who is bedridden she could sure rollaround, and potentially hurt herself, without all the preventatives in place.
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Someone’s suggested pool noodles as side bolsters. There’s a YouTube video available to demonstrate this. Google “pool noodles help prevent senior bed falls” and several articles/videos show up. Thought this was a good idea for toddlers prone to falling from bed, too.

My dad used a low-rise bed with foam mats on the floor when he was in re-hab to prevent injuries if he tried to get out of bed. He was very disoriented when he first arrived there and I noticed he tried to put his finger in the electrical socket on the wall his bed was up against (outlet was mid-way up wall, not down near floor). Re-hab assistants immediately helped to re-position bed against a wall without a socket! Mentioning this because electrical shock or electrocution from outlet high on wall beside a senior or toddler bed can be a hazard!
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Invisible Mar 2, 2021
I used pool noodles to prevent cat from falling off the vanity where he likes to sleep during a time when he was groggy from medicine.
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[mutter mutter grumble rhubarb lazy buggers..]

They can put up bed rails. But it is a faff because it involves a great deal of paperwork and training, plus if they do this for your mother they'll have fifteen other families all asking for the same - including some families for whose elders bed rails will not be at all suitable, and then there'll be war.

So they just shrug and say sorry it's the law. And it is the law. But it's only PART of the law. There are other equally important parts that explain when bed rails can be used and how this must be authorised, monitored and documented.

If you Google something like "how to apply for use of bed rails in [your state]" you might get some useful information.
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disgustedtoo Mar 2, 2021
https://nursinghome411.org/wp-content/uploads/2018/04/LTCCC-Factsheet-Bed-Rails-1.pdf

This gives some Medicare guidance on what NHs must do before resorting to rails, and reasoning behind Medicare's statement "CMS’s Interpretative Guidance adds that falls do not constitute a medical symptom that would necessitate bed rail use:"

There may be additional state laws or guidance, but in order to stay in good stead with Medicare (to be approved AND get paid), they have to follow CMS guidelines.
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