My 91 year old Dad has vascular dementia and lives in the Memory Unit of his AL facility. He fell and broke his hip and shoulder. He had surgery to repair the hip fracture last Tuesday; then was discharged to a skilled nursing rehab facility. I accepted the best rated facility I could research that would accept his insurance plan. The care coordinator assured me the facility was very good with dementia patients.

When we moved him to the rehab facility, I was concerned that there were no bed alarms. (I understand the "no rails/restraints" issue). Their approach is the lower the beds to the floor, so if anyone falls, it's a short distance.

Dad doesn't understand the concept of the "nurse call" button and he can't remember that he just had hip surgery. If he wants to get up out of bed, he's going to try. The admission nurse said that if I was concerned, I should hire someone to sit with him 24/7. Is that the only alternative?

This morning I got a call from the rehab facility that he had fallen trying to get out of bed. They took him to the ER to get checked out. His xray and scans were all normal, so he survived this fall.

I've researched other facilities and they have similar policies. Apparently, this is the acceptable "standard of care".

The ortho doctor who did his surgery said there is a good chance that Dad could regain most of his strength and mobility if he can get through rehab. I'm hoping there are other facilities that have a better plan. I understand there's no place that is "fall-proof", and that falls have happened with nurses/assistants standing right next to them.

I hope he can survive rehab.

If they have true hi-low beds they really do lower right to the floor making it pretty much impossible for someone to get up without help or to fall more than a few inches. The problem with restraints is that people with poor cognitive function will fight them, climbing over a full rail would cause a much greater injury.
Helpful Answer (6)
Reply to cwillie

I hate to say this but.....
With dementia of any kind participation in rehab is VERY difficult and the chance for a recovery is slim.
There is
1. The fear of falling again that will make him resist rehab.
2. Not having a grasp of what is trying to be done and following instructions.
I do hope the people doing the rehab are well versed in doing rehab on/with people with dementia. Very different doing rehab with a 50 year old with a broken hip or a hip replacement and a person with dementia and a broken hip.

At this point maybe the very best thing for you to do would be have an evaluation for Hospice done. If he is not compliant with rehab Hospice will help immensely for pain and symptom management.
If he is compliant it is still very possible that he would be eligible for Hospice and they will help you with supplies and equipment that he may/will need.
Sorry to be a "downer" on this but dementia and broken hips do not go well together. Not even mentioning the broken shoulder.
Best thoughts to you and your dad.
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Reply to Grandma1954
Linkabit14 Apr 4, 2019
That's exactly what the admitting nurse suggested to me today, although I want him to give rehab a try for a few weeks. He has no fear of falling, because he can't remember that he just fell. and he's determined to stand up and walk. If he could channel this properly during his therapy and exercise sessions, he'd probably be back in the AL facility in a few weeks. At the hospital, he followed the PT's instructions while she was there, but of course forgot all the instructions as soon as she left.

Thanks for the advice. I hate it, but it's probably near future.
I just went thru the same thing with mom. No side rails is crazy. What ever group of idiots made that rule needs to fall out of bed and break their hip
Helpful Answer (6)
Reply to slr002
MAYDAY Apr 12, 2019
If you put rails up without a "prescription" I was told, that you are basically "caging" the patient, holding them against their will....

That was the reason I was given for NO RAILS....

Really? but it's okay they roll over and hit whatever is in the direct path to the floor...which is usually not carpeted.
Grandma is pretty much the same way. She can't use the call button. She will try to get out of bed to go use the restroom. IVs are a disaster, she will pull them out. I warn them of this but they insist on having them even if she doesn't need it. They want it in just in case they need to push something. After the third or fourth time she pulls it out they wrap her entire arm so that she looks like a mummy.

Unfortunately this is the "standard of care". They are not allowed to restrain him. That's deprivation of liberty. Although they did this once to my grandma in the ER. They have a device for it. It's something they attach around the torso and then it's leashed to the bed. In that case though, I think the nurse did it more for his own convenience than for her safety. I had another problem with that nurse since he claimed to be too busy to help grandma with a bedpan yet had more than enough time to be chatting in the hall. His response when I asked was "She has a diaper on." Let's say he and I didn't end up on good terms.

All the other times I asked for both bedrails to be up, they told me they couldn't because it was illegal.

A bed alarm is no real solution either. Many times when that goes off they don't show up for minutes. A rehab or nursing home has even less staff. By the time they get there, they will already be on the floor.

As other posters have pointed out, even with professionals in the room, they can fall. That's why it's a pet peeve of mine when people say someone needs to be watched 24/7 to prevent falls. IMO, there is no preventing falls. You can reduce it but you can't prevent it. They can't even do it in a professional facility. Falls are common in rehab or nursing homes. Why do people expect someone miraculously to be able to do it at home? The people that say that have no idea what they are talking about. Generally it comes from people that no experience.
Helpful Answer (5)
Reply to needtowashhair

Thanks for the thoughtful answers everyone. Dad returned to his rehab facility this afternoon, but it was a tough week. The complications have started already. While he was at the ER, they noted an abnormality in his EKG that caused him to be admitted to the cardiac floor to make sure he wasn't about to have a heart attack. That problem resolved, and we were supposed to move him back to rehab on Wednesday morning. When I got to the hospital, they told me that his white cell counts were up and they were suspecting a urinary tract infection, and his lungs were congested. UTI test was positive, so they started antibiotics and decided to keep him another night. Today his counts were all good, so he rode the ambulance again back to the rehab center.

I've seen a cognitive decline in him; he can't speak as well, and speaks rapid-fire like he an auctioneer. I can only get 20% of what he says. He doesn't remember he's hurt and he wants to move around, so it's only a matter of time before the next fall and we're back on the hospital merry-go-round again.

I got him moved to an "Alzheimer's bed" for the rehab place that lowers almost to the floor with padded mats around it, so that if he falls out, it would not be far. It will also be difficult for him to attempt to stand if he's that close to floor level, so he should be OK when he's in bed at night. During the day, I'm hiring sitters to stay with him to keep him from getting out of bed or his chair without help. I met the first one tonight and she is wonderful.

Thanks everyone again for all your thoughtful comments.
Helpful Answer (5)
Reply to Linkabit14
97yroldmom Apr 4, 2019
It sounds like you’ve done another great job. Thanks for keeping us updated. I hope you can get some rest.
I agree 1,000% with MAYDAY suggestions!!. **No one can watch another 24/7 - (I tried; unrealistic for the long haul!) especially if patient "thinks" they can get up, walk, toilet them-
selves and is just uncooperative due to dementia or old age**
I found a licensed, 6-person board & care, private home "15 mins" thing I did for parents, me & my marriage. You're always the "advocate"; observe / oversee
(in partnership with facilty owner & caregivers) seek the best care for your loved ones; it is a process - For me, I choose to show up unannounced during visiting hours (10am-7pm), different
days & times to observe what's happening. I "openly" check for bruises, injuries, issues & ask parents if they are in any pain while putting lotion on their arms/ hands/legs/feet. I attend 1 meal daily (my mom must be fed; it's our bonding time) or every other day so I see food types, quality & amounts being served. I pass on occasion from feeding mom to observe how various caregivers feed my mom; I offer tips or show them better ways. Overall, every-
one's intent at facility is very good ...Yet, I don't believe in just blindly accepting practices / methods that don't make sense to me (as a novice or not) I ask questions!! We each have a brain; research online & learn) In any industry, it's human nature to become compla-
cent, but my job as an advocate is to be alert & bring attention to the facility owner if best practices are lacking for my parents & other guests in home -Note: must be done with a humble heart, spirit & tone! I have challenged Hospice management regarding practices that made no sense to me; after calm discussion using fact-based reasoning, we found agreeable practices that board & care iwner / caregivers would and could
implement. (Often board & care owners get stuck "between" laws they MUST follow, the hospice directives, and family member wishes - "It takes a village" of cooperation & good will. As an advocate; important to create the atmosphere of Win-Win-Win
(Patient/Family - Board/Care Facility - Hospice/Med team of doctors). I appreciate ALL they do; I am so grateful as I cannot do this alone (I earnestly tried and I was ineffective, destructive to my own health, body, marriage & finances)
Pray, Ask for & Get Help, Take Action; don't over think, Don't be afraid, Have courage. Good luck.
Helpful Answer (4)
Reply to YukiBob

Here’s what I’ve learned from Moms past falls. If he’s to be at his current facility for a while I would ask for a wider bed they use for very heavy people. It’s harder to get out of. Mom got one and she’s only 95 lbs. Also ask for a visually impaired call button. Moms is a flat disk about 4” across, and we place it by her legs so that if she swings her legs over to try to get up, and they hit it, it will activate the call bell. Also elevating the head and foot of the bed just a tad creates a small well at their bum that’s harder to climb out of. We roll up extra blankets and put them under the fitted sheet along both edges of the bed. (This is tippytoeing around the restraint issue, so it’s not written down anywhere). Make sure there is nothing he could hit his head on near the bed if he fell. Move the rolling tables, walker, wheelchair etc to the foot of the bed when he’s in bed. Pad with foam any sharp corners like a/c unit. Make sure the bed is lowered to the floor and the pads are down on both side. She still sometimes has managed to roll out but hasn’t gotten seriously hurt since we’ve done all theses things. Good luck, falls are a constant struggle.
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Reply to rocketjcat

If you can get his doctor to write an order for restraints or alarms, there is an arduous approval process that would allow them to be used ( I'm told).

Can dad understand and cooperate with PT and OT instructions?

We were in a similar situation with my mom. We did hire a full time sitter. Mom fell with the sitter in the room; in fact there were TWO aides in the room . ( I'm told this happens frequently).

This fall broke mom's hip which immobilized her, and rehabbed well. She then lived in her NH for another 4 1/2 years.

I'm sorry you are in such a difficult and painful situation. I remember the angst all too well. ((((Hugs)))))))
Helpful Answer (3)
Reply to BarbBrooklyn

Oh no. Linkabit
i am so so sorry. Unfortunately it does seem to be very common, this level of care in rehabs. And yes, sitters (who are well named) are about all you can do. My understanding is that they call the staff if the patient needs something. They don’t actually help the patient.
Does his hospital have a rehab that you can get him in?
You might be able to get hospice to provide an additional layer of care. I’m not sure that he could get hospice and rehab. Probably not. Talk to the doctor.
I know you will make the best decision for your dear dad. I’m sorry you are in this position I hope your dad’s pain is being controlled.
Helpful Answer (2)
Reply to 97yroldmom
needtowashhair Apr 2, 2019
The sitters in my hospital are "candy stripers". They are volunteers, very young, have little to no training and are in no position to render any help. They are baby sitters. They are there to call for help and not to render it. How long that help takes to arrive can be seconds or minutes. Sometimes they are slammed. There isn't a nurse for every patient. It can take time.
You’re correct, this is the acceptable standard of care. It’s because of laws that have been passed, the NH has no choice but to follow them. I remember back in the 70’s as a younge kid going to visit my grandad in a nursing home. Everyone was restrained in their wheel chairs & they couldn’t hardly move. Evidently the laws have swung so far to keep that from happening nowadays that there is no common sense being used.
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Reply to mollymoose

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