A NH was recommended for my mom, as she's a fall risk. Why?

I wonder the same, I was told skilled nursing care has staff with actual medical credentials that check in on patients vs assisted living, where staff do not have to be certified and fall along the lines of home health aides. Maybe if you’re not ready you can see about in home health aide or in home skilled nursing care? I believe this website can provide you a list of in home skilled nursing care agencies. If they are saying it’s medically necessary it may even be covered with insurance. A home health aide can also stay with her depending on how many hours she can get approved for but it sounds like the fear is not having someone always around, falling can cause serious complications or progression with the disease.

I have not read all the answers here, but I will tell you that an elderly man teying to lift dead weight is a recipe for disaster for both the lifter and liftee. I know. My dad’s back was permanently injured by trying to care for my mom who had dementia. Once she reached a certain level, she was no longer able to ambulate well or get herself out of the bathtub (this was where Dad really really hurt his back - and that was it for Dad being able to help). Get your mom the care she deserves, and let your Dad stay healthy. I cared for my dad after Mom passed in the last 4 years of his life. Mentally he was ‘00%, but physically, nope. I am a petite 5’4“ woman and had to lift my dad off the floor at least 3 times. By then, his physical strength was gone, and he, too, ws dead weight. While I am relatively strong, it took everything I had to lift him. Please be realistic in what is and isn’t possible.

I have my wife in a very good memory care unit. They provide her with so much that she would not get at home. Her day starts with someone getting her up, properly dressed, and to breakfast. Between meals they have planned activities that entertain and/or stimulate their minds. There really is something scheduled from 8AM until 8PM each day. The problem comes with those who do not or will not participate in things. They play bingo, balloon toss games, coloring, crafts, music, karaoke, anything to keep them stimulated and active. In the last year I have seen very little loss of her mental faculties. Her verbal skills have declined and I suspect that is just not remembering the words she wants to say. Yes, she has fallen, as most of them do, but there was help on site to get her up and evaluate for any damage. They administer her medications, and at times she makes it difficult for them. I visit nearly every day, and she is with family two nights each week for dinner. Sundays she still goes to church with me, and she does love to sing. Our lives are not what I would wish for, but they are the best we can manage with what we still have left. Life is not the same when you are in your 90s, but it can still be enjoyable and productive. Worst case, we can at least be examples of how to deal with memory loss and all the related challenges. I promised to care for her "until death do us part" at our marriage, and I will keep my promise. Actually, maybe the extra challenges are keeping me young at 92. When God closes one door, he opens another so just bloom where you are planted and keep moving. Life is good, well as good as you make it. I plan to enjoy whatever I can as long as I can.

Birdee,
I think after all the responses, and some few of your own, it's clear Dad isn't capable of caring for Mom in home and you aren't there yet to do so. Your mom's falls are almost certainly the least of it, because as AMZeb and others point out, falls will happen no matter where mom is. They are a matter of balance and your just hoping that a serious injury, which is often the beginning of the end, doesn't happen.

I would suggest placing your mom in care; her needs can't be met in the home by your father. You suggest this is his "choice". I think it is more than likely a matter of his age and ability.

I wish you, whatever choices are made here, the best of luck. No one WANTS what happens at end of life. But there's really no way to avoid the truth of the needs and our abilities to fulfill them.

Most post are correct with the fact that falls occur even in nursing homes. I suspect your mothers doctor feels that your father is unable to adequetely care for your mother and is suggesting the NH setting. Have there been numerous falls that require a assisted lift from the EMT's? Has she sustained major injuries from a fall?

If their income allows the hiring of aides then I would encourage the home setting if you feel that is what is best for parents. Never use your own income that jepordizes your retirement and long term care goals.

Are they utilizing a medical alert device? One risk is your mother with dementia will not remember or realize she needs to use it if she does fall and your father will need to press the button. Is your father suffering from health issues or dementia of his own.

Maybe now is the opportunity to look into a facility with increased levels of care? Also, highly suggest meeting with an elderly care attorney with your parents to protect the assets is one should go into a NH.

Best of luck. Discussions are hard but necessary.

Why worry what Dad thinks if he isn't willing to take her to the toilet? Private aides can do that and help prepare the meals, take out trash, find the tv channel etc. You shouldn't leave Mom alone with Dad if he is unable to care for her.

It sounds like your mom should not be at home, if alone without a caregiver with her 24/7, as you say she has a memory span of about 15 seconds.

In my experience, NH do not provide 100% attention 100% of the time to every person. They cannot do that.

You need to talk to facility administrator and dept managers to ask how they monitor residents in a memory care unit.

If you feel it is needed, you can supplement by paying for a caregiver to be with her some of the time. 24/7 home caregivers cost around 10k a month, depending on where you live (if overnight care is needed).

I don't understand if your mom is now home alone with your dad - when she seems to have severe or advanced memory issues. Although I do not know the full picture.

It doesn't sound like a safe situation for her - or your dad.
What would your dad do if she fell and couldn't get up?
Could he call 911?
Do they both have a 911 'watch' on or a button around their neck in case of an emergency? Could / would they be able to press the button if they fell down?

I do not know what you mean by creative solutions -
someone needs to be there with her or she may fall.
Have you called caregiver agencies and asked them what services they provide?

Does your mom walk - okay ? in a wheelchair ? on medication ?

I recall one of my clients in a MC unit was checked on throughout the night every few hours. And, yes, people do fall. Restraints on a bed are not legal - except for what they [may] call 1/4 restraints (very short) - there are very clear laws about restraining a person - memory issues or not (doesn't make sense to me if a way to protect a person although it is considered abuse.

Ask administrator about for more information.

My friend either fell out of bed or tried to get out of bed (forgetting that he couldn't stand up / walk. I bought him a 'body pillow' which made it very difficult, if not impossible, for him to re-move it if he tried to get out of bed / fall. It worked very well. He never fell out of bed again.

The only thing the facility could do was place a very thin mat (like an inch thick) on the floor next to his bed ... presumably to cushion a potential fall. That wouldn't do any good although it seems like all they (could) do in a NH.

Gena / Touch Matters

Falls will happen anywhere , however ,
my stubborn mother in law just died last week because she was living at home without any help . She lived with her partner who has advanced dementia . The whole situation was a train wreck .

Had she either hired help at home or been living in assisted living and allowed someone to help her in and out of the shower she may be alive now . She was frequently falling in the shower , the last one resulted in a fractured pelvis . Then she sat for days in bed refusing to go to the hospital , resulting in a decubitus on her butt that eventually killed her , while in rehab .

MIL had been having frequent falls especially on her sidewalk steps outside her condo. We kept telling her she would be safer in assisted living . Even though all falls can not be prevented , she would have had staff to respond to her falls and have her treated for same .

We also found my grandmother on the floor in her apartment , dehydrated after being on the floor for days alone after a fall .

Many elders are not willing to wear the “ fall button “ to call for help either , or take them off and forget to put them back around their neck or wrist .

Perhaps providers are seeing that this is too difficult for your Dad to handle any longer .

Doctors are trying to tell you that it is not safe for your loved ones to be alone. They need mentally and physically competent people with them 24/7/365. If you are willing to either live with your loved ones or have them live with you AND provide competent substitute helpers to watch them when you are not with them, then they can stay safely with you. If you are unable to provide round the clock care, then they need to be somewhere that this is available - skilled nursing facility or memory care.

Birdee,

You stated, "My dad doesn't go anywhere all day, and is fully capable of taking her to the loo... he just doesn't want the responsibility."

Then why on earth would you want to leave your mum with a man who doesn't want to look after her?

Your previous posts have said about your parents not getting on and how difficult they are. Why would you want to go and live with them, giving up your own life in the process?

Your mum needs more help than you are equipped to provide. Skilled nursing care means that your mum's increasing health needs will be met. She's not going to improve or get better.

Please be sensible, for both your sake and hers.

Falls WILL happen. That is a fact of life.
Generally Skilled Nursing is for people that have medical needs that require the care of skilled medical personnel.
Skilled Nursing is also for people that fall outside the spectrum of care for Memory Care or Assisted Living. So people that need equipment for transfers, people with "tubes". Most MC or AL can not legally use equipment and do not have staff that can care for "tubes"
If your mom is "simply" a fall risk she does not need the specialized care of Skilled Nursing. Because of the dementia she would benefit with care from Memory Care. these are typically locked so there is less of a risk that she would get out and leave the property on her own.
But just know most likely she will fall. You have to prepare for that and make decisions as to what course of action you will take when that happens.

There are smaller Group Homes that might be a possibility. That would be more of a "home like" setting.
The other option would be a Caregiver that comes in daily to help dad care for mom. If he does not need 24/7 help then the caregiver could be the hours that are needed. (I had caregivers come in during the day so I could get out and do things but I was perfectly able to do what needed to be done when they were not there. So I had caregivers from 9 AM until 4 PM Monday through Friday. When the caregivers arrived I had already gotten him up, showered, changed and he had breakfast. I could get him dinner, changed and into bed myself with the use of either a Sit to Stand or a Hoyer Lift. And Hospice staff, the Nurse, CNA and any others would come when I was there.

Not speaking for everyone, but my wife became a fall risk at home, and she moved into a memory care unit. Guess what, she falls there just the same. Doctors told me to make her use her walker, but? does that mean 24/7 eyes on care? Falling seems to be a part of her memory problem. Apparently balance is impaired when they have other loss of memory issues. Actually, she is probably safer at home, as she can lean on furniture, walls, tables etc when she is moving about. Big problem at home is it can be very hard for a 92 year old man to get her back on her feet. Worse yet, she would go to the bathroom, fall somewhere along the way, and crawl up to my side of the bed and wake me. It was affecting my sleep to have to get up every time she did and make sure she did not get in trouble. One night, she was missing and I found her sitting behind the wheel in our car. Good thing she does not have keys. This was solved by installing a key only deadbolt lock. Memory care units do an excellent job keeping them safe. Hard to break out, no cleaners, pills, sharp utensils or tools laying around to mess with. When one of them does fall, they have the help to get them back up, and take appropriate care in case of any injury. It would help if they had thick carpeted floors, but that would be a major problem to keep clean. The bad news, this care costs us, all out of pocket, $6800 per month. I do not know of anyplace that will give help paying this. It is not covered under our normal medical insurance, or medicare.

She will still be at risk for falling anywhere, however, in a skilled nursing facility, a trained medical professional can immediately respond and treat her if she is hurt.

They may also require residents to use a wheelchair to get around, although they can't watch her every second, and she may still try to walk and fall down.

You ask how they can give her "eyes on" care any better than you - You don't live with her. A SNF is staffed 24 hours a day with people whose sole job is to keep an eye on patients. And while no one can prevent a person from falling, the care facility will have preventive measures in place, such as requiring mobility aids, grab bars along the walls, and CNA's to take the arm of an elder or quickly whisk them into a wheelchair.

If you would like to keep your parents in their home for now, you should provide a wheelchair, scooter, or walker for your mother. Remove all trip hazards in the home; Rugs, cords, unnecessary furnishings that are in the way,...
And try to find in-home care until you can move in.

I am all for keeping them home with loved ones and the environment they know. Patients can fall anywhere. At some point maybe you will need to place the patient, but until then, you can keep the walkers & help handy. there is also a fair amount of equipment available. iethe bedside commode, bedrails. If your using a agency, you always look for additional caretakers via various websites. ie care.com. A family member or good friend,( that is willing )can also be trained to help and care for your parents.
You can also place cammeras in rooms, some you can hear and talk through, when viewing your parent or loved one. And of course a emergency button on thier writst or necklace, in case they do fall.

My husband is in memory care now. Before that I was his sole caregiver, as I have been to 3 other family members.

"I am struggling to figure out how someplace filled with people can give her 100% of the time eyes on care any better than I can and keep her from falling."
At MC, there is a team of caregivers 24/7. They are trained professionals whose training includes working as a team and understanding the psychology of their residents. They have seen it all before, and their experience is evident every time I visit, which is almost every day, You cannot provide that. Also, when hospice gets involved, that's a whole 'nother group with eyes on. It's free and helpful. Also at my H's MC, other wives and grown children interact with him when I'm not there. They call an aide if he needs help, as I do for their loved ones, or they hand them their spoon if they seemed confused about what it is (it happens). Socially it is wonderful for all of our Hs. They have friends and look forward to being with their group, none of whom can really talk but they've developed their own sign language, which is amazing. They are not isolated in a home with an exhausted caregiver.

"She is beginning to need help dressing and bathing, and can toilet herself but isn't able to stand safely without falling."
This is the beginning of a long downward spiral. Today is probably the best day she will ever have again. Dressing and bathing don't seem difficult to you yet. Maybe you can dress her in less than a half hour? With my husband, it could take an hour and a half by the time he went to memory care. He'd insist on putting on clothes himself, backward, upside-down, or not wear clothes, or refuse help or scream or babble I know not what. He'd remove his clothes and put both legs in one leg of his shorts, then not understand how to get out and become hostile toward me for trying to help. Baths? He wouldn't step up over the sill or out. Try that with a dementia elder who screams because the water hurts (it doesn't, but that's their perception). No matter how much explaining (gotta keep clean, it's just warm water, you have to get out because I can't stand here any longer), they cannot understand because each time it's a new experience, and in their mind, they've never done it before. A shower could take an hour or more, or maybe only ten minutes if he'd immediately sit down in the shower chair and let me wash him. Toileting becomes a nightmare when they purposely pee anywhere several times a day even when wearing a Depends. Standing safely without falling won't improve now. The only way she can be kept from falling is to strap her in a wheelchair, but sometimes they can unfasten themselves, so you need an attendant beside her to refasten the buckle. And leg muscles atrophy, so once in a chair, walking skills are lost.

These are the harsh realities. I've spared you some of the worst. My husband is the sweetest, kindest and most gentle man on the planet. Nothing indicated that he would ever become how he is now, but dementia is destroying his brain cell by cell.

I cared for my parents at home with caregiver help. I strongly advise you not to do that to yourself! You have enough to learn and understand so you can advocate for mom. You need to be planning ahead rather than for today. Be mom's daughter and best friend, but don't take her into your home. I will never allow my own daughter to become my caregiver. Never.

My MIL was moved to an ALF a solid year after she really needed to be moved. She lived alone with the 'kids' (ages 75, 73 and 69) taking 24 hr shifts with her.

Even tho they were RIGHT THERE all the time, she still fell. All the time.

They had made that awful promise to her that they would never place her.

It was a horrible, horrible 14 months. Finally she was so bad that they really had no choice. When they placed her in a beautiful ALF, she thought she was home, and that she's BEEN in an ALF for the previous 15 months. Upon arriving at the ALF, she was re-dxed as being waaay worse than initially thought and we were planning to move her to the MC unit on site. She fell several times in the ALF, even though one of the kids was with her the entire time. Having people on site made it so when she fell, she immediately had help.

She died one week after she moved into the ALF.

The 'kids' learned a really valuable lesson, although it was far too late. She should have moved right from the hospital (there after a bad fall) to ALF. She never even knew she was home.

All 3 kids were burned out and emotionally drained. My DH has not been the same since that experience.

At one point, of course he thought he should bring her here, to our house. I was pretty firm about that: he brings her here and I move out. Period. He thought I was horrible and selfish, but I pointed out to him that neither of his sibs were offering to house her. Didn't matter, he's still mad at me for being such a princess. (Joke is that I am far from a 'princess'--)

Think long and hard before you make the committment to bring mom to your home. It can work, but I've been on this forum long enough to know it usually ends in misery.

Birdee,

I think you know what is the right for you to do. My parents lived in a two story house and my dad was blind. They lived across the country from me. They had no close relatives or neighbors. We tried in home care. It's hard to find and expensive. When caregivers cancel, who comes?
My dad finally fell and he went into the hospital. My mom had dementia. She would wander, ring the neighbors doorbell at night, she thought people were following her. It was a mess. When my dad went into the hospital, they asked could he be sent home. The answer was no. My mom could not care for him or herself.
They went into SNC. My mom needed 24/7 care. My dad did too. My mom never adjusted. My dad did. My mom passed last year. My dad is still going strong.
I think my dad was thankful that they found a new safe home. Yes it was an adjustment but it was needed.
Please just listen to the voice you already hear. It may not be perfect, but it is needed and you are not supposed to give up your life for theirs.
I so wish you the best. This is a great site. People care and they understand.

Doctors recommend this due to their own insurance and neglect . Do what you feel best is for yourself and your parents .

I agree with the comments posted here of not moving in with your parents, I suspect it will be way more than you want to take on.
Ultimately, LTC may be the answer, but there could be a few remaining options if you haven’t already tried these:
1. Have your mom (and dad?) evaluated for home health care. Both physical therapy and occupational therapy might help with fall risk reduction and improving cognitive performance. They need to stay functionally mobile for as long as possible, and gentle daily exercise is crucial. Even a senior Tai Chi class would be excellent.

2. You might want to consider a nutritional consultation with a licensed nutritionist specializing in dementia care. This may be an out-of-pocket expense, so financial resources may be an issue, but gut health (the “microbiome”) is directly tied to brain health. This has been demonstrated in numerous studies.

3. On that same note of out of pocket expense, a consult with an Integrative Medicine doctor might be able to provide you with important strategies to help with the current situation. If you can’t afford one, look up the work of Dr. Dale Bredison. He has a book called “Reversing Alzheimer’s” ( I think that’s the name).

There is A LOT of science emerging in Longevity and “Anti-aging”, and research is now starting to show slowing or reversal of dementia related symptoms through lifestyle interventions is quite possible.

My mom is 97 with severe dementia and immobility, and she does live in a home now. But I wish I had known more about Longevity Science 15 years ago when she was first diagnosed, I think things could’ve been done then to improve her quality of life earlier on when she could still live on her own. But I’m learning now(just attended a medical conference on this stuff), and many of us with parents with dementia will have risk factors ourselves.
Right now there are 55million people in the US with dementia, and 10 million more are diagnosed each year. We can embrace lifestyle factors of exercise, nutrition, sleep, community, spirituality, and stress reduction to enhance our own wellness to prevent chronic disease and possibly dementia…..and I think we should try!
These epigenetic influences are so much more powerful than we can imagine.

Wishing you the best!

Whatever you do...don't move in with them, bad idea.

It is time for you to back off and get your mother placed, it takes an group to care for someone with your mother's issues, certainly not one person. You cannot keep her from falling nor can anyone else, she will continue to fall. The signals from the brain no longer work with a person who has dementia.

Start the process now, do what is best for all concerned not just your mother.

I just skimmed your previous posts. You seemed to have set everything up for these two, and it all fell apart plus your marriage. Now you are thinking of moving them in with you and hopefully getting paid. You also mention in one post that your daughter is pushing you to care for these two toxic people.

I think at this point you have done enough and given up enough. Living with them will effect your sanity. Its time to place them permanently into Longterm nursing care. No AL or MC, straight to LTC. A one time move. Both seem to need 24/7 help and one person can't do that. You won't have a life. And your daughter, she has no idea what taking care of two elderly uncooperative people is like. You don't owe your parents your life or your health. I feel so bad that your marriage suffered.

Please get them placed. If you don't have POA then call in APS and ask for help. Do not take care of these two on your own.

You don't mention your parents ages. From your first post last March, you were having problems with your parents then. You were even talking about AL for both. Your profile says Dad has his own health problems. Maybe a SNF is being suggested because Dad is not able to care for Mom. You also mention them being toxic so a good reason for not moving in with them.

Your parents should probably both be in some level of care. Mom will fall no matter where she is. My Mom was placed in a wheelchair where the seat slanted backward making it hard for her to get out of the chair. There was an alarm so when she did try to get up, the aide heard the alarm. Mom had a special mattress and pads on the floor around her bed. The bed was taken down as far as it would go to the floor. All precautions were taken but even then, they will fall.

I think someone with as many needs as your mom should be in care. She now needs not one person attached to her hip, but needs the eyes of many persons on her for several shifts. It should honestly be clear to you that in a home where there are steps, carpets, other things that may be hazardous, as well a tendencies to wander, make attempts to move about, there will be more falls in the presence of ONE person only, who clearly must get a bit of shut-eye, than with several shifts of several people each.

Sad truth here? She will fall. And falls are often the beginning of the end. The balance is gone and won't be returning. Falls are so very common and one of our posters I believe recorded over 80 for her mom before her passing. So often does it happen that when in care, a fall often isn't sent to ER for evaluation unless head or face is injured and unless there is obvious pain. The balance is just shot. As an 82 year old I guarantee you--it happens.

I am sure no one here is DEMANDING that you put mom in care, but there may be recognition that her care is now moving beyond what one person can provide?

With my dad I learned the danger of picking him up after a fall. It was a risk to both of us for injury to attempt it. We routinely called the fire department and they kindly came each time, lifted him safely, and assessed for injury. Likewise NH workers are trained in how to safely lift for both themselves, usually using two people, and the fallen person, and assess for injury. Many well meaning family members have been hurt themselves doing the lifting, or inadvertently caused further damage to the person they’re picking up. The falls are inevitable in the home or NH, a sad reality of advanced age. There is no solution for the falls, just a few preventative measures such as keeping paths clear and lowering mattresses. It’s clearly your choice where to have mom live, and neither choice is without issues. Make sure dad isn’t overwhelmed and know her condition will continue its sad decline. I wish you all peace

Birdee: I’ve been on this site for a long time and what I’ve learned is that if you’re looking for a caregiver to just sit with a loved one, that person would have to be hired from outside the MC. Staff at the MC are there to bath, toilet administer meds, etc. Re your dad, if he doesn’t want to help in his wife’s care, what can you do? If she remains at home, looks like a caregiver will need to be hired (using her money). And as to falling, the elderly can and will fall anywhere - at home or in a care home. The difference is that there are staff in MC or NC that are able to pick up the resident safely not to mention being available around the clock.

Hire People to come in to Help and sit .