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My Father is 91, he was in assisted living but had to be moved to Memory Care in March of this year because of night wandering. Since 5/23/18 he has fallen in the facility five times. He’s broken bones in his face, but he feels no pain. He has a walker and a wheelchair. They make him use them, but the second they or a family member turns our back he just gets up, or walks away from the devices. Also, they say he’s up all night walking the halls of the facility. We’re in Michigan and we are being told it’s illegal to restrain memory care and/or Alzheimer’s patients. No seatbelts for the wheelchair or night restraints. They have a motion detection pad on the floor next to his bed, but he avoids it.


Any suggestions?

I'm in agreement in adjusting medicine and maybe an alarm on the bed, so the staff is warned that he's up?
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Reply to maryt5
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Mom had dementia bad enough that she could not remember that she was not to get out of the wheelchair.  She had broken 1 hip, had surgery, and was pretty confined.  Not her way!!  The only thing we found, and this was after 2 falls as has been described here, "NO one is looking, I will take off"  Some Assisted Living places have the capablilty to use a seat belt.  The restriction was as follows:  She, Mom, must be able to unhook it, AND a Dr. must order it!!  This worked for us, because Mom would forget it was even there until she would try to get up. Then she would get help!!
Hope you can solve your dilemma!!
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Reply to vicky64
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I feel your pain my mother is 76 and she thinks that she can still go but she’s thinks shes in her 20s my dad was not even died for a month and she was talking about me n and how she was going to get a little sports car she’s got put on make up you know she’s already been calling men and at night I took the phone away from her because she don’t know who she is calling just call and talk but using the walker she has all that and she supposed to use it and what is she do she gets up goes to the bathroom and everything without her walker and then she falls I don’t know what to do either I wish we had all the answers in the world
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Reply to relucas9
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Dear Gothic88,

There comes a time when there is really nothing that can be done to make sure that our LO is doing what he/she is supposed to do. As far as I can figure out, they are either in denial or just not used to being dependent on an apparatus to get them around safely. It's just something that you will have to come to terms with. If not using the walker makes him fall....so be it. Maybe, after a number of falls, Dad will realize that he really needs the walker. I've told my Mom over and over again that she needs to use her walker. I've also told her that she's going to do what she wants, but that maybe the next fall will make her a vegetable in her bed and other people will have to bath and toilet her. One of her greatest fears. She now uses the walker 95% of the time. A lot different than it used to be. Mom will be 95 in a couple of months. And, I'm sure, like your Dad, no one is going to tell them what to do.
Hang in there and pray/hope for the best.
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Reply to nebbish1964
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It's a real conundrum because first my late mother wanted a memory foam pad placed atop her bed, which my brother purchased from Wal-mart. Then she wanted it off and then back on again. Other than a safety belt around this man's waist (with a person walking behind), I cannot think of a solution, else taking Seroquel low dose. And yes, I did read the comments.
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Reply to Llamalover47
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1 persons idea of restraint is another’s idea of forced detention.

The easiest solution is probably a change in medications so that he sleeps through the night and has at the end of day adult overnight pad placed at bedtime. For daytime, perhaps he’s wheelchaired over after his breakfast in dining room to pass the day with the group of residents that sit in front of & around the live theatre that is the nurses station. At least it gives more eyes watching him than alone in his room.

but whatever the case, invariably they are going to fall unless they are in 24/7 1:1 caregiving situation. And one of those falls is going to be life threatening.

My mom finally had hers and it was the time she was once again pulling her wheelchair from behind that she fell forward & shattered a hip at her NH. Before this she was a pretty spry nonagenarian with Lewy Body Dementia. Went onto hospice & bedfast. If you as DPOA and your siblings and your elder have not had a discussion as to end of life options & decisions, please try to do so now & before an incident happens. It can be brought up at your dad next Care Plan Meeting with an DNR or other orders updated into his chart.
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Reply to igloo572
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Mthr has had this problem as well. Risperdal (sp?), Tramadol, and seroquel have helped her at different times to overcome her nighttime anxiety and pacing. She would stay up all night with the nurses until she thought it was time for her bus to come, at which time she'd pack as much as she could carry in the trashbags in her room and show up at the front door. The anti-anxiety drugs have helped make her feel more at ease and not as panicked. The seroquel actually gave her peace and made her into a nicer person in general. Each of them worked for a season, and as her brain grew worse, something else was tried.

Give Being Mortal by Atul Gawande a read. It's all about nursing homes and end of life issues. I really would prefer for mthr to be happy and have a shorter demented life than for her to be struggling against restraints and live longer with a broken brain. Looking at her advance directive, I think that is what she would prefer as well. If she falls and injures herself in what could be the beginning of a cascade towards the end because of the drug she takes to make her happier, I am fine with that. It's a question of tradeoffs. We will never have them back like they were before.
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Reply to surprise
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Some places consider any alarms outside of a hospital, a restraining device. Which is the dumbest thing I ever heard! There is something called a scoop mattress that fits a twin bed, or a hospital bed. It is very hard to get out of. If you get one, don’t get it from anyone that is mimicking the mattress. There is an original scoop mattress. A hospital bed can be lowered too and the scoop would make it very hard for him to maneuver out of it.

What I found out for my State, nursing homes can restrain, but not memory care homes. So ridiculous. Are our legislators all in cahoots with ER’s? Plus his clock is off and they can remedy that presumably with a drug to have him sleep at night. At his age, try anything to keep him safe.
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Reply to Rosemary44
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INMO, the alarms and "falls detection" pads were a total joke with mother. What good did it do to know AFTER THE FACT that she'd fallen out of bed, yet again. We moved her to a better facility and the falling stopped. In her case, she had post op dementia and simply was trying to escape this prison. Their rules did not allow for any type of restraint and also refused to move the bed so one side was firmly against the wall. They needed to be able to access her from all points, I guess.

At home, we don't allow her a bedskirt (she'd catch her foot and slip) throw rugs, cords across the floor---a grab bar next to the bed...beyond that, I do not know what we can do. She wears a fall pendant, but half the time she loses it in the wash or misplaces it. A bed rail she HAD to have lasted one night as she slid between it and the bed and was trapped fer several hours. Those, unless part of a hospital bed, are just too dangerous.

Sadly, thinking she can walk the 10 feet from bathroom to closet, she has still fallen several times.

Short of 24/7 hands on care, you are going to have seniors falling.
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Reply to Midkid58
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Because of his falls they can use a sensor alarm or even a bed/ wheelchair alarm. It’s not a restraint but only alerts him to a noice which at times has them stop trying to get up or and is to alert staff and they are to RUN to the alarm. This will not stop him from falls but it might help. Good luck. Maybe move him closer to nurses desk if he had so many falls
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Reply to Bucky1960
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Barb53 Aug 6, 2018
Those sensor alarms for bed and wlchrs are illegal in IL now.
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They can get a Doctor's order to do a minimal restraint. It becomes a safety issue.
Unfortunately what happens in most/many instances is the resident falls, breaks a hip, a leg and can not participate in rehab or worst case does not survive reconstructive surgery or the anesthesia itself becomes a problem. (Dementia patients do not do well with anesthesia, it fogs the brain far longer than a healthy person.)
Have a care plan meeting and ask that they get a Doctor's order for restraint. Start first with side rails on the bed and get an alarm that clips to the person and to the wheelchair. Adding wedges to the bed so it is difficult to roll up and over them to get out of bed also works.
Also if the back of the chair adjusts tilt it back so it is more difficult to get out of the chair. If the alarm does not work and tilting the back does not work ask that the order include a belt for the chair.
It sounds like he is not a good candidate for a walker so that should be removed.
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Reply to Grandma1954
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This may be seen as a restraint, but it works for us with Dad at home. One side of Dad's bed is against a wall. On the other side, we use three body pillows which are a soft barrier. At the foot of the bed (he used to wiggle and get into a pretzel twist at the foot requiring a 911 lift assist), we put a chair with it's back against the foot of the bed & wedge another soft pillow.

At 97, Dad is becoming too weak and fatigued to get those bursts of energy and increasingly the above measures are unnecessary.

When I toured ALs and NHs, it was very clear that they cannot truly provide one-on-one monitoring 24/7. It was sobering to me to realize that falls are inevitable without being constantly with one's LO. I turned my back for maybe 20 seconds, and Dad had bolted up from the toilet and fell hard, requiring a trip to the hospital and rehab, which treatment itself triggered a marked decline.

It's impossible to "do the right thing." I am so sorry about how exhausting and heart-rending this is. It seems that some of the suggestions regarding medication may be the most humane way to get these souls through the night,
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Reply to 50sChild
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I thought the detection pad is supposed to be on the chair or bed? I've never heard of one on the floor.
My dad forgot he couldn't walk anymore (lack of muscle tone) and hit his head a few times. He even got a skull fracture in the hospital. They had him in a room in the back bed with curtain hiding the bed with the sign falls risk. His room wasnt near a nurse station. If I hadnt asked why his memory was so bad they werent going to tell me he had a skull fracture.
He also tried to get up at the nursing home. It finally stopped. Maybe he finally remembered or was too weak to try.
Always be proactive in your dad's care.
They can give your dad something to help him sleep to get him back on days, altho it's not a guarantee.
Can you ask him why he is getting up? Maybe he has to go to the bathroom. Maybe he is looking for something. It might be a simple answer. Then again he might not know. He can have a urinal put next to his bed. He might have gotten up at home to go to the bathroom at night due to enlarged prostate. And now doesn't remember he is too weak to walk there.
I can't imagine why they would not have personal alarms. Clients wander. That is a given. Good luck
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Reply to Jasmina
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What I don't get is don't the idiots who passed the law saying you couldn't restrain residents that even with alarms, but the time they go off it's too late to keep the person from getting hurt? Have they ever sat in a hospital with a loved one in a coma (I have) hoping they wake up? There are restrants that are not like tying them down. Something simple as a seat belt in a wheel chair is very humain. And so are posies to keep them in bed at night. They can still move but keeps them from getting hurt if they get out of bed. I'd like to know what we can do to get the "no restraints" law removed.
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Reply to whaleyf
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Agingmyself Aug 6, 2018
There are so many who agree with you! If it's a State law, why not phone your State Representative and ask about getting it changed? Do some activating!
If it's a federal issue, I'd think now would be a good time to start getting it changed--start by calling your Congressman.
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How about a three wheel type walker? I don’t know if they are recommended for all balance type issues, but my stubborn mom took to hers immediately, uses it constantly in the house to maneuver around. She first had a standard walker with seat that she avoided and refused to even consider. I keep that one on her second floor at the top of the stairs positioned that she can grab it to walk the few steps to the shower room and back.
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Reply to GAinPA
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They do not have chair alarms in his facility, however I am going to suggest it strongly as besides my FIL there are several other patients who has severe mobility issues that would benefit from them. As of today, the new doctor has prescribed different medication so we’re hoping that will help with all the night wandering. And he is in a bed that lowers, but it doesn’t seem to hinder him in the least. Thank you so much for taking the time to help me, it is very much appreciated.
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Reply to Gothic88
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In Moms NH they were allowed to use alarms on the wheelchair. Maybe the doctor could give a script for sleeping pills. My Moms bed was put as low as it would go. Pads were put on both sides and a concave mattress to make it harder to get out of bed.
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Reply to JoAnn29
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What you are encountering is so difficult. I know that I went through it with my LO as have many others. I think it's matter of going through all the things that you can do and hoping that something will help. If it doesn't, it will likely result in some falls and fractures. Eventually, the mobility is so poor that they are unable to continue getting up. I realize just how stressful it is for the family.

I'd likely start with his doctor to ask about meds for sleep disorders. That is very common with dementia, and often the patient will be up most of the night. After, my LO went on a nightly medication, she would sleep more soundly and only occasionally, would she awake and be restless.

I'd also explore a bed alarm to alert if and when he gets up, but, if he's sleeping more soundly, he might not be up as often. (Is he getting up to go to bathroom? Is he incontinent? If he is in Depends are they being kept dry before he goes to bed? I'd confirm that his bed is dry and that he's not up due to having to use bathroom or due to being wet or soiled.)

I'd also meet with the facility and explore ALL options to keep him in his wheelchair. My LO had an alarm belt. This was not a restraint, because she was able to undo the thing and get up anytime she wanted. BUT, it would buzz and alert them that she was up. It was rather funny, because she would unsnap the belt and let it buzz, laugh and snap it back on! lol Eventually, she stopped doing it though and stayed in the chair. Thus, decreasing her falls. Make sure they are providing you the correct law on the matter. It varies by state as to how it's applied.
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Reply to Sunnygirl1
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Gothic88 Aug 2, 2018
Hi, yes he has a hospital bed that goes almost to the floor. Also there is a motion pad on the floor, but only on one side. Per your suggestion, I’m going to request one be placed on each side. I’ve not seen any of the Memory Care patients with alarms on their wheelchairs, but that is an excellent suggestion. There are several patients who have no business getting up. And the Depends being fresh before bed. It is very difficult, but I’m hanging in there for my husband. Thank you so much for your positive suggestions.
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It's not permitted to restrain any patients pretty much everywhere, not just in Michigan. Do they have a chair alarm? Have they recommended or tried any medications to help him with sundowning/sleeping? You could ask if they have a bed that lowers to the floor, it makes it difficult for most people that age to get up.
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