Falling and won’t use the walker or wheelchair in memory care. Any suggestions?

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.

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,

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.

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.

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.

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.

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.

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.

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

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