One of my senior charges had polio as a child. As a result they have had lifelong issues with falls. No obstacles just spontaneous falls with no obvious reason. Now that we are in year 6 of a dementia dx, their physical abilities are weakening. At this point, physical therapy seems futile to me. Falls are simply unavoidable. They also can’t remember to push the call button for help. Given this situation, would skilled nursing be any better than assisted living? They will continue to fall regardless. I want them as safe as they can be but with the current “right to fall” laws it’s seems like the differences would be minimal. Thoughts?

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Post-polio syndrome, I read up on it and asked my mother's GP about it. He smiled on me kindly and encouraged me to take up its management principles if I thought it would help (breaking tasks down into energy-conserving steps, e.g. - it certainly couldn't *hurt*). By that time it was all a bit late but he didn't want to shoot me down, bless him.

Falls are unavoidable, this is true, very sadly; but the "right to fall" - which is only intended to be a thought-provoking way of describing a person's right to personal liberty - still has to be balanced with their right to be safeguarded. There are legitimate "deprivations of liberty" but these have to be formally applied for and approved; and I suspect avoidance of paperwork and protection of behinds have more to do with it than any sincere belief that it's a good thing for people to have the right to get out of their chairs and land on their noses.

My actual knowledge is limited to the UK process,* but I did look this up for one of the States not long ago and was not surprised to see that the issues discussed (and legislated for) were pretty much identical.

Hazard observed
Potential harm assessed
Proportionate preventive measure proposed
Deprivation of Liberty order applied for
DoL Safeguarding body considers application
Order approved or refused

There is also provision for an applicant - nursing home manager, e.g. - to gain an emergency DoL to prevent immediate harm to the adult to be safeguarded, which can then be approved retrospectively.

When you boil it down: nobody really thinks a vulnerable adult should be cheerfully encouraged to chuck himself on the floor, but everybody wants to be sure that busy nursing homes aren't just tying people into wheelchairs to err on the safe side. The result is endless fun for bureaucrats, committees and draughtspersons.

Have you discussed this with any facilities you might have earmarked for him/her? They might be more imaginative in their falls risk management than you fear.
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My husband’s grandfather had polio as a kid. I remember him wearing special shoes that were very expensive. I think he had one leg shorter than the other so one shoe was built up higher.

It’s so hard watching people fall. My mom falls due to Parkinson’s disease and would not be able to walk without the aid of her walker.

It is sad that some people end up in wheelchairs as a last resort due to falls. It’s safer then continuously falling though.
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frazzledteacher Sep 2020
Ah the shoes! It took me six months of hoop jumping to obtain their last pair of shoes!
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I would say a NH. They will put the client in a wheelchair because of their falling. I just read that polio can come back. The person really never overcomes the effects. Here is a good article.
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