I think you need to sit down with the care team and have a discussion regarding the falls and how they can be prevented or minimized in the future. Maybe have some sort of pad or alarm to alert when resident is getting up or out of bed, more PT to work with person on getting up or moving around safely.
They may be legally responsible to notify you of falls. Maybe you can tell them to only notify you if the fall results in injury and then establish standards such as mild bruising, cuts, break, requiring dr care, etc.
having worked in nrsg. home for 47 yrs. restraints are a no no ..& 2side rails up are out of the question as a pt. climbing over them results in worse injury....pads under pts. with alarms are in...but some pts. take the batteries out sometimes facility runs out of them..the only sure solution is having the nrsg. aide checking their rooms every 15 minutes which is practically impossible...but the state inspection teams expect this is the be all answer as they have no idea what it takes to watch 40 to 60 pts. ..the only way to prevent falls is to hire an aide to be with the pt, 24/7...or a family member may solve the problem....and good luck with that one.........just the reality folks
certainly don't discourage the NH from notifying you when there is a fall. be sure to visit ASAP and check your self for bruises etc and photograph them in case there is any abuse occurring. Sit down with the senior staff and find out what options exist to improve safety. Discuss with the Dr if there are any health changes which may be affecting her balance or med changes. Does she have shoes or slippers with non slip soles. Is she wearing clothes that are too long. lots of little things can contribute to falls. Are they in the same place or happen at the same time of day maybe when the sun is shining in her eyes.
When you say "before something can be done" - what do you have in mind? Preventing 100% of falls is a pipe dream. A dream I sometimes have, I admit - I find myself thinking fondly of strait jackets and handcuffs - but not one that's going to happen in the best nursing home.
In your place, I think I'd want to know what's causing the falls. Is your father physically frail, has he a chronic illness, is the AD causing him to forget that he is not capable of moving around freely and safely? If you can identify a primary cause, you might find there's a way to prevent or at least ameliorate it.
I really wouldn't discourage the NH from contacting you. God knows they don't need a green light to reduce communication with relatives; and twice a month isn't such a problem, is it?
My mother lives with me at home; she has poor balance because of chronic disease, and because of her dementia she is not able to understand that she cannot walk around, move furniture, carry objects safely. She now has a wrist watch style alarm that she can use to call me, and - because she will not call me except on the very rare occasions when she wants to - pressure pads under her easy chair cushions and bed mattress. The alarm and the pads set off an alert on a box of tricks I carry around in my back pocket or keep beside me at night. It has reduced my stress levels beyond measure, and I'm grateful, but there is one obvious flaw in this system: it does not alert me BEFORE she gets up and starts toddling off around the house. You can get movement sensors which would buy you an extra few seconds, but until they invent a mind-reader…
My daughter also tells me you can get movement-activated voice recordings that tell the patient "Sit down, Joe, and use your call button" - or whatever message you like. Well, now. For one thing, my mother is deaf, so for this to work the entire neighbourhood would have to hear all about her daily activities; and for another I suspect a disembodied voice like that would scare the s*** out of her. I haven't tried it.
My aunt lives in an excellent care home (I'm extremely picky, and I approve); but even so fell 3 months back, onto carpet, while walking accompanied indoors, and sustained fractures of her upper arm, elbow and hip. My cousin was furious with the carer who was with her mother; but you know what? If your client doesn't want to be held too close, seems to be doing well that day, and your grip isn't quite firm enough… well, once they start heading for the ground you're never going to catch them in time.
"Deprivation of liberty" (I once made a quip to a social worker about my mother being at liberty to hurl herself to the ground and got a long lecture back, which served me right for being flippant) is taken extremely seriously, and for an AD patient could be very frightening. What we have to do instead is cover as many bases as we can think of and then learn to live with the residual risk. Sorry.
Cm two things. 1. Your Aunt's hip may have fractured causing her to fall. There is a lot of chicken and egg discussion about that scenario. 2. A 100 lb female aide taking a 500 ib patient for a walk would not have had a prayer at preventing the fall. she would have died of suffocation - the aide not the patient.
I agree, Veronica, there can be all kinds of reasons for its happening (that's why I gently told my cousin not to be too quick to complain formally).
Only for the record, then, my aunt has very long-standing Parkinson's (which strictly speaking the aide should have borne in mind, and yes of course on the other hand the med's she's been on for so long won't have done her bone density any good) - and weighs about 90lbs wet through! BUT she doesn't like being supported…! - and with my mother, that's the real biggie, too.
We were lucky to have a brilliant OT who showed me the ropes; no walking around falls since then, just slipping off the edge of her chair type ones. The only downside of that is that now I find it hard to trust anyone else with her and tend to go puce if anyone tries to take her arm..!
My MIL falls at least once a week. The dementia unit where she lives does not use restraints or bed rails. The restraints would make her very mad and agitated. She has dementia, but on good days is quite clear, but with short term memory loss. Other days – wacky! Accuses us of never visiting (could have been there that very morning), mad because she is incarcerated, wants to go home (to her childhood home), go back to her job (whatever she imagines that might have bee). She is not bedridden, and not in a wheel chair. Alarms (that sound when she stands up) would do no good. By the time someone got to her she could be on the floor.
She has dementia, and as part of that disease she loses her balance. Also, as part of the aging process, she cannot react to “catching herself” before she is already down on the floor. She forgets to consistently use her walker (though 7 years of reminding her is making that better). She falls in the dining room, getting up from her chair, just about anywhere. Fall mats come and go in her room. Sometimes she falls onto them, and sometimes she trips over them and that causes her to fall. Sometimes she falls on the way to the bathroom where there are no padded mats.
So short of restraints (which I am not sure are used anywhere anymore), falls are quite often a consequence of aging, and not of neglect. You will have to investigate and see which it is.
It's helpful to know how/why she is falling. Does she fall when she stands up because of dizziness? Is she falling because she trips over things? Or maybe she has a foot drop that makes her trip over her own foot. Does she fall because she doesn't have the core strength to hold herself upright? Does she have a bone fracture or has had a stroke that makes a limb weaker?
A big cause of dizziness is medication. Lots of common meds, like blood pressure drugs, can cause lightheadedness. Find a pharmacist who is knowledgeable about geriatric issues and ask which of the meds or combination of meds could cause it.
If there is a reason for the falls, you try to address the problem. But sometimes you can't prevent falls without using restraints, which means you have to chose between her dignity/freedom and safety. I hope my eventual caretakers chose dignity.
My mother is in a wonderful NH with the most amazing staff. She has Parkinsons and dementia and is unable to stand alone. She has an alarm pad on her bed. When the alarm goes off staff come rushing but by that time she's already on the floor and they can't stand over her 24/7. She was taken to hospital yesterday for stitches to her hand after a fall. I don't think there's any answer to it.
They may be legally responsible to notify you of falls. Maybe you can tell them to only notify you if the fall results in injury and then establish standards such as mild bruising, cuts, break, requiring dr care, etc.
In your place, I think I'd want to know what's causing the falls. Is your father physically frail, has he a chronic illness, is the AD causing him to forget that he is not capable of moving around freely and safely? If you can identify a primary cause, you might find there's a way to prevent or at least ameliorate it.
I really wouldn't discourage the NH from contacting you. God knows they don't need a green light to reduce communication with relatives; and twice a month isn't such a problem, is it?
My mother lives with me at home; she has poor balance because of chronic disease, and because of her dementia she is not able to understand that she cannot walk around, move furniture, carry objects safely. She now has a wrist watch style alarm that she can use to call me, and - because she will not call me except on the very rare occasions when she wants to - pressure pads under her easy chair cushions and bed mattress. The alarm and the pads set off an alert on a box of tricks I carry around in my back pocket or keep beside me at night. It has reduced my stress levels beyond measure, and I'm grateful, but there is one obvious flaw in this system: it does not alert me BEFORE she gets up and starts toddling off around the house. You can get movement sensors which would buy you an extra few seconds, but until they invent a mind-reader…
My daughter also tells me you can get movement-activated voice recordings that tell the patient "Sit down, Joe, and use your call button" - or whatever message you like. Well, now. For one thing, my mother is deaf, so for this to work the entire neighbourhood would have to hear all about her daily activities; and for another I suspect a disembodied voice like that would scare the s*** out of her. I haven't tried it.
My aunt lives in an excellent care home (I'm extremely picky, and I approve); but even so fell 3 months back, onto carpet, while walking accompanied indoors, and sustained fractures of her upper arm, elbow and hip. My cousin was furious with the carer who was with her mother; but you know what? If your client doesn't want to be held too close, seems to be doing well that day, and your grip isn't quite firm enough… well, once they start heading for the ground you're never going to catch them in time.
"Deprivation of liberty" (I once made a quip to a social worker about my mother being at liberty to hurl herself to the ground and got a long lecture back, which served me right for being flippant) is taken extremely seriously, and for an AD patient could be very frightening. What we have to do instead is cover as many bases as we can think of and then learn to live with the residual risk. Sorry.
1. Your Aunt's hip may have fractured causing her to fall. There is a lot of chicken and egg discussion about that scenario.
2. A 100 lb female aide taking a 500 ib patient for a walk would not have had a prayer at preventing the fall. she would have died of suffocation - the aide not the patient.
Only for the record, then, my aunt has very long-standing Parkinson's (which strictly speaking the aide should have borne in mind, and yes of course on the other hand the med's she's been on for so long won't have done her bone density any good) - and weighs about 90lbs wet through! BUT she doesn't like being supported…! - and with my mother, that's the real biggie, too.
We were lucky to have a brilliant OT who showed me the ropes; no walking around falls since then, just slipping off the edge of her chair type ones. The only downside of that is that now I find it hard to trust anyone else with her and tend to go puce if anyone tries to take her arm..!
She has dementia, and as part of that disease she loses her balance. Also, as part of the aging process, she cannot react to “catching herself” before she is already down on the floor. She forgets to consistently use her walker (though 7 years of reminding her is making that better). She falls in the dining room, getting up from her chair, just about anywhere. Fall mats come and go in her room. Sometimes she falls onto them, and sometimes she trips over them and that causes her to fall. Sometimes she falls on the way to the bathroom where there are no padded mats.
So short of restraints (which I am not sure are used anywhere anymore), falls are quite often a consequence of aging, and not of neglect. You will have to investigate and see which it is.
A big cause of dizziness is medication. Lots of common meds, like blood pressure drugs, can cause lightheadedness. Find a pharmacist who is knowledgeable about geriatric issues and ask which of the meds or combination of meds could cause it.
If there is a reason for the falls, you try to address the problem. But sometimes you can't prevent falls without using restraints, which means you have to chose between her dignity/freedom and safety. I hope my eventual caretakers chose dignity.