How to avoid falls at nursing home?

Well, Dave, you raised an interesting theoretical legal question. I'll take a stab at answering your query.

I wouldn't think that any facility accepting Medicare can be released or excluded from a stated Medicare presumption. It would still have an obligation to prevent falls, but is hedging its position by first stating that the issue of falls is in fact a recognizable event (it's probably going to happen one way or the other, and sooner or later) but that it's going to develop a care plan, which, however great, can only result in lower numbers of falls.

So it's taking the position of what that particular facility has decided in its own wisdom is the best course of action, perhaps laying the groundwork for stating and recognizing the inevitability...and perhaps requiring patient direct pay if Medicare actually does not cover care for in-facility falls.

Actually, I wasn't aware of this, but it strikes me as unrealisltic, even though it's obvious Medicare is shifting the blame for fall prevention to the facility. I say unrealistic because of the higher fall risk of older, and osteoporotic, people.

Nicely put; reading between the lines, I'd say it's essentially a CYA position.

I don't know if it rises to the standard of pre-emptive notice to patient and families though. That's a topic for a medical malpractice attorney to research and on which to opine.

Not to discriminate against the facility, Medicare's own statement contains some CYA elements as well.

The issue overall is I think not so much the falls as the fact that the elderly are so much frail and vulnerable, especially from osteoporosis, together with balance, eyesight and hearing issues.

Toddlers fall when they're learning to walk but they have a lot of padding; children fall during play. Unless there are specific medical conditions present, and generally speaking, they don't have osteoporosis or sight, vision or hearing problems. If they did it would heighten their own risk of fracture from falls.

Seriously and somewhat facetiously, if elders could be padded up like football players, their injuries might not be so dangerous. It was with that thought in mind that we searched for options to "pad up" my father to prevent further injuries when he fell.

I looked at football players padding, helmets, and etc before we decided on using pipe insulation as padding on his walker. We never did resolve the issue of padding for Dad - I'm not really sure he'd be comfortable walking around bulked up and helmeted like a football player, even though it might be more protective.

Interesting question you posed - do you have legal background?

Though unable to stand unaided my mother (in a NH, parkinsons, strokes and advanced dementia) has got out of bed numerous times over the past few months resulting in lacerations and two trips to the ER for stitches as she's on blood thinners. There's an alarm on the bed but by the time it goes off and staff come running she's on the floor. At this point she's too weak and frail to try it any more.

One thing to remember - nursing homes are always under staffed. The staff at my mother's NH are fantastic but there are only so many of them to care for 60 residents so no-one can be watched every minute, day and night. Whether it's the advanced dementia or some hallucination, many can find a burst of energy to hop out of bed quicker than you and I can.

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"When the patient falls out of bed, who pays?

"In 2008, the Center for Medicare and Medicaid Services (CMS) identified falls as Hospital Acquired Condition (HAC). CMS no longer covers the cost of care as a consequence of an inpatient fall based on the presumption that falls are preventable by the organization." (CMS, 2009)"

I got this comment in a reply when I commented on my wife's fall at rehab unit. "Mary Ann Morse is a restraint free facility and look at each individual patients needs in developing a plan of care. Among the population we serve, falls tends to be a frequent problem." " Mary Ann Morses fall rates are significantly below the State and Federal average rates."

So is a restraint free facility released from the presumption that falls are preventable by the organization?

thanks for the comments. I appreciate them. They do have two alarms on her -one on the bed and one that attaches to her clothes but she is very good at disconnecting them and get out anyway. The lowered bed and pads are a good idea-I will follow up with that. No meds that seem to be affecting her.

FeelingLost and Pam, I wasn't aware that beds could be lowered that far, but it's good for me to know as well if my father's situation ever comes to that.

I have seen beds at Nursing Homes that lower to within a few inches of the floor, with a mat next to them. This really works to keep them in bed, because they cannot get UP to a standing position when squatting on the bed.

It seems as if the staff is taking precautions already. The only other things I can think of are (a) some kind of monitor either on the bed or the sides of the beds (where your mother can't remove it) that connects to a nursing station and alerts when your mother gets out of bed (b) a mattress or something like a workout pad on the floor so if she does fall she doesn't hit anything hard.

If there are any meds she's being given at night that might keep her awake, perhaps the staff can give those early or at mid day. And conversely, if any of her meds make her drowsy, give those at night.

Is she getting any therapy for balance and leg strengthening? Is she in a nursing home, and/or does she have any dementia?

One easy exercise I did with my father after seeing it down in a SNF was to get a fairly good size ball, slightly smaller than a volleyball, and soft - not hard like a volleyball or football.

The staff would have Dad sit in a chair, throw the ball to him initially then gradually throw it a little farther to left and right, forcing him to bend slightly to catch it. Later when he was stronger, this exercise was performed standing up at a walker, with a large chair behind in case he lost his balance.

That might be something you could do if her therapists/nurse/doctor approve.

Near the end my mom had major neuro problems, lots of falling and also trying to get out of bed at night. The nursing home put her in a "low fall bed", which was adjustable height with the lowest setting less than 2' off the floor, which is where it was kept unless she was being attended to. They also put thick vinyl-covered pads on the floor on both sides of her bed. And a pressure pad under the bed sheet that sounded an alarm if her weight moved off it.

For a few days she was also moved to the room directly opposite the nurse station, so that a nurse at the desk could look right in at her. The other woman in that room was quite disruptive, so we decided to sacrifice that extra level of observation for a quieter room once the doctor figured out which med was causing most of the overnight agitation and eliminated it.