Mom has dementia, was released to back to the nursing home after only 2 days following surgery for a broken femur. She can't put weight on it for 3 months. Nurses say they can't put bed rails in or restrain her at night. She can't remember to call the nurse, and has already fallen. Is the nursing home correct? Can we force them to keep her safe?

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In my state doctors cannot prescribe a restraint for NH residents. It makes too much sense. Here are some ways we try to keep Mom from falling out of bed or minimize the damage if she does. These are on her care plan:

Bed is lowered to its lowest setting while sleeping.
Head and foot positions slightly raised, putting her bum in a slight well.
Fall mats on both sides.
Rolled up blankets placed under her fitted sheet on both sides, making it harder to get her legs over. (this was a fight to get implemented, as they considered it a restraint too, but they’re finally doing it on the down-low, just not documenting on her care plan)
Her call bell (which actually is a 4” round disc for the visually impaired) is placed by her legs so it’s activated if she rolls on it.
Her wheelchair and rolling table are moved to the foot of the bed so she can’t hit them if she falls.
Her a/c unit has had the hard corners padded.
They suggested moving her to a room right across from the nurses station, but I didn’t want her to lose her excellent roommate (who looks out for her) so I declined. But that might be an option for you if you have no attachment to her current room.

Good luck, this is one of the most difficult and frustrating aspects of NH residency.
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I feel for your situation. It is so hard when the patient does not remember they can't walk. We are in a similar situation with my Mom, broken hip and dementia. Restraints and bed rails are illegal - people have hanged themselves in bed rails and restraints has been abused. Alarms sound like a nice idea, until you think of the reality of a place where there are alarms going off and not always able to be attended to immediately. Not to mention the person who has fallen and is not attended to immediately lying there with an alarm going off...

My Mom is in memory care and, through hospice, we got her a lowering bed. The mattress has an air core set for her weight, and the edges are raised except in the very center so it's hard for her to roll out. The bed is about 18" from the floor when fully lowered, add there are mats on ether side on the floor. If she's in her room, she is supposed to her checked at least every 2 hours.

This has been working well for they past 6 months. Ironically, she climbed out of the bed and feel last week while she was in it and had a food tray, so both in lowered position. She was unhurt as she fell into the mat.

It's impossible to avoid every situation, so you put the pieces in place that give them dignity and protection.
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This sort of thing drives me absolutely wild. You shouldn't *have* to force them to. A well-led Nursing Home would be looking for solutions on its own initiative, taking instructions from your mother's surgical team, and making whatever applications it needs to to take appropriate safety measures.

The thought that they can just stand there saying oo no we can't restrain her we're not allowed *like there is NOTHING else they can do* makes me froth at the mouth.

But there is a lot of it about. Keep pushing on her behalf, and may you get a more sensible care plan in place very fast.
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Roscoe2118 Dec 2018
Agree w u. Trouble is the law. It dictates what a nursing home can do about restraining a patient. If they don't follow the rules their license is revoked

Petitioning state authority for new regulations is a possible answer. Let's work to change the rules before we boomers need nursing home help.
RocketjCat is spot on as to how to deal with this.

My late mom broke her hip @ the NH while pulling her wheelchair behind her on her way to a morning activity. Backside of 90 & later stages of Lewy Body Dementia. MD / medical director was actually doing rounds in another wing at the time & she called me within minutes of the fall. Not the floor RN or DON but medical director. It was on retrospect one of the more insightful conversations regarding approaching the challenges of caring for dementia residents I’ve ever had. MD pretty matter of fact on the choices.... either
1. mom goes by EMS to ER then up into hospital for surgery next day or so then perhaps 3 days post in general ward then discharged back to NH and onto rehab with all the stressors each of those entail and realistically mom would be unable to do any rehab as her dementia was past the point of doing new stuff in sequential order (what rehab PT, OT does) or understand that she had had surgery & needed assistance on transitioning and she was going to fall again & again.... OR
2. Mom’s stays at NH, made super pain free till pain gets manageable, placed on hourly check in for 72 hours initially and MD would write orders for hospice consult to the hospice group on call for that day. Hospice would be approved as mom was totally bedfast & less than 6 mo to live. Hospice would bring in all the equipment to accommodate being bedfast: lower bed with pneumatic mattress, bed alarms, nestling pillows (to keep her body shifted so couldn’t get out of bed easily), floor mats plus hospice personnel initially 5 days a week to work with NH staff on bathing, feeding, medication management. Dietary already knew what mom liked and how she was able to eat so they could change her meal plan to accommodate being bedfast.

Went with choice 2 & mom ended up on hospice for 18 months at the NH. Between NH staff and extra staff from hospice, her needs were really taken care of. MD wrote orders for feeding assistance for 1 meal a day too. Now I did switch hospice providers within initial 90 days as another one would have hospice RN do Skype & regular emails with photos to me.

Hip healed amazingly well although she could never put leg totally straight and flex that foot or weight bear past a few minutes. So she stayed bedfast for 18 long l...o...n...g months. She’d get a fentanyl lollipop added to regular pain meds on bathing days as to be more pain free between the transfer to the geri bathing chair & movement needed for showering.

My point in this for those reading this is that the automatic default to having surgery or other extraordinary care may not be the path to take when there’s dementia. Health care in the US is geared to doing things to “cure” or “fix”. Broken ankle = surgery & wearing the boot; broken hip = hip replacement. Surgeon does their job then they exit. Sure mom could have had her hip replaced with all that surgery and hospital admit entails but to me she would have ended back with yet another fall and broken something else. Nothing was going to fix her continued aging and wearing out of body parts. As her MD said at a care plan meeting a year after her fall, “your mom’s being bedfast in many ways protects her from harm”.
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Toadhall Dec 2018
Absolutely correct. Doctors are trained to fix everything that is broken and treat to the maximun every illness. Being able to look at the entire patient and decide what is in their best interest is usually our job. This is a heavy burden. Even in middle age I have had some medical care or had care recommed to me that was not the best choice for my overall health.
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No, you cannot, it is considered restraint and subject to penalties. It can be considered elder abuse. You do not want to have APS become involved. Any sort restraint would have to be prescribed by her doc.
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MargaretMcKen Dec 2018
Perhaps that's the answer - get the doctor to prescribe a sensible restraint.
Thats what I read on this forum. No restraints. I have seen floor pallets, bed alarms, pads on the floor. Some people in your situation hire a “sitter” to watch your loved one and call the nurse when needed. For three months that would get very expensive. Perhaps you have family members, church members, friends who could help you rotate sitting with her for a portion of this time?
Perhaps someone else will have better ideas than these.
I’m very sorry for this hardship for you and your family.
Let us know how it goes.
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The nursing home can only do what a doctor prescribes. Talk to the surgeon asap.
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Can the nursing home place her mattress directly on the floor? I've seen that done, and, at the very least, it keeps her from falling a distance to the floor if she tries to get up at night. Also a bed alarm might help; perhaps they don't have a rule against that. HettaK96
Helpful Answer (3)

I am sorry to say it is true. Caregivers are not allowed to restrain a patient in any way, shape, or form. I think that is more dangerous than being able to restrain them. At least if they were
restrained you would
not worry as much as if they were able to get around and truly hurt themselves.
My dad and mom were both 93. Both required a nursing home after both falling in their home, one week apart. Put them into
a home close and with a therapy dept to help them with their issues. Dad is not one to sit in a chair for a very long period of time. he got up and fell of bed so many times it was scary. I
finally told them to cushion the floor real good and put just the mattress on it and let him sleep down there. Now when he tried to get up he was already on the floor. He couldnt fall that far. It helped. UNTILL he figured out he could crawl. than he crawled
around the nursing home like a kid.
mom had no desire to get out of bed at all. She just laid there
and had everyone cater to her needs.
I will tell you that I found out that if you request to have a one on one watch care for the patient they must give you someone to sit and watch over the person 24/7. you need to tell them that they need to have care day and night so that the patient doesn't get hurt as they have done in the past. This was done in the hospital and in the nursing home once I confronted them with this knowledge.
Check out the state you are in rules for nursing care/hospital care
for the elderly. Call your elderly service in your town, county and
state. you will learn what can and can not be done.
I wish you luck.
what got me thru years of caretaking was a promise to myself that I would forget the bad and only remember the good that occurred that day when I was finally able to rest my heard on a
pillow till the next time one of them screamed
Helpful Answer (3)

In most if not all sets restraints are against the law except in Military hospitals. A Dr can do all the prescribing he likes but it is still against the law.
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