Mom keeps falling in assisted living. What are our options?

This may seem obvious. Check all of her medication's potential side effects.

My 89 yr old mom has dementia and cannot be still. She lives in memory care and is receiving hospice. She gets anxious and needs to move. She is constantly walking and rearranging objects in her room. She has fallen multiple times.

Her walking was becoming more and more unstable and her connection to the world around her fading. We advocated for a medication change and her walking has improved as well as her focus and redirectability.

We did have private aides coming to her facility 24/7 for a couple of weeks after her 1st fall to administer morphine and for fall prevention. Hospice recommended morphine for pain but in memory care nursing is not available 24/7. Only the nurses, family or the private care could give her the morphine. As her injuries improved we were able to remove the morphine and the 24/7 private care.

If your mom needs a higher level of care make sure you understand the medication management in the facility. In my state only nursing homes can meet the 24/7 administration of specific substances like morphine.

In my state the average hourly wage for private care is $37 hour. It's very expensive and not everyone can afford it.

I know my mom will fall again. I cannot prevent it. I expect sooner or later a fall will be the beginning of the end for her. I cannot afford 24/7 private care for her.

Its been very hard for me to accept that I cannot fix things for my mom. I can only strive to make her comfortable and less anxious.

I hope your mom recovers.

Wow her bleed stopped?

Worst case scenario is mom needs to move into Skilled Nursing if She requires more care than this adult foster home is capable of providing. BUT, oftentimes a facility like this WILL allow the resident to stay until death IF hospice is coming in for extra care. That was the case with my dad. Find out before hand and don't get gobsmacked!

MomsBrain: Perhaps your mother requires a higher level of managed care facility living, especially with failing cognition at play. Even so, if the elder forgets that they need help to stand, it is going to result in a fall event. Prayers sent.

She may no longer qualify for AL type care. You would either have to hire people to attend to her at the AL or move her to facility that handles the additional care she needs. It may even be NH time where facility care is concerned.

Adult care where she is sounds wonderful since minimal other patients. However, talk to them to find out if THEY think she needs to move on or if they can handle her care for now. Even if she goes to NH, it doesn't mean she won't fall again. So if she can stay where she is, better for her. More one on one care with less people needing help

My heart goes out to you and your mom.

* Hire outside caregivers if you can afford it (to supplement nursing home care).
* Get her in Hospice if she isn't already for extra care. She doesn't need to be terminal to quality for Hospice (depends if MD will do).
* Bed restrains - in San Rafael, CA - 1/4 bed restrains are allowed. They may not be enough to keep a person from trying to get out / falling out of bed though.
* I got a body pillow and put near to the open part of the hospital bed-frame. It worked out very well. The N-Home MD was quite impressed saying "I never thought of that." It worked although by then, my friend/companion didn't move around much although the pillow WAS a barrier between the two ends / sides of the bed-frame. 'JUST' be sure that the staff know what the pillow is for . . . too often I would find the pillow against the wall ... on the other side of the bed.

* My friend likely tried to get up and out of bed forgetting that he couldn't stand-up / walk. I believe this is why he fell out of bed twice (before the pillow although he had the 1/4 rails/bed rails). It may not be 'movement' causing someone to fall out of bed. They may be trying to get up and out.

* Be sure to work with Ombudsman in your area should standards of care be inadequate. I did ... sending her photos and description of situation (no call button and no water available / in reach) ... 3-5 x / week ... only to find that the Licensing board of nursing homes could not use any of my information/witnessed situations due to being 'a third party.'

I find that the best way to get attention and care for a loved one is to create good relationships with management / staff / line staff, CNAs. Of course, it helps if the administrator is on the ball...

Gena / Touch Matters

As an OT who has worked in nursing homes, and as a daughter who had a mother in that level of care, I hate to suggest that your best option may be some type of restraint. I always hated to see this used for patients, but if the home doesn't have enough aides to watch her, she is probably going to continue to get up, try to walk and fall again. There is a type of cushion used in hospitals on chairs or in beds that sets off an alarm when the patients tries to get up unaided. I don't know what it's called or what it costs, and it probably needs some type of electric cord.
Can you use a simple seat belt opening in back?
I'm glad the scan was helpful.

Most Assisted living facilities we found out/ including rehab no longer use a clip that lets them know if someone is getting up. We were told the patient has the right to fall. Very sad because it allows the caregivers in these facilities to ignore the calls for help when patients need to use the bathroom.

I am not familiar with foster home care, but from what you are saying your mother may be needing care in a SNF.

How about a second opinion with a neurologist and an MRI brain scan? How about Assisted Living with an Occupational Therapist?

http://brainmi.com/

What you described was a terrible concern I had when my mom fell flat on her face. I got her a 2 caregivers for 7 days a week (4 hours/day-mom sleeps alot)Caregivers did the PT with her because they were with her during her PT sessions. I am fortunate so far because mom is doing well with only 4 hours -5 hours of private caregiver a day. She gets encouragement, showers, hair fixed, lotions applied, eyedrops and warm compresses as well as a person with her during 2 meals. She has no recall but she can follow step by step directions. Even MC people fall and with the leanness of staff numbers, I wasn’t confident of her care. Mom may eventually need a wheel chair and increased private care. I know that when Hospice is called in it is supposed to be helpful and probably if mom is bedbound it might be sufficient. However, I have not been thrilled with Hospice care in terms of time spent with the loved one and assurance that she is getting the best care. In my mom’s facility, the hospice lady comes in and checks mom’s neighbor but when my caregiver started helping one 4 hour day a week, my caregiver found a pressure sore on the woman’s coccyx (tailbone) the size of a quarter and the loved ones husband didn’t know about it, it wasn’t being treated, etc. even though Hospice is there 5 days a week for 15 minutes! That brings me back to being grateful I have my private caregiver for mom-so grateful for the “eyes” I have on her. I am sure this Hospice is getting paid whether staff are working or not. Or maybe the bar is much lower now for good care.

hire a sitter on care.com to give her so many hrs of having indivdual attention.

I just want to chime in on the "falls are going to happen" aspect.

To give context, but not hijack the thread, our elder has issues with dysautonomia, not connected to any disease. This means that when she lays down, her BP can go WAY up (scary), and when she stands up, her blood pressure can drop—sometimes precipitously, because she can faint. The latter has been the biggest issue; she's fainted and fallen four times now, across a number of years. In the process she's torn her rotator cuff, and broken her elbow. The other times, she couldn't get up off the floor and called us to help her.

Docs can't regulate her pressure. There's nothing wrong with her heart. Neurologists won't see her; even at Hopkins, they're so specialized they only see folks with dysautonomia adjacent to something else, which she doesn't have.

So, we've done all the things we can (and that she'll let us do; she's 83 and fully competent to make her own decisions) to help her stay as safe as possible. She insists on aging in place. She decided on her own not to drive, we have a chair lift to help her navigate the stairs, one of her sons lives in the house (but isn't there 24/7) and takes care of the house, does shopping, etc., there are bed rails to help her get in/out of bed, a commode that's bedside every night, and she finally agreed to wear an alert button.

All that to say that we, like others here, are doing what we can to help her live as long as she wants to, while having to make peace with the fact that something bigger than all of us is *clearly* in charge of this journey.

We know that she's likely to either die from a stroke, or from a brain bleed after falling and hitting her head. And, chances are she's going to be alone when it happens. That hurts my heart.

People, trying to be helpful, tell us we should "place her in care" where she can have someone always with her. Some of them have been medical professionals, with the most vocal of them being a visiting nurse who was freaked out by her BP. I'm often astonished that more medical folk don't come from a place based in reality, or who judge and react without understanding the fullness of the situation.

But, as others have said, someone can be with her every moment of the day and every step of the way, and she can still fall.

Short of confining her to bed to "keep her safe"—which, for her, would be a kind of death in and of itself—there's nothing we see that can be done.

So, for as long as we have her, we help her live the best life she can, we love on her as much as possible, we show up for anything she needs or wants, and we're letting go of trying to "fix" things, or push radical ideas to "protect her" or "keep her alive."

Sending you such big love as you navigate your journey.

Hospital bed to floor at night and mats by bed.

You need a medical evaluation which you won't get here.

The shared experience here is very good, insightful; tho I don't see any mention of the piece of information I learned when my mother began having falls. It was shocking and upsetting at first to learn that average, Average, lifespan once an elder begins having falls is...6 months. Sparing you all the sad details it became true in my mom's case, who had just turned 79, and then again years later when my favorite uncle died, age 96, tho hale and hearty up to then, still driving, etc. So, sad and as hard as this info can be, I concur with one poster to 'let go and let God', which does not mean don't try to help your mom stop/prevent falls (PT is almost useless at this point if the patient cannot comprehend nor practice why to do their exercises.) Ask for a hospice determination, then place your mother where she will get the best comfort/safety care; have her treated when she falls, prepare yourself for her demise, whenever it comes. I often wonder what the very elderly did in olden times; it occurs to me that falling, especially when living alone, probably led to immobilization where they lay, with the person gradually losing consciousness from thirst/dehydration. The late, great Steve Irwin often said, "It's Nature's Way", which we try mightily as humans to defy/postpone, but a life 'winding down' ought to be respected, imho. The elder care 'industry' is a business, useful to a point, but not when it's merely prolonging the natural process of an individual's exit from this world.

My mom’s ALF put a bed alarm on her bed so they knew when she was getting out of bed. Also we moved a bedside commode next to her bed so she does not try to walk to the bathroom. This has worked for the last 4 months after mom fell in the bathroom her very first night there.
Wishing you the best of luck with this and hoping for continued good news about the brain bleed continuing to improve. 🤞

Have you considered hiring a sitter for her. In asssitant living there are large windows of time which the resident is alone and unattended and until a daily routine is identified for your mom it might be a good idea to hire a sitter/caregiver to help during these gap windows. Also your mom should be identified with the facility as a fall risk resident and that should also change the amount of time she is unattended or left on her own for too long.

Sadly once a person is a fall risk they will continue to fall even if someone is with them 24/7.
Case and point...I was my late husbands 24/7 caregiver for the last 4 years of his life, which meant I was home with him all the time. He fell a lot. And usually I was somewhere near by.
There was a span in July and Aug. of 2018, that I had to call 911 nine times so the EMS folks could come get him off the floor and back into bed. And yes I was often in the same room as he was when he fell.
So unless you want someone to be glued to your moms side 24/7, you're just going to have to accept that falls are going to happen.
It's the sad truth.
It was almost a blessing when my husband became completely bedridden as I no longer had to worry about him falling anymore.

Nobody can prevent falls, period. Not any SNF or memory care ALF, or home health aid, it's not possible, especially when dementia is involved and they forget they can't walk. That was the case with my mother who took 95 falls, literally, with some cracked ribs and sternum as her only injuries. Pt is pretty impossible w dementia too, bc they don't follow cues, can't retain new info, and have no motivation or interest in working hard w exercise.

Just bring in hospice so mom can get a hospital bed and other useful things to TRY to keep her safer. Hospice brought mom a bolster pillow type thing for her hospital bed that cupped her body a bit. It cut down on her falling out of bed a little. A new wheelchair that tipped backwards also stopped the falls from reaching 200. The toilet was another story. 9 out of 10x she would roll over to it in her wheelchair w/o help, climb on and fall off. Once she fell 3x in 4 hours.

Let go and let God direct this show for mom now. And get hospice on board If she qualifies. My company used "Senile Degeneration of the Brain" as the Medicare qualifier for mom's dementia to get services approved.

Best of luck

I hate to say it but..
Falls WILL happen
There could be an aide standing next to her and she could fall.
This might even continue if she were confined to a wheelchair, she would try to get up and fall.
This may be the start of the slippery slope that will eventually end your mom's life.
The fall in January probably did more damage than thought. She may now be having mini strokes and if it is not a fall it will probably be a stroke
My Husband had Alzheimer's and I suspect Vascular dementia and I suspected that each fall he had was a mini stroke that would cause a steep decline. (literally overnight there would be a marked decline)
This all is your probable "worst case scenario" But do expect the falls to continue.
((sorry))

This is going to be a "lather, rince, repeat" situation. She needs more care; SNFs don't want a fall risk patient because of potential lawsuits. If there's money available, a home health aide who lives with your mom would be best. There are belts she can wear so the aide can guide her, but they have their limitations. PT is only going to go so far.

As with Geaton, I've lived this. My friend could escape any restraint the hospital had, and she'd fall or leave the ward.

The "worst case scenario" may be your best solution. There really aren't good ways to keep forgetful seniors safe from getting up and falling. Recently been there, done that with my 100-yr old Aunt (mod/adv dementia) who we had to watch all day with a family aid, an alarm connected to her when she was watching tv, and bed "barriers" (which she sometimes got around). Finally she got up in the night, wiggled past our barriers, fell and broke her hip. Surgery not an option at her age and state of dementia. We were about to transitiion her from rehab (which she wouldn't do) to a permanent LTC facility, but she passed peacefully in her sleep before this could happen. FYI, most states' Medicaid programs will only cover LTC. A doctor would assess your Mom's need for this level of facility care.

The admins of your Mom's facililty need to help you come up with some solutions, none of which will cover her 100% or perfectly. For instance, she can be seated in a wheelchair and a "tray" can slow down her ability to get up out of the chair. Her mattress can be put on the ground (many facilities do this); or there are concave mattresses that make getting up and out much more difficult. There are alarms, as I mentioned. The best is to hire an aid to be with her during the day. I wish you peace in your heart as you do the best you to protect her.