For future readers of this old post: They have beds that are lower than the traditional hospital bed and still have side rails to protect the patient. I'm not sure where you're located but check to see if they have low hospital beds and the rails should be padded for protection against bruising and or/getting a leg/arm caught in the rails if the person is trying to climb over the rails or trying to get up and is confused they won't know the dangers. I had a patient that was in a room right across from the nursing station at the nursing home, fell out of bed and broke her hip. she died 3 weeks later due to complications of the hip fracture. They tried to cover up the fact that the nurse had left the rails down until I pushed for an answer not letting go then it was confessed. I'm a senior advocate, by trade and a care manager so I will not leave any stone unturned and will get to the bottom of any incident or injustice. Nursing homes must be closely monitored by family members, an advocate/care manager, etc. and the chart should be reviewed, not everything will be disclosed to family members and by the time red flags go up, it could be too late. I've been in healthcare 40 years so please trust that I know what I'm talking about. Dr. Sheila
There are several situations where a nursing home could be sued for a resident or patient injury. If a nursing home accepts Medicare, the nursing home must follow Federal Regulations which set forth the standard of care. One of these regulations is 42 CFR sec. 483.25 (h) which provides:
The facility must ensure that:
The resident environment remains as free of accident hazards as possible; and Each resident receives adequate supervision and assistance devices to prevent accidents.
If the nursing home fails to comply with these regulations and a resident is injured, the nursing home is liable to be sued
More than 1.4 million people 65 and older live in nursing homes.2 If current rates continue, by 2030 this number will rise to about 3 million.3 About 5% of adults 65 and older live in nursing homes, but nursing home residents account for about 20% of deaths from falls in this age group.4 Each year, a typical nursing home with 100 beds reports 100 to 200 falls. Many falls go unreported.4 Between half and three-quarters of nursing home residents fall each year.5 That’s twice the rate of falls among older adults living in the community. Patients often fall more than once. The average is 2.6 falls per person per year.6 About 35% of fall injuries occur among residents who cannot walk.7
How serious are these falls?
About 1,800 people living in nursing homes die from falls each year.1 About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures.1 Falls result in disability, functional decline and reduced quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation.5
Why do falls occur more often in nursing homes?
Falling can be a sign of other health problems. People in nursing homes are generally frailer than older adults living in the community. They are usually older, have more chronic conditions, and have more difficulty walking. They also tend to have thought or memory problems, to have difficulty with activities of daily living, and to need help getting around or taking care of themselves.8 All of these factors are linked to falling.9 What are the most common causes of nursing home falls?
Muscle weakness and walking or gait problems are the most common causes of falls among nursing home residents. These problems account for about 24% of the falls in nursing homes.5 Environmental hazards in nursing homes cause 16% to 27% of falls among residents.1,5 Such hazards include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs.5, 10 Medications can increase the risk of falls and fall-related injuries. Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs, are of particular concern.11, 12 Fall risk is significantly elevated during the three days following any change in these types of medications. 13 Other causes of falls include difficulty in moving from one place to another (for example, from the bed to a chair), poor foot care, poorly fitting shoes, and improper or incorrect use of walking aids.10, 14
How can we prevent falls in nursing homes?
Fall prevention in nursing homes presents multiple challenges. It requires a combination of medical treatment, rehabilitation, and environmental changes. Fall prevention interventions can be implemented at the organizational, staff or patient levels.15 The most effective interventions address multiple factors or use a multidisciplinary team.16
Fall interventions include:
Assessing patients after a fall to identify and address risk factors and treat the underlying medical conditions.6 Educating staff about fall risk factors and prevention strategies.10 Reviewing prescribed medicines to assess their potential risks and benefits and to minimize use.17, 18 Making changes in the nursing home environment to make it easier for residents to move around safely. Such changes include putting in grab bars, adding raised toilet seats, lowering bed heights, and installing handrails in the hallways.10 Providing patients with hip pads that may prevent a hip fracture if a fall occurs.19 Exercise programs can improve balance, strength, walking ability, and physical functioning among nursing home residents. However, such programs do not appear to reduce falls.20,21 Teaching residents who are not cognitively impaired behavioral strategies to avoid potentially hazardous situations is a promising approach.23
Do physical restraints help prevent falls?
Routinely using restraints does not lower the risk of falls or fall injuries. They should not be used as a fall prevention strategy.24, 25 Restraints can actually increase the risk of fall-related injuries and deaths.5, 25 Limiting a patient’s freedom to move around leads to muscle weakness and reduces physical function.3 The average rate of physical restraint use in nursing homes has fallen from more than 40% in the 1980s to approximately 10%.26 Some nursing homes have reported an increase in falls since the regulations took effect, but most have seen a drop in fall-related injuries.9 Direct injury from bedrails appears to be due to outmoded design or incorrect assembly; bedrails do not appear to inc
The problem with bed rails is they have been proven to do harm. People try to climb over, resulting in even worse falls or get limbs trapped between the rails resulting in broken bones.
My boyfriend's parents are both in a nursing home in Oregon. They keep falling due to one having alzheimer's and the other one just being very elderly and mostly bed ridden. They usually try to get out of bed to go to the bathroom and fall. It's always an emergency and the usually end up in the hospital and he has to drive 1.5 hours to go see them every time it happens. This "no restraints" law is in Oregon and it's really stupid to sat the least. I'm sure it applies to some people, but I think it should be enforced only if the legal guardian ok's it. They should have a choice. Bed rails would help so much as I don't think they can get a lower bed, but that is a good idea. Some laws need to be revisited as I don't see how falling and breaking bones is better than bed rails. Really???
If you can afford it, hire a private granny nanny. My mom's been in a nursing home for 2 month, has fallen at least 6 times. She has a 24/7 sitter now, expensive but d@mn well worth it.
Riley, you can contest POA in court. You can petition for guardianship which will cancel out all other POAs. This will force that guy to show up and put his own case together to contest it. He will need to prove that he's visiting and at care conferences, in contact with the facility, making care decisions, etc.
Take lots of pictures and document, document, document.
Someone reported this situation with my father being on the floor to APS, and I was informed, soon after their visit, that magically, the facility will be giving my father a hydrolic bed, even though they have been adamant all along that he must remain on the floor. Maybe APS had a different opinion about it. We won't know since we didn't file the report, but the timing is interesting.
Excellent point, Mallory. I wish the long term care would use some type of seatbelt in a wheelchair for my Mom, as she tends to bend over to try to pick something up off the floor, and there she tumbles. Instead, Mom is now in a Geri Recliner which I know is very uncomfortable for her, she keeps saying her back hurts.
It's really interesting that babies and toddlers are required to be contained in cribs and carseats, for their own safety, and parents/ daycare would be arrested if they did not prevent them from falling out of bed, or crawling around the car. But an incapacitated adult, oh no, we can't put them in a bed with bedrails, or a set belt on their chair, that's not right. There has to be a middle ground, some room for interpretation of the circumstances. Seniors who cannot walk, but forget they cannot, could cause themselves great harm or death if the caregivers don't prevent them from getting out of bed/ chair. Personally I think restraints are just fine. But because of misuse by a few unscrupulous carers, now the seniors that really really need them have to do without, or their carers go thru massive red tape to get simple bed rails or seat belt approved.
Pixieish13, my Mom has the same issue where she is staying, in her mind she still thinks she can walk but in reality she can no longer even stand.
What the facility did was put bumper guards around the bed, lowered the bed, and have rubber fall mats on both sides of the bed. These mats are soft but not like gym mats. In fact one can move a wheelchair over them without any problem.
I visited a friend in a nursing home recently. Her bed was on the floor. A small one liked described above. She said she had fallen so often it was safer for her. She had an attendant with her. She used her wheelchair to get up from the floor and sat in it and visited and seemed happy with the whole arrangement. She said getting in and out of the wheelchair was her therapy.
Someone in our family reported it to APS recently because everyone in our extended family is concerned bc on a recent visit we found other neglect ie, his teeth were all corroded and gunked up, they hadn't been taken care of in over 4 months. Since we weren't allowed to visit bc of legal battle with the POA, until we got an attorney, otherwise we would have caught it sooner. Anyway we reported it to our attorney, and the facility just made a bunch of excuses. Also the carpet smells like urine, and my dad is lying on the floor right there in that smell, and they said in their report back to the attorney, the carpet is fine and doesnt smell! Except it DOES bc I have to sit on it to talk to my dad who is on the floor and it wreaks! (He is not incontinent, it is not from him and it's disgusting). After the report full of excuses, a family member called APS. It is hard to find out what the results of the investigation are, it takes 30 days to receive the report once its been requested. Another thing that is just wrong is that when the CNAs go to pick him up off the mattress for transfer, they step on his bed in their shoes. Maybe time to call the health dept. too. I know some people here on this thread have said they would be okay with the mattress on the floor, but I think it's less than ideal, especially with tranfers. A hydrolic bed would be way better, and one that can go very low so he doesnt get hurt crawling out of bed. He doesn't understand what his call medallion is even for, so he has no way to call a nurse. Our experience when we were there was that it didnt matter of you used the wall call button or the medallion, they only answered 20% of the time, and even if they answer, it took at least 15 mins for them to get to the room. Half the time I run around the facility to find someone after the call buttons got no answer while dad is waiting to go to the bathroom. After a while we just started transferring him ourselves, then got scolded by the nurses when they finally arrived. And this place claims to have 5 stars. If I didn't live in another state I would be there with him everyday.
If you suspect Elder Abuse, and you are the children, you have every right, and a moral duty, to report the situation to Adult Protective Services. Have you done this, yet?
By the way, my dad is/was being kept there against his will, and he kept trying to escape. But they wouldn't let him leave. He wanted to go home, or at least get out of that hospital. But POA blocked us from getting any information about our dad, so we couldn't do anything to help him, he forbid everyone to talk to us if we called. My Dad would just call us begging us to get him out of there. It's been totally heartbreaking, we want to help him but this F-ing POA document doesn't have any guidelines for ethical behavior, POAs can do whatever they want, no matter how immoral or wrong, but they can get away with it because it's a legal document. I hate the POA as a document it gives too much room for psychos to take over someone's life when they can no longer take care of themselves. This whole thing has practically destroyed our lives. Now he's so debilitated that he can't escape, he crippled now, he was walking when he went in there 6 months ago. This whole thing is criminal.
The guy is both POA mental and health, total and complete nightmare. My Dad did want to change the POA when we talked to him about it, but when the facility manager found out we were there and talking to my dad about it, he told the doctor they'd slap a lawsuit on her if she did the witnessing on the change, so she backed out, and we didn't have anyone else to witness it. At the time he had enough where-with-all, but he had been diagnosed with dementia, my dad's lawyer balked at us and said there's no way anyone would honor it. The lawyer, consequently, was the guy who advised my dad to put this Agent "friend" on his POA, and this a Agent had only known my dad for 4 years. What lawyer does that? He ought to be disbarred. Now my Dad is too far gone, doesn't understand at all what is going on. He also tried to fire his lawyer around the same time he wanted us to be the POA, but the guy wouldn't go away, we also have a voice message he left my sister telling her to find him a replacement lawyer that he wanted to fire his present one. He was totally lucid at the time, speaking clearly and he was obviously disturbed about the lawyer, who had just "dropped by" un-invited on my father's dime, to talk to my dad at the hospital. He was already locked up, no way to find himself a lawyer by himself. He always called my sister and me when he needed something done. But since we are not the POA, (we are the 1st and 2nd Alternates on both POAs) we couldn't fire the lawyer, who is a crooked as they come. It's like living in the Twilight Zone, or being stuck in a nightmare you can't wake up from, having to deal with these 2 psychopaths.
Riley90, does his POA have Medical POA as well? Financial POA has nothing to say about where person can live. Does you Dad want to move? He has dementia, but does he still understand the concept of POA? Does he want to keep this guy?
My Dad has dementia, he is in a very understaffed facility. Unfortunately his POA Agent (long story, "Friend" 20 years younger who ingratiated himself onto all of my Dad's documents, unbeknownst to us, Elder Abuse Predator) won't let my Dad move anywhere else. We, the daughters, are not allowed to "Interfere" as the Agent calls it, apparently caring and advocating for your parent is "Interfering." Anyway, he is crippled (he was walking 6 months ago when they locked him up there, but Agent wont allow him to have PT, criminal) but he will crawl out of bed. So they put his mattress on the floor. But its really thin and I hate that it has no support at all. He is 86, frail. They put the gym mat next to his bed, but since he can't stand up it doesn't matter that it's squishy, as Samara said above, but if he could stand up it would be dangerous. He hates it and always tells us to move it into the corner. I wish they would just give him a low bed, that can go up and down for Wheelchair transfers. Then the mat would make more sense. If he had a low bed, I doubt he would hurt himself crawling out of bed. I hate the way he is treated there, it's like he has nothing and they are just waiting for him to die.
I have to wonder, while it is safer for someone to fall from a bed onto a gymnast-type of mattress, what about if they try to get out of bed the "normal" way swinging their legs around, and then they try to walk on that squisky gymnast-matt, isn't that going to make them dizzy and unstable, especially when it is dark at night? What a tough situation. Hope I never have to live like this (but genetics suggest I could go to 100 easily).
"unless you can get them a 24 hour sitter there is no reasonable way to supervise them enough to prevent a mishap" I so agree, vstefans! Same goes during the day, but it is probably worse at night. Dementia makes keeping someone safe harder!
They use a gym-mat type pad and crank my mother's bed way down low. And I would not object if they wanted to put her mattress on the floor, but it is really easier for them with an adjustable height bed so they can have her at a reasonable level to change her and dress her.
Looking for a different facility is all well and good, but how can you be certain the new place won't be understaffed next month, or will be as creative in problem-solving?
Olma - you've never seen even a gym-mat on the floor next to a bed? I think that's pretty common and pretty reasonable. Some folks don't sleep well, and particularly at night forget to ask for help to get out of bed, and unless you can get them a 24 hour sitter there is no reasonable way to supervise them enough to prevent a mishap.
Frankly, I've NEVER heard of this solution and I've worked in many nursing homes. I'm guessing they are understaffed and unable to monitor her properly. If she is able to fall or get out bed, she may be also be wandering. I'd look for another nursing home.
The mattress on the floor and a lower bed is an excellent non-restraint type of solution. Hip protectors that you wear are a possible consideration though the evidence suggests that "routine" use does not reduce fracture incidence. There are also bed alarms but frankly by the time a person gets up and you hear the alarm they might be on the floor. If a person can operate their own bed rails they shoudl not be considered a "restraint" and should be legal, but getting HIPAA and PLTC phobic people to think through that may be a challenge.
In New Hampshire, they can not use a hospital bed with full rails because that is considered a "restraint" and a violation of patient care in most facilities. My mom wanted a full rail but was told she could not have them. ;-( Putting one side next to wall is a good idea as long as bed does not move. Mattress on floor sounds good unless getting up and down is a problem. like the idea of mattress that slides under bed. Could that be used to cushion a tumble out of bed? Mattress on floor is better than broken hip or arm. Hope you find a good solution.
I just posted this answer in another question, it seems to fit here too: Hi there, I recently had to deal with this topic. My mother had started having falls which included rolling out of bed. Her bed is fairly low, and we recently took the oriental rugs out of her Assisted Living room to try to make a safer environment for her. One afternoon about 2 weeks ago, I got a call from the director of nursing talking about a mattress on the floor. She had me call SunCare (a medical supply store in central Florida) to order one for her. It was the best thing we ever did. The mattress is about 5 inches thick..a bit smaller than a twin mattress (it easily slides under her double bed during the day when she isn't in it), and the material is accident/liquid proof. It reminds me of a gymnast mat but thicker.
They have beds that are lower than the traditional hospital bed and still have side rails to protect the patient. I'm not sure where you're located but check to see if they have low hospital beds and the rails should be padded for protection against bruising and or/getting a leg/arm caught in the rails if the person is trying to climb over the rails or trying to get up and is confused they won't know the dangers. I had a patient that was in a room right across from the nursing station at the nursing home, fell out of bed and broke her hip. she died 3 weeks later due to complications of the hip fracture. They tried to cover up the fact that the nurse had left the rails down until I pushed for an answer not letting go then it was confessed. I'm a senior advocate, by trade and a care manager so I will not leave any stone unturned and will get to the bottom of any incident or injustice. Nursing homes must be closely monitored by family members, an advocate/care manager, etc. and the chart should be reviewed, not everything will be disclosed to family members and by the time red flags go up, it could be too late. I've been in healthcare 40 years so please trust that I know what I'm talking about.
Dr. Sheila
If a nursing home accepts Medicare, the nursing home must follow Federal Regulations which set forth the standard of care. One of these regulations is 42 CFR sec. 483.25 (h) which provides:
The facility must ensure that:
The resident environment remains as free of accident hazards as possible; and
Each resident receives adequate supervision and assistance devices to prevent accidents.
If the nursing home fails to comply with these regulations and a resident is injured, the nursing home is liable to be sued
More than 1.4 million people 65 and older live in nursing homes.2 If current rates continue, by 2030 this number will rise to about 3 million.3
About 5% of adults 65 and older live in nursing homes, but nursing home residents account for about 20% of deaths from falls in this age group.4
Each year, a typical nursing home with 100 beds reports 100 to 200 falls. Many falls go unreported.4
Between half and three-quarters of nursing home residents fall each year.5 That’s twice the rate of falls among older adults living in the community.
Patients often fall more than once. The average is 2.6 falls per person per year.6
About 35% of fall injuries occur among residents who cannot walk.7
How serious are these falls?
About 1,800 people living in nursing homes die from falls each year.1
About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures.1
Falls result in disability, functional decline and reduced quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation.5
Why do falls occur more often in nursing homes?
Falling can be a sign of other health problems. People in nursing homes are generally frailer than older adults living in the community. They are usually older, have more chronic conditions, and have more difficulty walking. They also tend to have thought or memory problems, to have difficulty with activities of daily living, and to need help getting around or taking care of themselves.8 All of these factors are linked to falling.9
What are the most common causes of nursing home falls?
Muscle weakness and walking or gait problems are the most common causes of falls among nursing home residents. These problems account for about 24% of the falls in nursing homes.5
Environmental hazards in nursing homes cause 16% to 27% of falls among residents.1,5
Such hazards include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs.5, 10
Medications can increase the risk of falls and fall-related injuries. Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs, are of particular concern.11, 12 Fall risk is significantly elevated during the three days following any change in these types of medications. 13
Other causes of falls include difficulty in moving from one place to another (for example, from the bed to a chair), poor foot care, poorly fitting shoes, and improper or incorrect use of walking aids.10, 14
How can we prevent falls in nursing homes?
Fall prevention in nursing homes presents multiple challenges. It requires a combination of medical treatment, rehabilitation, and environmental changes. Fall prevention interventions can be implemented at the organizational, staff or patient levels.15 The most effective interventions address multiple factors or use a multidisciplinary team.16
Fall interventions include:
Assessing patients after a fall to identify and address risk factors and treat the underlying medical conditions.6
Educating staff about fall risk factors and prevention strategies.10
Reviewing prescribed medicines to assess their potential risks and benefits and to minimize use.17, 18
Making changes in the nursing home environment to make it easier for residents to move around safely. Such changes include putting in grab bars, adding raised toilet seats, lowering bed heights, and installing handrails in the hallways.10
Providing patients with hip pads that may prevent a hip fracture if a fall occurs.19
Exercise programs can improve balance, strength, walking ability, and physical functioning among nursing home residents. However, such programs do not appear to reduce falls.20,21
Teaching residents who are not cognitively impaired behavioral strategies to avoid potentially hazardous situations is a promising approach.23
Do physical restraints help prevent falls?
Routinely using restraints does not lower the risk of falls or fall injuries. They should not be used as a fall prevention strategy.24, 25 Restraints can actually increase the risk of fall-related injuries and deaths.5, 25
Limiting a patient’s freedom to move around leads to muscle weakness and reduces physical function.3
The average rate of physical restraint use in nursing homes has fallen from more than 40% in the 1980s to approximately 10%.26
Some nursing homes have reported an increase in falls since the regulations took effect, but most have seen a drop in fall-related injuries.9
Direct injury from bedrails appears to be due to outmoded design or incorrect assembly; bedrails do not appear to inc
Take lots of pictures and document, document, document.
There has to be a middle ground, some room for interpretation of the circumstances. Seniors who cannot walk, but forget they cannot, could cause themselves great harm or death if the caregivers don't prevent them from getting out of bed/ chair. Personally I think restraints are just fine. But because of misuse by a few unscrupulous carers, now the seniors that really really need them have to do without, or their carers go thru massive red tape to get simple bed rails or seat belt approved.
What the facility did was put bumper guards around the bed, lowered the bed, and have rubber fall mats on both sides of the bed. These mats are soft but not like gym mats. In fact one can move a wheelchair over them without any problem.
They use a gym-mat type pad and crank my mother's bed way down low. And I would not object if they wanted to put her mattress on the floor, but it is really easier for them with an adjustable height bed so they can have her at a reasonable level to change her and dress her.
Looking for a different facility is all well and good, but how can you be certain the new place won't be understaffed next month, or will be as creative in problem-solving?
I'm guessing they are understaffed and unable to monitor her properly.
If she is able to fall or get out bed, she may be also be wandering.
I'd look for another nursing home.
Putting one side next to wall is a good idea as long as bed does not move. Mattress on floor sounds good unless getting up and down is a problem. like the idea of mattress that slides under bed. Could that be used to cushion a tumble out of bed?
Mattress on floor is better than broken hip or arm.
Hope you find a good solution.
Hi there, I recently had to deal with this topic. My mother had started having falls which included rolling out of bed. Her bed is fairly low, and we recently took the oriental rugs out of her Assisted Living room to try to make a safer environment for her. One afternoon about 2 weeks ago, I got a call from the director of nursing talking about a mattress on the floor. She had me call SunCare (a medical supply store in central Florida) to order one for her. It was the best thing we ever did. The mattress is about 5 inches thick..a bit smaller than a twin mattress (it easily slides under her double bed during the day when she isn't in it), and the material is accident/liquid proof. It reminds me of a gymnast mat but thicker.