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Since February 2020, while in assisted living, my 92 year old Mom has fallen and broken her hip and then had another fall and broke her leg. Currently in rehab, she fell out of her wheelchair this past weekend trying to get up by herself. Thankfully, nothing is broken. She has mild cognitive impairment that has been made worse by being isolated in hospital and rehab on & off since February due to our state restricting hospital and nursing home visitors due to the pandemic. I thought being in a wheelchair would help decrease falls, but not if she keeps trying to get out of it. I don’t want them to strap her to wheelchair. Has anyone experienced this? I am at a loss as to how to best help her.

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My aunt with advanced dementia has broke 3 bones in 3 falls in 2 years all while under the watchful eyes of her many relatives and hired agency caregivers. I do not think any facility can "restrain" a person, even in a wheelchair and even if they are a known fall risk. Her short-term memory is not allowing her to remember to stay seated. Even with a full leg brace on my aunt kept trying to get up on her own (she's 98). Just writing my experience so that you can know that even if your mom were in your home it may not solve the problem. For some problems there are just no good solutions and this is what I've had to come to terms with.
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I'm sorry to see this about your mother. Falls are so worrisome and for good reason. They can really cause a lot of injuries and disability. My LO used to fall so many times and got many fractures. Eventually, she stopped, because, she wasn't able to even try to get up anymore.

States differ on their laws, but, you might explore if it's possible to get her a geri chair on wheels. It rolls around, but, looks more like a recliner. The seat slants back. You might also ask about chair alarms that go off if they get out of the chair. Those kinds of things may not be possible, but, I'd inquire about it.

It's very difficult to await of falls, ER, etc. But, for as long as they are able, this may happen. Eventually, they may not recover from an injury or they progress to the point, that like my LO now, she is unable to move at all.
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PAH321 Jul 2020
Sunnygirl1 - I’ve never heard of a geri chair on wheels and am going to look into it. I’m sorry your LO experienced so many falls and now cannot move at all. It’s heartbreaking to see such a decline. Sadly, my Mom might find herself in a similar position someday, possibly sooner rather than later. Thank you for your response.
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I hope this proves completely out of line and unnecessary, but if I were you I would get someone reliable to check your mother over for pressure sores. It can be one reason why people become anxious to get to their feet and is at least worth ruling out.

What walking aids does your mother use when she needs to mobilise?
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Beatty Jul 2020
Good point. Sore tush = try to get up & move!
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Geaton777 - Yes, I wondered if being at home would help, but I would not be able to watch her ever second of every day and that’s all it takes for a fall - a second. Thank you for sharing that. My brother was convinced Mom’s facility was not providing proper care because she fell so many times. Although possibly the care could have been better at times, we are learning that she may (and probably will) fall where ever she is. Like you said, it is a problem with no good solution. Coming to terms with that is going to be difficult. Thank you for your response.
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You simply cannot prevent falls. Stand up from the chair you're sitting in. Took like 3 seconds right? That's how long it takes a senior to try to stand and fall. It's inevitable unless you literally have someone sitting within meter of her starting at her 24/7, or strap her to the chair which is usually illegal.
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PAH321 Jul 2020
ZippyZee - So true. Thank you for responding.
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They fall. Initially, they trip and fall. Then they fall because they forget they cannot walk and try anyway. Facilities are no longer allowed any restraints no even wheelchair seat belts so there are more falls. She will fall at home too. It is easy to blame the facility but it is usually not their fault. Falling goes with the territory. There really is nothing you can say to remind them or keep them in the chair. I don’t know if taking them to the toilet every 2 hours helps since they may have to go and that sensation prods them even when they are incontinent. My MIL who tried to get up all the time, was found to have UTI. But other times she fell and there was no UTI.
The Geri chair or even a reclining wheelchair may help since it will take her longer to get up when slightly reclined. Elevating her feet may help in chair. Also, the Geri chairs are big enough that her feet’s won’t touch the ground and again, that makes it harder to stand up. Her bed should be kept at lowest position and padded mats put around bed so she will land on them.

Falling ultimately killed my MIL. She had significant dementia. She was obsessed with going to the bathroom. She would never agree to a walker. She fell and broke her hip on way to bathroom. She had surgery and the bone healed but she was more confused and really never was able to walk well afterward. But she persisted to try to get up with repeated falls out of bed. She stood up suddenly in wheelchair in the dining room while at lunch table and fell over, hitting her head on sideboard. Nothing was fractured this time but she was in constant pain from the fall. She was already on hospice, so her pain was managed. She stopped eating and died within 2 weeks of the final fall.

I only tell that story to illustrate how this progresses. The facility was great with her but she was so determined. She was 92 years old, and only weighed about 95 lbs. I don’t mean to be fatalistic but there literally was nothing we could do. I am a retired nurse, from back in the day when we could used restraints and belts but they would get free of those and fall anyway. So maybe try the chair options even if you have to rent one. And have them check for UTI just in case. And be at peace that there is little you can do. Bringing her home is not the answer. She will fall there too and if family members who don’t understand want to lay blame, they will blame you.
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XenaJada Jul 2020
^^THIS!^^
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HI PAH321,

I agree with most of the replies posted. A long, long time ago I worked in nursing homes myself and restraint of residents was a common place procedure when it was determined they are high risk for fall injuries. If you don't have the funds to hire a private sitter for your mother, her continued falling is probably inevitable and that is very unfortunate. We now know that elderly falls can contribute significantly to a shortened life span. My family is getting ready to put my mother in assisted living and I plan to give them permission to take want ever steps neccesarily to prevent her injury and keep her safe. That's the reason we're placing her there. Good luck to you.
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PAH321 Jul 2020
Johnson1 - In case I can help someone with what I have learned, I’d like to tell you to thoroughly investigate the types of assisted living facilities (and what type of care they are licensed to give) available in your area. I thought they were all the same — they’re not. My Mom’s facility is now refusing to take her back after these 2 falls yet another is willing to take her due to different licensing by our state.
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I've lost count of how many times my 93.5 y/o mother has fallen; I think she's up to at least 46x now. She's been wheelchair bound since May of 2019 which I too thought would help stop the falls, but nope. She's still as stubborn as hell and determined to do things independently that she has no business trying to do independently, so she falls. She lives in Memory Care so I am the one who gets all the calls. One day, she fell twice in one day, about 4 hrs apart. She's broken ribs and sternum bones in her various falls, but has NEVER taken a trip to the hospital for one of them, believe it or not. And yep, she has bed and chair alarms in her room but guess what? By the time the alarm goes off, it's too late to STOP the fall from happening. Trust me, I know; I am an expert on the subject, unfortunately.

It's nobody's 'fault' but my mother's that she keeps falling, in all truth. If she would agree to play by the rules, 80% of the falls could be prevented, at least. But as long as she's living and breathing, she will continue to do things 'her way' and as a result, we all pay the dues. "Tying someone down" to a wheelchair is no answer, either, b/c it's against the law. So just allow your mother to live life as SHE sees fit, while YOU keep visiting her at the hospital and rehab, what else can you do? You can't help a person who refuses to BE helped.

Good luck!
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NobodyGetsIt Jul 2020
"Lealonnie1"- is she one of my mom's long, lost sibling? LOL! - couldn't agree with you more!!
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Dear PAH321,

My mom had always been an active and strong person. In 2014, she was diagnosed with Alzheimer's and I moved her into an AL facility in early 2015 at the age of 90. She was completely mobile as well as able to dress herself. I still remember when she had her first fall, I was extremely upset even though she didn't get hurt other than a black and blue eye. Another year went by and she fell again - no injury. Another six months from that fell again - still no injury. It is so common for the elderly to fall. I know my father-in-law would fall and he was a big guy but, it was always upsetting. For me I just hated to think "how long were they lying there before anyone noticed?" - especially for my mom who would never push the "call" button.

She is now 95. After she nearly died from severe dehydration and getting the COVID virus in April, she has fallen at least seven times in two months. She is too weak to walk so now she has a wheelchair but, always requires assistance. They can't restrain her. Maybe it's so no accusations can be made - I don't really know. But, the problem is when she as well as your mom are trying to get up on their own either because they don't use their "call" button or they don't want to wait for someone to come and assist them. In my mom's case, they pushed one side of her bed against the wall so that eliminated one way of falling out and then hospice provided a "fall" mat which they place beside the other/open side of her hospital bed at night. That's when she fell most often - I suspect she wanted to use the bathroom even though she wears depends. However, now that hospice has given her a low dose medication to help take some edginess off (as she would get agitated/combative occasionally) and to help her sleep through the night, the amount of times she's fallen has significantly decreased. She has fallen maybe once or twice during the day but, I know my mom - she's a very independent person who was the oldest of 8 siblings - so she gets up even when she knows she shouldn't! But, I don't think I will ever come to terms with this aspect so I feel for you especially, because your mom has broken her hip and leg which as we know can cause a quick decline or worse. I'm sure there are a lot of others on this forum who will be able to help you and I wish you and your mom the best!
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PAH321 Jul 2020
NobodyGetsIt - Hi, it’s a tough journey isn’t it? Despite everything, my Mom tries to be very independent as well (to her own detriment). When I suggest she ask someone at the facility for help with something, she’ll tell me she hates to bother anyone. No matter what I say, it’s her nature, and she isn’t going to change. I’m sorry your Mom had COVID, dehydration and subsequent weakness and falls. People often tell me they wish they would live to 92 like my Mom. Sometimes there are 92 year olds who are still doing pretty well, but I think most are not. To me it is a ‘be careful what you wish for’ scenario. Best of luck to you and your Mom as well!
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*High vis* needed. Seated in a high visibility area, lounge etc where staff either constantly are or can see at all times. The trick is for the staff to get there before/as she gets to her feet. Even then, sometimes they are up, wobbling, grabbing then falling in seconds.

So sorry this is happening.
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disgustedtoo Jul 2020
Sometimes there is no one in the "High vis" area. Mom's MC might have some staff in/near the kitchen area or helping others in that area, but I have been there when they are off dealing with other residents and there is no one to 'vis' anyone. There are only so many caregivers and more residents than that, so, it will happen.

Even if they are in the "High vis" area with someone in attendance, unless they are virtually glued to the person's side, a fall can still happen. In order to have someone "glued" to their side, it would likely have to be a hired person, adding to the enormous cost of MC, and even then, that person will need a break, even if just to use the bathroom.

No really good solution to this issue. It's one thing if someone is just obstinate, but dementia brings a whole new issue, since they will forget they can't stand or walk.
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With dementia, it is hard to keep falls from happening if the client has poor balance and/or muscle weakness. All facilities try to avoid falls but have come to the conclusion that some falls will happen and strapping people down leads to other problems. So fall management is more the current trend: beds really low to the ground, thick mats on both sides of the bed to absorb impact, no tables next to the bed, keeping clients in high visibility areas with staff nearby, keeping clients pulled up to tables, toileting schedules, exercise classes...

We used to think that people fell and then broke their hips. Studies have shown that many of those falls are the result of osteoporosis; the person's hip fractures under their weight and the person falls afterwards. The same may also be true of falls with leg fractures. Please have your older loved ones evaluated and treated for osteoporosis.
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disgustedtoo Jul 2020
Can't hurt to ensure osteoporosis isn't involved, but then again, my mother has had this for MANY years and as a result has the old "dowager's hump." "A dowager's hump is usually caused by vertebral fractures due to osteoporosis." It can be due to other conditions, but in her case it is because of osteoporosis. She's never taken any of the "drugs" they offer (these have been suggested/offered to me several times and there is NO way I will consider taking them! reading up on them, sometimes the "cure" is worse than the "disease"!)

It is likely she had a couple of minor falls when still living alone. I didn't get to see the bruising (YB wasn't smart enough to take a pic!), but she did bruise one of her knees. By the next visit from me, the bruising was gone. The last injury at home was, in a sense, a bit of a godsend because it allowed us to present a fib to get her to move to MC. She bruised her shin and developed cellulitis. At that point, dementia overrode her previous plan to move to AL - she refused to consider moving anywhere.

Since moving to MC, she has had falls, more often than not just tumbles, with no real injury. Maybe just lucky, who knows? Initially she walked unaided and was able to dress, shower, and get around okay, it just wasn't safe to leave her in her home alone. After a few years, she decided she needed one of "those", pointing to another resident's rollator. I brought the one she still had from dad, but it took many months before she really started using it (more likely felt she needed it to 'fit in' than a real need.)

Many months ago (she has been there 4.5 years now) she started having fears of standing and walking on her own - more likely mostly anxiety and weakness from NOT walking enough (she likes to sit and read most of the day!) The aides would "help", but merely be touching her, but it progressed enough that she's in a wheelchair now. No falls as yet from that, but has had 1-2 times at night, apparently trying to get to the bathroom.
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There are some great posts here and unfortunately most of them are spot on - it is quite impossible to prevent falls in the determined elderly if they are able to move. Even within line of sight at a facility...the nurse turns to answer the phone and in that second.... the resident attempts to stand and crashes to the floor. 24 hr/ resident sitters have to go to the restrooms themselves and so there may be minutes when there are no "close" eyes on the resident. Tying someone into a wheelchair is a serious "no no" in most states. Geri chairs (they recline so the resident's feet are off the floor and usually have deep seats to make getting up difficult) are one solution you might try but you will need to check with your facility to see if it can be accommodated in her space. You could ask the rehab facility to try her in a Geri while she is there because they might have access to one while the AL will probably not. If her behavior continues you may want to discuss with her AL if she needs to move to another sector upon her return. AL only provide a mild "assist" with activities of daily living and have even less staff that MC or rehab facilities. She may now need more care or watching than the AL can give. Best of luck to you and the family.
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PAH321 Jul 2020
geddyupgo - Yes, I really must look into the Geri many here have mentioned! Yes, we did look at one facility which provides a higher level of care than the facility she was in before the fall. We’ll see what happens. Thank you for responding.
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There is NOTHING you can do to prevent every fall, short of hiring someone to sit less than a foot away and stare at her and be ever ready to prevent her from getting up on her own.

I had guardianship over a relative who was in a Memory Care facility. She fell 3 times in one week, each time requiring an ER visit. She finally broke her kneecap, which was the beginning of the end for her.

Everyone's suggestions of a bed that is low to the ground, padding around the bed at night, furniture with rounded edges and pulled away from the bed at night, geri-chair, etc. You can do things to mitigate the risk, but sooner or later, it WILL happen.
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PAH321 Jul 2020
XenaJada - Yes, I am learning how inevitable another fall will be. Thank you for responding and sharing your experience.
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My mother has a custom reclining W/C with seat belt and is very comfortable. I know it is considered a restraint, but try discussing it with her primary. Medicare will pay for the W/C if she qualifies. My mother has severe spinal stenosis so she qualified. The doctor needs to fill out a form and sent it to Medicare. Once they review it, you will be notified. The W/C is high quality and is a life saver for my mom. Doctor should speak to the administrator initially before moving forward. Good luck!
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PAH321 Jul 2020
earlybird - I didn’t realize there could be such a difference in comfort in different wheelchairs but it sure makes sense. I’ll investigate. Thank you for responding.
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wheel chairs are horrible -- try sitting on one for hours and see how they feel like.
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earlybird Jul 2020
cetude,
My mom has a custom w/c which is extremely comfortable. It is more comfortable than her recliner. Physical Therapy was amazed how functional it was for elders with potential for decubitus ulcers . My mother travels a long distance to see her urologist and she has no complaints of pain. She was able to go on long vacations due to this chair. She could not with other chairs for they were quite uncomfortable. This particular w/c gives her a high quality lifestyle. She has severe spinal stenosis and does not have pain when she sits in it. Would highly recommend this chair for elders with potential for breakdown, pain and safety!
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My sudden trips due to bladder urge incontinence were diminished by halving caffeine intake and taking oxybutinin for bladder relaxing. I am 83. Tried cold turkey total caffeine avoidance but just couldn’t wake up, so only one cup coffee for me now. But good to know it is an easy option to prevent falls. I live at home with my daughter.
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PAH321 Jul 2020
Mcooney1937 - Interesting.,.. I wish caffeine reduction was something I could try, but my Mom has very, very little caffeine in her diet.

I’ll have to check with her doctor about bladder relaxing. I don’t know if her bladder needs relaxing, but it’s worth finding out more about this. Thank you for responding.
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They do make a tray/padded thing that keeps someone from getting out of the wheel chair. They also make alarms that warn that a person is attempting to get out of a bed, so you could probably use it on a chair.
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PAH321 Jul 2020
my2cents - Interesting ... I’ll check into the tray and try to find the padded thing you refer to. Thank you for responding.
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As XenaJada (and others) said, there are ways to reduce the risk, but there is no 100% method to eliminate falls. Until they are fully bed bound and can't get up, falls are a risk. There isn't a whole lot any of us, including staff, can do to eliminate this issue. For those with dementia, this is a higher risk, because they forget they can't stand or walk.

"My brother was convinced Mom’s facility was not providing proper care because she fell so many times. Although possibly the care could have been better at times, we are learning that she may (and probably will) fall where ever she is."

Hopefully the WE in 'we are learning' applies to your brother. As many have stated here, there is no foolproof way to eliminate falls. They happen in their/our homes, even when family is care giving, they happen in NH, AL, MC, rehab. It just goes with aging and especially when dementia factors in.

Hopefully when rehab is done you will consider moving her to MC, not back to AL. AL can assist with some needs, but isn't geared to watching anyone all day every day. There should be more staff per person in MC, so she would have more eyes on her, but there is no guarantee that she won't fall there either. IF she is still in the early stages of dementia, perhaps you could get PT/OT set up after she moves to MC. Mom had knee pain, interfering with standing and walking, and they were able to get her mobile again, for a bit. Once she started fearing standing and walking, they tried again to work with her, but she wouldn't do anything they asked her to try - their last attempt was met with YOU do it!

There was a woman in mom's MC who was still able to manage her TV, use a computer and phone, and walked with a rollator. She was 99 when she moved in and almost made it to 101! I interfaced with her a lot when visiting with mom. She was a lot more "with it" than many in the MC area. Clearly as she neared 101 I could see some decline, but the last time I saw her, a week or 2 before she passed, she had a terrible fall. The side of her face and down her neck was badly bruised (I think she hit some furniture in her room on the way down.) She had other medical issues ongoing and was on hospice as well, but this fall was certainly a catalyst in her passing.
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PAH321 Jul 2020
disgustedtoo- Yes, the ‘we’ included my brother. He went from (1) insisting that I try to ‘get it in writing’ from any facilities we looked at that they would help with all transfers to (2) recognizing that Mom isn’t always pressing the call bell and a fall can happen anytime, anywhere. So I think that’s progress.

I have thought about memory care but all the memory care units I have seen in my area are locked units. Thankfully, Mom doesn’t wander. And she is still mentally with it enough to recognize that the unit is locked, the knowledge of which would be very upsetting to her.

Yes , I’m definitely going to get physical and occasional therapy going when she leaves rehab.
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If the chair is adjustable tilt the back backwards a bit. This makes it a bit more difficult to get out of the chair.
She also may need more "supervision" than she is getting in AL.
Chair alarms. Bed alarms. Placing the bed lower to the floor. Putting a mattress on the floor next to the bed will provide a "softer landing spot" if she tries to get out of bed unassisted.
They can not "strap her into the chair" that is considered a restraint and are not legal to use virtually every where.
But as you have gathered from the responses a fall is inevitable. With luck with no injury.
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PAH321 Jul 2020
Grandma1954 - I’ll look into all of your suggestions. Thank you for responding.
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When my late mother was 92, falls started at home because of her mental decline. A final fall at home caused a fractured pelvis then landed her in nursing homes. Even with staff available more falls happened because she would not ring for help. She just did not know the difference and often forgot how her injuries happened.
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PAH321 Jul 2020
Patathome01 - I’m sorry for your loss. (You don’t say when she passed, but I don’t think the pain of missing a Mom ever goes away.)

Yes, I can see a downward spiral with my Mom. I tell her over the phone (she is in a facility for rehab currently) not to try to get out of bed (or wheelchair) by herself, but I feel like it is not sinking in.

Thank you for responding.
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PAH: I see by your profile that your mother suffers from Alzheimer's. With the disease of the brain, she is not going to remember that she shouldn't rise up out of her wheelchair by herself. Place an alarm on the WC.
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PAH321 Jul 2020
Llamalover47 - She has mild to possibly moderate cognitive impairment. (I’ll have to look at my profile and see where ‘Alzheimer’s’ came from. Maybe me? Maybe there was not a selection for cognitive decline? I’ll check.) Either way, I understand what you are saying about diseases of the brain and the inability to remember not to get up by herself.

Anyway, I’ll look into WC alarms. It is still unclear how much she will be using a wheelchair versus walking with a walker, but I’ll definitely look into WC alarms.

Thank you for responding.
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My relative fell this morning 🙁. Not injured but unable to get up. I wonder how long the non-emergency EMS will take in our current state of emergency & lockdown situation.
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PAH321 Jul 2020
Beatty - I’m glad your relative was not injured when he or she fell.

Both times my Mom fell at a facility. As far as I know, the emergency EMS came fairly quickly. Arrival time didn’t seem to be affected at all by the pandemic.

Thank you for responding.
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Even being right with my LO a few feet away barely helped me prevent my LO’s fall. Her balance and judgment were so poor that she let go of her walker and walked around it! There was no reason for this. She started to fall straight back when I was able to jump behind her and catch her. It was barely possible and I was right there, so even if a hired person had been near, it might not have helped.

Later, after many falls and fractures she ended up in a wheelchair, though not due to falls, but progression of her dementia. Sometimes, she would try to get up from wheelchair and fall. Somehow they were able to use a belt alarm to alert when she tried to get out of the wheelchair. It was said it was legal, because she was able to unsnap the belt. Even with substantial dementia and no speech, she would play jokes on the MC staff. She would get this devious look on her face, disconnect the belt...it would alarm...a staff member would head down the hall towards her location, but before she got there my LO would reconnect the belt, so it’d stop alerting..,then she’d grin real big! Like she got one over on them! I couldn’t help but laugh.
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PAH321 Jul 2020
Sunnygirl1- Awww... that gives me a smile. God bless her! Thank you for sharing and thank you for your response.
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YES! my mother is almost 100(next month) This isolation has wreaked havoc on all the elderly! In my mom I have noticed great deterioration since the isolation. She lives in Assisted Living, has a pendant, but now she is forgetting to push it for assistance, last week she got up 3 times and fell, luckily no injuries. I think it is increased Dementia, her brain is telling her that she can walk around?? Anyway, the hospice is suggesting an alarm in the seat of her chair and wheelchair, at least until we can move her to a board and care where there are less people and more eyes on her.
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PAH321 Jul 2020
Cares4123 - I’m glad there were no injuries in your Mom’s most recent falls.

Yes, I think your Mom’s dementia worsening might contribute to the falls. (I think my Mom might have the same issue.)

I’m curious what a ‘board and care’ is? I live in New York State and am not familiar with that term. I am wondering how it differs from an assisted living facility.

Thank you for your response, and best of luck to you and your Mom.
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I cannot and will not speak for others but if she was in MY care, I don't care what anyone would say, I would strap her down into the chair so she could NOT get up and fall. And if you are unwilling to do that, then please place her - or live with it if she falls.
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PAH321 Jul 2020
Lockett2166 - Both times she fell were at the assisted living facility she was living at. At that point, she was still walking with a walker. The most recent fall was out of a wheelchair at the nursing home she is in for short term rehab due to the 2nd fall. As others have said, I believe straps are no longer legal here in our state in facilities. She will be going to a different facility soon as rehab is finished.

Thank you for your response.
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My heart goes out to you PAH321. Falling is a very real concern - but when it comes to broken bones and the suffering that goes with them - I opt for the strap, without question. My Mother has dementia with Sundowners and there are times when she is just out of control. I put her in her rocker (soft cushioned seat) and strap her in with a cloth strap and after about ten minutes of trying to get out of it, she's fine.
I'm surprised they don't have an alarm on her wheelchair. The alarm lets the caregiver know immediately when the weight comes off the chair.
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PAH321 Jul 2020
dlpandjep - I think I might feel more comfortable with a strap if she were living in my home, and I would be sure it was used properly.

However, I think others have mentioned that straps are no longer legal in nursing homes.

I honestly don’t know why they do not have an alarm on the wheelchair??? Something to look into.

Thank you for your idea and response.
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Back in 2013, I visited someone in a care home that had an alarms next to beds to sound if a resident starts to get up, alerting staff to assist. That place is more expensive than places without alarms but worth it if financial resources are available.
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