My mom is 94 years old with moderate dementia. She broke her hip last week, a displaced femoral neck. We have opted not to repair with surgery due to risks with anaesthesia and her dementia, a recent heart event, and her risk of falling again.

She's back at her home in a memory care unit in a level 6 assisted living home, and in the first 24 hours she has already used the commode on her own and got herself halfway across the room before falling. Thankfully she did not further injure herself. She did join the other residents in the common area and was quite jovial, and we know she gets good care at this place.

How do we keep her safe from falling again? There is usually an aide within sight if she's in the common area, but what about when she's in her room? Even if we pay a sitter, they only need to turn their head or blink and she can be off again. There are no restraints or alarms allowed where she lives and I think that goes for skilled nursing facilities also.

Any similar experiences or advice?

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For whatever reason, elders don't want to use the walker and would rather risk falling instead.  Every time I had turned my back, my mother was ditching her walker! If you're not allowed to put an alarm or some kind of other device to indicate that they are a fall risk, I do not know what the answer is. Tough one.
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The reason that bed rails cannot be used is because in 1990’s residents put their head through the railing or between the railing and bed mattress; then their body would fall off of the bed resulting in strangulation. Not a nice thing to find when you are checking on a resident or patient. There were news articles in the nursing journals/magazines about this problem.

Chair and bed alarms CAN be used in nursing homes. There are pad alarms that sound when the resident attempts to stand up; and alarms that clip onto the resident‘s clothing and when the resident tries to sit up in bed or stand up from a chair, the string is pulled away from the magnetic pad activating the alarm.

One time Hospice was allowed to use side rails on a hospital bed because the resident preferred to lie on his right side and he would lean his body into the railing. Because the railing was used more as a body support than as a restraint, Hospices was allowed to use it in our facility. They did have to put a long body pillow between the resident and the bed rail to cushion the resident's body as it lay against the bed rail.

FYI: Medicare and Medicaid say that "the resident has the RIGHT to fall." That is the response our Nursing Director got when she asked why we couldn't use bed rails or restraints.
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Wow, this is rough! I'm going through this with Mom too. I put the walker right in front of her, when she's in her chair. Don't you know she moves the damd thing and walks around it. I just went to the store, hubby told her 10 times in an hour to use the walker!

I'm going to tie a string from her wrist to the walker, so she can't move without it.
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This is an ongoing problem with my mother, who has mild vascular dementia. I've had her in a nursing home for the past almost three weeks because I had to travel for work, and I also combined that with a little time off for me. She fell twice there. Now I'm going to bring her back home, and when I'm gone, I hire an aide. The aide and I literally can't turn our backs on her long enough to go to the bathroom and she could get up. We have to say "no getting up" before we even step out of the room. It's worse than taking care of a toddler! This is why she needs 24/7 care.

Mom has severe arthritis and has had a stroke, and she can barely stand up and take a few steps with her walker, but she either forgets she can't walk unsupervised, or else she is stubborn and tries anyway.

At the nursing home, when they didn't answer her call bell soon enough, she tried to take herself to the potty. She talks about getting up and going herself when she's home. It's a constant fear. So all we can do is the best we can, and Amy is right, we have to let go. I tell Mom over and over that if she falls and has a hip fracture, or a severe brain bleed because she falls, then she will have to live in a nursing home permanently, but she refuses to listen. They can't even use chair alarms in the nursing home now, but at home I'm seriously considering using her gait belt as a seat belt and strapping Mom in the wheelchair. At least she can't get the rails down in the hospital bed, so when she is down for the night I can at least sleep.

They fall all the time in nursing homes. It sounds like you're doing all you can.
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After my Dad's stent procedure he was suppose to stay in bed with limited movement. Each time he woke from a short nap or deeper sleep he would start to get out of bed. I placed a chair in his sight line and each time he started to get up would ask "Where are you going Daddy?" and he would lay back and look at me. Sometimes he would say "no where I guess" and sometimes he didn't respond verbally but he always resettled. I would ask him if he need a drink or something else to get comfortable. If he said he wanted up I would remind him that he was suppose to stay in bed until the cath wound had healed. I came to believe he was disoriented when he woke in the hospital room and settled once he recognized my voice. I'm not sure how that would work with a sitter, but maybe if you could find someone she knew before the dementia took hold?
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Amy, you are so right, you could have a room filled with nurses and aides, and Mom could still fall. It is what they do.

My Mom was always falling because her mind told her she could stand and walk, but in reality she couldn't do either. The Staff tried a variety of things. Mom even would fall out of her wheelchair when she was trying to pick up something on the floor [there wasn't anything on the floor]. Finally a geri-recliner would slow down my Mom when the nurses put a pillow under her knees, worked fine until Mom learned to pull out that pillow.

Alarms do ring, but by the time a nurse or aide hears the alarm and races to the room, the resident is already on the floor.... [sigh].

One positive note, your Mom enjoys being around others. That is super great :)) So many residents refuse to socialize.
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I was guardian of an elderly aunt with Alzheimer's several years ago. She was in a MCF. I had a very similar situation happen. This is what I learned.

Restraints cannot be used in any facility, even SNF. Some types of alarms can be used at SNF, but not ALF. Bed rails cannot be used at ALF or SNF for dementia patients as there have been instances of them putting their head through the railing and getting strangled. Who would even think of that?

There are other devices used to "protect" the patient. There are hospital beds that will lower almost to the floor. The elderly patient, especially one with a broken hip will be highly unlikely (but not impossible), to be able to get herself up off the bed to go anywhere if it is that low. Someone has to ensure there are no chairs, walkers or sturdy furniture near the bed to be used for pulling up. There is also a mat that goes next to the bed in case she does get up and then takes a tumble.

In SNFs I've seen wheelchairs that sink way down in the rear of the chair, almost impossible for even a young, agile person to get out of. The person is still able to scoot the chair around. SNFs are allowed to use a type of lap pillow that sounds an alarm if the patient tries to get up and the pillow falls.

You are correct that a sitter cannot prevent every fall. That is where people need to just learn to let it go. Unless you are sitting there 24/7 holding onto your mom, she IS going to find a time when nobody is looking and will get up.

Even patients who don't really have dementia will fall. My granny did this several times. Her thinking "I just hated to bother anyone. I just wanted a glass of water at midnight."

You can only do so much - clearing obstacles from the floor, using the tools mentioned above, protecting corners of furniture so she won't bump her head if she falls (my aunt did this).
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