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She has dementia..She fell last night and had to go to hospital. She had injured her hip about six months ago and was in a lot of pain. The doctor was waiting for a slight fracture to heal and was going to do a hip replacement, but her pain went away, so they decided to leave it alone. She has been doing physical therapy doing pretty good, until last name night's fall. Now that put all her progress back to step one. They put her on pain meds and sent her back to the center. She is wheelchair bound, but insists she can't wait for help to go to bathroom at night, even though she wears depends. So, she gets up and goes on her own. She has even been making her bed. We had her bed moved so it could be hooked up to the alarm to sound when she tries to get up, but she talked someone into moving it back. She said it was too noisy on that wall, even though it was only about 10 ft. away from the other wall. The plug is only on that wall, so for the alarm to work it has to be on that wall. She says she doesn't want to bother anyone for help. Our family can't take care of her at home, we own two businesses and my two brother-laws work out of town. My husband isn't the main poa, but has had to make all of the decisions and we don't know where to turn next. I think the center is understaffed as it is. There are only 45 or so residents, but at night there are only like 3 attendants. They gave her an alarm button to use if she needs help, but it is huge, and she says she doesn't understand how it works. You just push the red button down to turn it on, but she thinks it is a telephone. Any suggestions? Please.

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nancy2275: Unfortunately, it's very difficult for your dementia-ridden MIL to learn a new skill...yes, just as simple as pushing a red button to call for the nurse. It's huge for a reason, but that still won't assist a person with dementia. It's akin to teaching a normal-minded person trigonometry! These facilities are understaffed, but she should NOT be arising out of the wheelchair alone. "She doesn't want to bother anyone for help" is a typical elder's response, BUT.........SHE MUST!!
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Falling is a common and complex issue. You can try everything, but an all night sitter sounds like the best option. Of course, not everyone can afford to pay for that.

A bedside toilet sounds good too, but depending on the degree of dementia, it may not work. In my cousin's Memory Care facility, she nor most of those residents would realize what a bedside toilet is for. Plus, pulling down panties or Depends, getting up and down.....they are not capable of doing that. They don't have the ability to use their hands anymore and many aren't aware of their surroundings.

I know that with my cousin, who is double incontinent, doesn't really have the ability to plan a bathroom trip. She doesn't even realize when she's urinating, yet, she will get up during the night and try to walk. We guess she's going to the bathroom, but, it's almost like she's just up and walking. It's not the purposeful walk to the toilet that you might expect with a person who doesn't have dementia.
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My mother had dementia and was falling down in her house every week. Talk about a nightmare! When I finally got her on Medicaid and into a nursing home, it was such a burden lifted, it was 'over to them' to worry about! Well, she fell down in the nursing home. Got up in the middle of the night, 3 a.m. and walked down the hall toward the nurses station, fell before getting there. She had been there over a year and had never gotten up and walked around unsupervised before. She broke her hip, was taken to the hospital, they put a pin in it, and she was taken back 3 days later. Is doing fine, she will outlive me. I must say, I am amazed a poster here has a relative in a home AND is paying for an all night sitter. Must cost quite a bit to keep the dear 93 year old lady safe and sound.
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I don't have anyone in a facility but my Aunt is here with me. We have a bedside potty. Wouldn't that help? Maybe because she didn't have to walk to bathroom she won't fall?
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There are fall safety pads for beside the bed but get non skid. A toilet schedule. Problem with bedside commode is it may encourage her to get up by herself. Extension cord for alarm.
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Would they let her use a bedside toilet. I have one for my wife, at home, which she uses during the night if she needs to. She is considered a fall risk.
Don
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MsMadge I'm impressed you didn't drop your Starbucks. You go Girl!
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Yes falls are inevitable - I fell a couple of years ago at work in the plaza in the rain - my hip has hurt ever since - but I didn't drop my Starbucks

My mom has had at least a dozen bad falls - three right in front of me
She has broken ribs, shoulder, back, wrist , ankle and has hit her head so many times it's no wonder she's now demented - add a torn tendon in her foot and it's a wonder she can walk at all but she's a big strong Viking and has controlled diabetes so pees a lot and won't go in a diaper unless by accident -
of course peeing on the carpet on the way to the bathroom was not a problem - insisting she hadn't left the trail of spots it must have been water from her hands - but I digress

Of course her 20 something caregiver has fallen 3x this year too - once during her overnight shift at 2:30 am

FF - I wear progressive lens glasses - think trifocals - the first 2weeks I was afraid to walk anywhere and stairs - forget about it - long before the scandals came out, Bill Cosby had a fabulous tale about getting trifocals at age 50 and how a curb seemed like it was three feet high but I digress again

Sunny girl
I hear the Carolinas are beautiful but afraid a move across country isn't in the cards - I'm only allowing a tiny dose of seroquel which knocks her out within an hour only if she swallows it - she'll only take it by mouth for me and most nights they either out it in coffee or ice cream to give her but she's onto them and if she feels it in her mouth will spit it out - she's always been a light sleeper so if she goes 3 or 4 hours without waking it's a good night for her but add any stress - UTI - a cold - men coming into her room or a screaming roommate into the mix and she can wake up multiple times a night .....
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Granted, I suppose that looking in on the resident is a good thing, I just don't see how that helps prevent the resident from falling if they get up and are not able to walk. In Memory Care, it's unlikely that a resident is going to reason that they will wait for a person to come on their hourly check-in.
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When my Mom was in the nursing home I was told that they looked in on Mom every hour. When I was there visiting her they checked in religiously every hour. My Mom said that they did when they knew I was there but that they didn't when it was just her. I hated not believing my Mom but since there was really no way to check up on that I had to just hope that they were.

Either way my Mom managed to fall at least three times that I knew of. She was only there for a year before she died so three times in one year she had fallen. Which doesn't sound like a lot until you think of a woman in her nineties with fragile bones and all the complications that come with that.

I guess unless we stay there with them 24/7 there is nothing we can do except hope and trust that our seniors are being given proper care.
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Hey Nancy, if she needs the bed alarm, then her bed needs to be where it needs to be. I'd find out what the foul up was and have it fixed pronto. Once the plan is established, people who are not able to think or process information or staff who are not in the loop don't have the right to move furniture around that can thwart a safety plan.

Keeping in mind that nothing can fully guard against falls. But, if you have a fragile senior with severe dementia and they have had repeated falls and repeated fractures over and over....,,.you feel the need to take some steps. My cousin had fallen on multiple occasions and fractured her spine, then hand, then left shoulder, then right shoulder, and then foot. The last fall, she didn't get any fractures, but we had to do something. So far the belt and night alarm are working. Knock on wood.
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Jeanne is right, even us caregivers can fall. I remember asking my parents [in their 90's] who is going to pick me up when I fall? They looked at me like my hair was on fire.

Well, one day I fell off my high heel shoes :P The shoes weren't that high but some how I turned my ankle and down I went. Broke my shoulder as I had reach out to brace the fall. Good grief, I use to be a hiker and never tumbled down a mountain. And here I fell in my office parking lot.

Oh speaking of glasses, I read where elders who wear bifocals are more opt to fall because they are looking through the reading portion of the glasses while walking. Ah, so that explained why my late Mom when outside walking was so extra careful around curbs, she had trouble seeing them, and would do her foot like someone does when carefully sticking their toes into the ocean.
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A physical therapist told me I was a "moderate risk" for falling. A friend with some medical training told me that was because I'm diabetic, wear glasses, and am over 60. I have no mobility issues, pain issues, or cognitive issues. Last night I fell in my bedroom. No consequences, thank goodness.

Old people fall. It is what we do. Some old people are even more apt to fall than average. This is sad. Minimizing the risk is the best we can hope for, in my opinion. Remove floor clutter. Strengthen legs with PT if appropriate. Make assistive devices (like walkers) available. Make sure glasses prescriptions are up-to-date. Blah, blah, blah. We know the routines (and we should follow them).

Persons with dementia often cannot make judgments in their best interests. Even simple judgment like "should I call for help as I have been told?"

So there are going to be falls. As others have pointed out, there can be falls with three other people standing in the room.

Do your best. And keep in mind that you are not responsible for the aging process or the progress of dementia. This is Not Your Fault.
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The alarm was on her bed, but she has to have the bed on a certain wall for it to work. She didn't like her bed there, so she had someone move her bed. Don't know why they moved it without our permission though.
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MsMadge, how is your mom taking Seroquel before bedtime and still getting up multiple times? That's really surprising. Most people who take that sleep pretty soundly.

I'm not that impressed with call buttons, because most residents in Memory Care would not remember what a call button is for. I would promote a bed alarm though. Although, if you are paying a person to sit with her all night, that might not be needed. Still, if you can't continue to pay the all night person, I'd insist on the bed alarm. I recall that you've had some issues with the facility, but this kind of thing is not that complicated. They should be able to figure it out.

It's great if the staff checks during the night on the residents, but a resident could attempt to get up and fall 2 minutes after they are checked on. If the resident is not controllable and keeps getting up and falling, I'm not sure what options you have except for the alarm and/or an overnight sitter. Oh, and figure out why she's getting up so much to use the bathroom.

There are some great Memory Care facilities in NC. If a move is an option, you can explore what is available. The costs are competitive too.
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FF
I hope they honor their word and check on your dad every hour but since I was told a similar story be prepared - like Nancy my mom's memory facility only has 3 overnight staff and close to 60 residents - so one check during the night is all that happens - when I'm there til 1:30 am sometimes the trio are in the common area on their phones etc

Within her first three weeks my mom was dehydrated from a UTI and fell in her room during the night - someone had put her walker in a corner
By the grace of god she didn't break her hip but was sent to ER and kept overnight for observation
Dr sent her right back the next day

Now that she's on seroquel which causes dizziness and drowsiness I have a caregiver overnight with her as she gets up to pee several times at night
I wish the facility had a call button - I insisted on a baby monitor but if no one is listening it doesn't matter

We don't have resources to continue to pay $5,000 a month for the overnight caregiver on top of $300 a day for memory care which as I've posted elsewhere is no care just assisted living for residents with disturbing behavior which frightens my 93 year old mom

I struggle everyday with what to do next
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Nancy, my Dad will be moving soon to a memory care room and the Staff told me what they do is check on the residents at least once an hour and at the time will ask them if they need to use that bathroom, that they would help. Thus a pattern will be set, hopefully less falls.
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I can relate. First of all, based on the fact that she's in Memory Care and that her representations don't really add up, I wouldn't take them as fact. Relying on her to use an alarm button is absurd in a Memory Care facility, imo. Most people at that level don't know what an alarm button is, nor would they remember to use it.

My cousin had similar issues with getting out of her wheelchair and bed and falling. She would forget that she couldn't walk and hit the floor. Her Memory Care, with doctor's orders, put an alarm belt on her wheelchair. It alarms when she unhooks the belt. She is able to unhook the belt and when it alarms, (which means a staff member will come to her) she then hooks it back. This seems to work.

AND they installed a bed alarm that sounds if she gets out of the bed. These alarms can be obtained that sound only for the staff member. The staff member can keep the monitor with them throughout the night and go to her if the alarm sounds. It doesn't have to sound in the patient's room, according to what I read. Plus, even if it did sound in her room, why would it matter, because that means she's already awake and out of the bed, so the only person it might disturb would be a sleeping roommate.

I have seen those bed alarms online. They have many types and are not expensive, though, the Memory Care should have plenty on hand. I would ask to meet with their team and discuss the PLAN for keeping her safe. This issue is very common for people in Memory Care, so they should have some good ideas for addressing her problem.

In most states the number of staff in Memory Care is regulated. You might check to ensure they are in compliance.
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This is very sad. I went through this with my mom. She also couldn't figure out how to use the call button. She fell (in memory care with two aides in the room, because we had hired her 24/7 helpers to prevent a fall from happening) and broke her hip--the aide couldn't get out of the recliner chair she was in fast enough to stop mom from falling. A fall WILL happen, mom will break her hip, and then she'll be where my mom is, in a nursing home. I don't think there is any way to prevent this progression. We gave it our all and it didn't work.

I was quite distraught talking to the nurse who was doing discharge planning for my mom. She told me that HER mom had broken her hip "just standing there" in a room with THREE RNs, one of them her own daughter.

Maybe others will have better ideas.
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