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My 97 year old mother had a stroke and now has left side neglect. She needed to leave her apartment and move to a nursing home. In the past 6 months she has fallen and injured herself 10 times that I know of. Her request for railings around her bed, a Geri chair, or any other safeguard have been denied since restraints of any kind are forbidden. Isn’t this a ludicrous interpretation of the danger of restraints? My mother will definitely fall again and injure herself again.

It seems clear that she is in need of a level of supervision if she has to remain at home.it may be helpful to ensure that an ergonomic assessment be done.
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Reply to BmsCaribbean
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Imho, they should use other alternatives, e.g. a lowering of the bed, et al.
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Reply to Llamalover47
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I know you are frustrated. These regulations can sometimes make us want to just shake our heads, even if we do understand they are needed. Lots of good comments here. I just want to add that sometimes vocabulary can be a stumbling block. Be sure you describe your needs so that you are clearly understood. Example, I called an 'adult diaper' a pee pad and the aide thought I meant the 3x3 quilted bed protector but of course I probably just now typed the incorrect term. Your mother is fortunate for your concern and care. Good luck!
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Reply to Lynn47
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I also believe restraints were outlawed because they were overused. We had the same problem with dad. His falls started in IL - he fell several times getting out of bed - unbeknownst to us he was having strokes in the balance portion of his brain. Because of those falls my parents moved to AL. He was provided with a hospital bed with a handhold attached to - however he mostly slept in his recliner. Of course dad didn't use his walker often enough - trying to furniture surf throughout the apartments.

Falls continued but not out of bed- most of which resulted in bruises and scrapes (I was beginning to think his bones were made of rubber.) Many of the early falls in AL were because he wasn't using his walker. Later before moving to SNF on hospice he was weaker and while using the power chair to get up he'd just slide on down to the floor. One time when discharged from the hospital he fell twice within 24 hours - 1st shortly after being admitted and the following morning.

After he was admitted to SNF I swear he fell at least once a week and early morning or late evening phone calls would leave me cringing while I answered the phone. Yes that power recliner. While alone in his room he engage the power to move and - you got it - down he'd slide. I asked why they just couldn't unplug it - and yup - that was restraint. The state would get after them for restraining the residents and would get after them for the falls. HOWEVER, at some point the staff moved his chair to the common area - get him comfortable in it, unplug it, then when they saw him try and climb out of it would go plug it in and move him to his wheel chair. The Monday of the week he died, the hospice nurse called me saying dad was still doing well and was still feisty and trying to climb out of his wheelchair - he died peacefully the following Wednesday.

The hospice provided his bed at SNF and wheelchair - it wasn't the tilt chair just a regular wheelchair. There was a rubber mat next to his bed - he never fell out of bed - he'd fall getting up out of bed.

Best of luck - and continue to try and work with the administration to prevent your LO's falls.
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Reply to cweissp
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marydys May 12, 2021
Look up "halo" as a bed rail device. It is allowed at our memory care which doesn't allow bedrails. They also put an alarm under his sheet and put a fall pad next to his bed... I'm still worried about him falling out of bed though... he tends to just slide out.
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In Texas, you could/can have one rail up on a bed. It's been 9 years since my mom was in a SNH, so things may have changed. Since she was paralyzed on her right side, we put the rail up on her left side.
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Reply to Maple3044
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Nursing homes used to try to prevent falls and were held accountable for every client fall. Now, nursing homes have the duty to protect clients that tend to fall. The change is that there will be some people that are at risk of falling so we try to prevent injury rather than falling. Fall risk protocols usually consist of: keeping beds at lowest levels possible, placing thick mats on sides of bed, being in line of sight of a staff member when awake, assisting when ambulating or transfers (bed to chair, chair to standing...). Restraints have been indicated in other problems - especially in the development of pressure wounds. This is why restraints are not used anymore.
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Reply to Taarna
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She is 97 years old, so anticipate she will eventually die. Get her affairs and estate matters settled, DPOA, Will, and prepaid funeral arrangements if not done already. Nursing homes are very dangerous because they still fall, and prone to any contagious disease that goes around. They can also suffer neglect due to too many patients and only one nurse's aide to care for an entire hall. They are prone to dehydration and malnutrition.

Railings are actually dangerous because they can get their leg or arm caught in it and fall out that way. In a nursing home, those are considered restraints and against Federal standards (Medicare/Medicaid).

What helped my mom a lot was a fall mat and put it near the bed. It will cushion her fall and prevent catastrophic event. Also get a FLOOR alarm. and put that on top of the fall mat. As soon as her feet go on the floor alarm, it will sound off an alarm. You can buy both of those things on Amazon. Those saved my mom from falls multiple times. *Most falls occur while getting out of bed*.

She will require 24/7 supervision. You cannot ever leave her alone. Even then they can fall. It happens too fast. Still if she is ever alone that is extremely dangerous. I mean every second. When she goes to the bathroom, someone needs to be with her. I do mean every moment of the day.
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Reply to cetude
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No restrainst?that's ridicules, they just don't want to spend the money.

Sounds like your mom would be better off living in her own place with Caregiver help.

Sad how most of the Senior Homes don't take could care of loved one and that's why if they're any other solutions, you should take them.

Senforcement Homes are understaffed, cold and not very loving.

If a Senior hives any kind of problem to them the Senior is medicated and live out the rest of their life in this environment if you want to call it a life. So very sad.

Prayers.
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Reply to bevthegreat
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LoopyLoo May 11, 2021
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I agree that restraints not being used can cause other issues.....however I think the reason it became unlawful to use them is because someone caught their arm or leg and got twisted and broke....... I do know that the NH can put the bed down on the lowest level and put down thick pads on both sides of bed so if they fall out of bed, it will soften the blow. (they did this for my dad). In the chair the only option would be to use a chair that tilts back so that they can't get out or fall out. Normally they put on a alarm type thing that is connected to chair and their clothes so that when it pulls loose, it sets off the alarm. Does she have dementia in addition to the stroke she had? Not sure what else they can do, but wishing you luck.
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jacobsonbob May 11, 2021
I guess the reasoning is that if something negative happened once, then the safety of everyone afterward must be jeopardized. It would appear more sensible to consider this on an individual basis. It's the same reasoning that's causing masses of people to refuse COVID vaccination because somewhere, someone had a serious side effect. Nothing is ever 100% safe, but if >99.99% of people benefit from it, then it would seem logical to employ it when the stakes are so high. [Okay, end of rant..]
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I would pursue hospice for mom. If she is admitted, she would qualify for medical equipment through this Medicare benefit. Hospital bed, appropriate wheelchair, etc. At 97 and after having had a stroke it is likely she will qualify. Also additional Hospice services will be allowed in the facility. There is a wonderful not for profit hospice in my area that took good care of my mother before her passing.
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Reply to Jpapke
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My mother is in a memory care facility in hospice-type care she also kept falling. They allow rails on the bed and use a geri chair for her. So it can be done. It may help if you can get her doctor to request it.
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Reply to NancyIS
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jacobsonbob May 11, 2021
It's reassuring to see that there ARE some facilities in which brains are actually engaged to keep the residents safe!
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Yes, it's ludicrous - and ridiculous. When my mother was admitted to LTC, she was horrified that there were no rails on her bed, and she panicked - and so did I, the first time I went to see her after admission and found her dozing in the bed, dangerously slumped to one side. She had been using rails on her home hospital bed for over a decade.

Mama and I both asked for the rails, and "they" kept putting us off until I mentioned the word "litigation," after which the staff quickly ordered an evaluation of her physical status and finally approved her for bed rails.

Get on their case, and stay there until your mother gets what she needs. The guidance on restraints is in place to prevent unnecessary or abusive use of them. If a resident specifically requests them for her own safety, the issue is moot.
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Reply to PeeWee57
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Where are most of the falls occuring? Any standout/common locations?

Speak to Manager about different prevention strategies. Staff will need to document these, implement the strategies, review the effectiveness & ideally, keep you updated.

The aim won't be to restrain, the aim will be *reduce risk of falls*. (Reducing all falls is unfortunately not always possible).

A wheelchair that leans back is called 'tilt in space' by OTs. It is not used as a restraint, but for people who lack trunk control to sit upright. A PT or OT could make a recomendation for one.

A floor lowered bed may also be recommended. This also is not used as a restraint, but to increase safety.

Just small matters, these 'labels' but if you ask "how do I restrain her?" you will get no-where. If you ask "How can we improve her safety?" hopefully you might. I hope you can. It's very sad to see frail elderly having multiple falls.
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Reply to Beatty
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I'm shocked about the bed rail rules as well as my dad's whole recent injury was because he fell out of bed. It really sucks because he keeps trying to get up and he will for sure fall again.
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Reply to marydys
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Its against the law to have bed rails. There are concave mattresses that can be used. As said, the beds now lower within inches from the floor. Pads, liked used in gyms, can be put on each side of the bed. Someone said on the forum that there now are wheelchairs that the seat slants backwards making it harder to get out of. My Mom had a great chair the NH provided but I would have paid to have one. It looked like those beach chairs with the vinyl strips. She could scoot around in it. The seat slated back making it very hard to get out. She could nap in it because the back reclined and she had cushions on each side of her head to support it.

Talk to the Social Worker. See if there is something that can be ordered. And if Medicare will pay for it or partial.
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Reply to JoAnn29
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Full rails are banned but bed assist rails may not be, in any case there are beds that lower to within inches of the floor and/or fall mats that can be placed bedside. I'm not sure what the problem would be with a Geri chair (or other similar devices), as far as I know they are commonly in use in many facilities.
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JoAnn29 May 9, 2021
I was told no rails at the AL. Mom had a small one to help her pull up because of a bad back.
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