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He is in assisted living. He is getting out of the hospital today after a week, with a broken arm. The assisted living facility advised us to get a private sitter to stay with him from 7pm-7am to help him to the restroom if he has to go. It's $25/hr, so $300/day for the foreseeable future! Just because he will not call for help or use the urinal! He doesn't seem to understand or to care about how much it costs! What should I do??

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Falls often equal severe head injury or even death for seniors. I would remind him of that. How do you know he is not calling for help? Are you sure he is not requesting assistance but nobody bothers to assist or it takes a long time for them to respond? It happens, Neglect. Then seniors 'chance it' and suffer consequences. Neglect is a crime. I would rule that out for starters. (hidden camera?) Why doesn't he want to use bedside urinal?
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Reply to renoir
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MEN... They sometimes have too much pride for their own good...

So, it boils down to that, I believe. He has too much pride...Why should I call for help? I know how to get to the restroom. I have done this since as far as I can remember. Maybe 3 or 4? So, why can I not go by myself now? I am an adult, you know. Ok, so my balance is a bit off, but I'm ok.. I can just get back up..hopefully...

But, wait, what happens if I cannot get back up? No, I will not think about that. That never happens.
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Reply to MAYDAY
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bolliveb Jun 14, 2020
Right. "I'm careful".
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He needs to be evaluated to long-term care as he no longer can be safe at an assisted living. I'm so surprised to see the assisted livings not referring their people who need it.
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Reply to shar1953
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So get the bed as close to the floor as possible, so if he falls, it won't be far. And you may want to get a nice floor covering that may cushion the fall.
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Reply to MAYDAY
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ABRI-FORM DIAPERS. L4 are very good. bed chucks, disposable bed pads.

Get a hospital bed, if he doesn't have one. Put the rails up so he can't get out. If he is that stubborn, then perhaps a night sitter will be needed.

GROWING UP AND UP is so much fun until someone falls... If he breaks a hip, then you won't have to worry about a night sitter... You may want to tell him that.
PARENTS.. WHEN WILL THEY EVER LISTEN !
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Reply to MAYDAY
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shar1953 Jun 12, 2020
That is the absolute worse advice to give anyone to put up both rails so they can't get out. They ""will"" crawl over and injure themselves more. If you want that route you lower the bed or put the mattress on the floor: people use mats but tripping is an issue. There are more forgiving tiles.
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Edit - You may be forced to hire the *evening* sitter.
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Reply to Llamalover47
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Imho, if he won't call for help or use the urinal, you may be forced to hire the eveing sitter.
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Reply to Llamalover47
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It does cost your father much more with injuries than required sitters. Not to mention much pain from fall injuries. Spend his money down for his safety.
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Reply to Patathome01
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My mom needed help at night as well. We hired privately and paid much less than $25/hr. As some others have indicated, the fall risk isn't reduced at a skilled nursing facility because restraints are not allowed. You will need to hire someone. It is better than falls or multiple falls and resulting injuries, and those costs.
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Reply to amoeba
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Same thing was happening with my mom, who fell several times - the last one landing her in the hospital - always while getting up to go to the bathroom at night. We now have people to stay with her 24-hours a day in her house, but she's really not happy about it -- she feels like she has no privacy, and, truthfully, she doesn't. Wish I knew a better solution for her, too.
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Reply to losingitinmo
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Well, my mother is 93 and lives in a Memory Care Assisted Living place for the past year, and in the regular Assisted Living annex for four years prior. She's fallen 46+ times so far, and I've lost count now, truthfully. I've tried everything, including a bed alarm and a chair alarm. By the time the CNA gets to her room after hearing the alarm go off, she's already on the floor. If and when I send her to a Skilled Nursing Facility, the same events will happen THERE as happen in the ALF.

What's the moral of the story? You can't prevent a person from falling no matter WHERE they are. At home, at an ALF, at a SNF, at rehab. Nowhere. You also can't prevent a person from exercising a stubborn behavioral trait. Trust me, I've tried everything on God's green earth for that too. To no avail. Trying to get a stubborn elder to pull a cord or push a button to ask for help is akin to asking them to climb Mt. Everest, for some odd reason unbeknownst to me.

When dad was alive, he'd fall out of the bed and crawl to the bathroom rather than pull the cord to ask for help.

It is what it is. I wish I had some brilliant, fool-proof answer for you but hey, if I did, I'd have used it myself rather than suffer through all of The Phone Calls for All of The Falls. Last month, I got two calls in one day! And she's NEVER been to the hospital for a fall YET. Honestly. She's had broken ribs and sternum bones as a result of some of the falls, but no trips to the hospital b/c she's also a wonderful actress and capable of hiding the truth. Which means she's fallen a lot MORE times than we're aware of and has managed to get herself up w/o help. Ergo broken ribs & sternum bones which were revealed during one of her many hospital stays unrelated to falls (via CT scan). The doctor was kinda scratching her head saying, hmmm, your mother has all sorts of broken bones in various stages of healing, I wonder why? Yeah, me too doc.

Wishing you the best of luck with a very, very, very difficult situation. Is marijuana legal in your state? :)
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Reply to lealonnie1
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Houghd62 Jun 14, 2020
Thank you for writing this. I am early in this scenario but my dad is 93 and I’m going thru the same thing, Take him to doctors and get surprises because he hides things. He is currently in skilled nursing/rehab for shingles on face which have possibly caused damage to his eyes. When we told him we needed yo take him to ER he stated he would wait to go to eye doctor on Monday and he could crawl to the bathroom and bed until then. He is beyond stubborn.

Thank you, I now know I’m not the only one dealing with stubbornness.

Debbie
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Do you think he would use a bedside commode? If there's room it could be tucked away during the day and then moved near his bed at night so he wouldn't have to walk so far. The staff could then deal with the bucket in the mornings. That's worked for some people were able to adapt, but it just kind of depends on if he'd be willing to try it, use it, etc. Some men don't like a handheld urinal but will use a commode where they can either sit or stand so it's more similar to standing & peeing into a regular toilet.
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Reply to richamj
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I got a bed alarm for my mom. Every time she got out of bed it rang and the psw could get to her and assist her. It lies under the sheets ( or bed pad)
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Reply to noreenn
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If you have been advised to 'assist' the assisted living in his care, he probably needs to move on to nursing home care. Assisted care means someone is competent and just needs a little help here and there. It will not include sitting at a bedside to make sure someone doesn't fall down. Nursing home is next level of care, but in all actuality he won't get 24/7 care there either. Patients get out of bed when they shouldn't and fall down.

If he has plenty of money, then hire someone to sit with him for those 12 hours for as long as the money holds out. At that time, he'll probably have to go to nursing home care anyway unless family will begin picking up the tab for his care.

Is he competent and just refusing to use a urinal? Or is there a dementia issue where he no longer understands he is likely to fall down? If you decide to go the private care route, do you know any friend or family member that wants to earn maybe 1/2 that amount in order to stretch his finances as far as you can? If you do the family/friend thing, contact an atty to help you set up contract and appropriate tax forms so Medicaid doesn't view any payments as gifts further down the line.
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Reply to my2cents
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My mom broke her shoulder among other injuries when she had a severe fall. She too has to get up to go to the bathroom at least two times each night. She has a tension pole next to her bed and a bedside commode near her bed. She can get out of bed with the help of the pole and keep her hand on the pole to take a few steps to reach to sit on the commode. Then the same to get back in bed. Nobody needs to help her now. It took a couple weeks of a private caregiver to make sure she had enough balance and control to be independent in this manner though. That was an expensive two weeks especially since most of the night the caregiver is just sitting there watching Mom sleep. Hope this helps.
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Reply to CABinCA
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Have you looked into a Palliative Care assessment? We are new to this, but this is an assessment paid for by Medicare that will talk to your Dad about what is happening, why he doesn't call for help, etc.... In our case, my parents were much more responsive to this outside group helping them problem solve and find ways to get what they needed than they were to us. I was stunned that I hadn't read about it or it hadn't been recommended by doc or assisted living place. But both doc and assisted living teams were very familiar and quite supportive. Here is a link: https://fourseasons.teleioscn.org/what-we-offer/palliative-care/. My heart aches for you, good luck
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Reply to hobson92
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Dexpends, if you have the say so over his affairs and who would be paying for the overnight Care person. First if all, you could go on line and find a Caregiver willing to accept $12 an hr and allow them to cat nap until your Dad has to go to the bathroom.

Or, tell your Dad he'll have to wear Adult Diapers at night.

The ladt option would be hzve the Senior Home tell him that they won't allow him to stay if he doesn't call for help instead of getting up.
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Reply to bevthegreat
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Same thing happened with my dad. The assisted living staff would not respond to a bed alarm that I suggested, so I ended up moving him, but not to a nursing home. I moved him to a residential care facility AKA Board and Care. They can meet more 1:1 needs than an assisted living. There, he uses a bed alarm, and the staff come right away in the night.
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Reply to SofiaAmirpoor
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Concerned43 Jun 11, 2020
Thank you for your post about a residential care facility.Not familiar with that particular one so I will do some research.My dad has been in a SNF three times and an ALF once after a stroke,falls,etc.
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I have the same problem with my 84yrold father.The last night time trip to the bathroom resulted in a fall ,and a trip to the hospital .He hit his head when he fell requiring two staples.

Even after the initial fall he would still get up.As of now he has stayed put at night and wears nighttime depends with extra bedliners to protect the bedding.

Hopefully,This will become the norm.
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Reply to Concerned43
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Sensing devices are many and can satisfy your needs.
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Reply to PaulBern
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My husband was in a nursing home for several months, followed by care at home for several more, and I can feel your pain. For almost 70 years, when he felt the urge to go at night, he got up and went. And it's hard to change that habit.

What finally worked (as some others have suggested) is nighttime briefs - thick enough that they didn't leak onto the sheets if he did go. And, as you may remember from dealing with kids, cutting back on fluids close to bedtime.

Good luck!
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Reply to Amywoody
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Carabobara72, breaking an arm is extremely painful, and there is still pain no matter what pain meds one is given. Plus you can feel helpless, and in a fog from the meds.

I was in my 60's when I broke my arm. Oh my gosh, the pain was terrible and here I always had a high pain tolerance. Sleeping at night was difficult, I had to prop pillows around me so I wouldn't roll over. Going to the bathroom was difficult because it was my primary arm that I broke, so doing things with my other arm felt awkward. Thus I can fully understand why your Dad doesn't use the urinal, he probably can't.

For men, it can be difficult for them to "call for help", for some it makes them feel weak. They rather chance a trip to the bathroom on their own.

Now, with that broken arm, it will take longer for the arm to heal as we get older. Chances are your Dad will need rehab to help get back the use of his arm, as the muscles will freeze in place. My rehab was 3 times a week for a couple of months. It was painful but I knew it wouldn't be forever.
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Reply to freqflyer
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Thanks everyone for your comments. I think a nursing home or moving him into the memory care unit will be the best answer for us. It sucks to see your loved ones in such a decline.
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Reply to Carabobara72
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Harpcat Jun 11, 2020
Yes, because you will be paying more with AL and a caregiver than the fees for a NH room.
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Clearly he needs a higher level of care. Either he goes into skilled nursing or memory care (if applicable), or you pay for the night sitter.
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Reply to MJ1929
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Carabobara, I work in a branding company that has mostly med-tech clients. One project involved a medical procedure which they hoped would alleviate the over-active bladder sensation and to stop his exact problem, as it is extremely common in facilities and a main cause of fall injuries. But he probably has cognitive decline, so he will just keep forgetting through no fault of his own. Also, he may be experiencing a sense of urgency from a UTI, so he should be tested for this if he hasn't been recently. UTIs are also incredibly common in the elderly. A not-so-fun fact I recently came upon: once a senior starts to fall they usually have a catastrophic fall within 2 years. Since NHs in my state cannot use "restraints" like guardrails on hospital beds, I've seen them just put the mattress directly on the floor. Staff will have to help lower him into bed at night, but he most likely won't be able to get himself up just to fall. May be worth a try. Also, adult incontinence underpants if he isn't already using them. There may be no "good" solution for this issue, just a waiting game to see what happens. I hope you and the AL can figure out something that works!
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Reply to Geaton777
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This may be cruel but most likely it will ring true. If he is so stubborn or mentally deficient, nothing is going to make sense to him and he is not going to do what he should do. So he falls and something happens, then he will be put into a facility that will be able to deal with him. The cost of caretakers will bankrupt you. Let him end up in a nursing home or whatever - remember, what you sow is what you reap. I don't have much compassion for stubborn people who do not cooperate.
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Reply to Lockett2166
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Davenport Jun 11, 2020
Thank you for being brave and honest, Lockett. Yeah, my mom is also stubborn and selfish and lacking compassion for her 3 daughters (me), who worry and work almost full-time to figure out how to enable her; I also fear coming across as 'cold, cruel, insensitive', etc., etc. I learned PAINFULLY, the reality of it was that the logistical, practical, physical aspects just plain overpowered ALL emotional and sentimental stuff, until finally, I realized that I was the final, last, human between my mom and me--and it was on me alone to accept, accept, accept--and be the 'bad guy'. But really, my concern was that of other, outsiders, thinking me the bad guy. I had to do the work that I wasn't the bad guy, and others' opinions musn't affect the rest of my life and my self understanding. This shit is HARD!
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If he has a hospital type bed you can try lowering the bed so it is difficult for him to get out of bed or up from the lowest position of the bed.
A bed alarm so that staff is aware that he is trying to get out of bed might help IF the staff is quick enough to get to him before he falls.
And worst case..you wait until he falls again and possibly breaks a hip so that getting out of bed will be more difficult.

If he has dementia a Memory Care unit might be better, staff is more tuned to people trying to get up at night. What are his reasons for not wanting to call for help getting up or using a urinal?
And is it the getting up out of bed that is causing the falls or is it the walk to the bathroom that is the problem? If it is the walk would a bedside commode work?
And could you possibly convince him to use a pull up brief at night so that he will not have to get up, will not have to call for help and will not have to use a urinal.
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Reply to Grandma1954
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