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Mom lives in a restraint free nursing home. They will not let her use a wheelchair tray, even one that is easily removable as it is seen as a restraint. Her bed only has a small handle bar on each side. Bed rails are also seen as a restraint. She has dementia. If something catches her eye, she tries to get up to get it and falls. Falls from the bed happen in the middle of the night when no one is in the room with her. The bed and chair alarm are being removed as they consider the alarm startling to the residents. It is also an after the fact notification once she has moved. Any suggestions on how to keep her safe? I have requested mats be put down on the floor along her bed. I would appreciate any ideas you might have.

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By law, no nursing homes in the US can use physical restraints for any resident.

The mats are ok, and another possible help is to lower the bed as low as possible, or place a mattress on the floor.

”Fall proofing” is very tough to manage, even with 100% full time supervision.

I slept (well not sleep, really) on the floor by my mother’s bed for 6 months to keep her from falling.

A wheel chair tray is not legally “seen” as a restraint, it’s a restraint..
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The NH where my MIL is puts the mattresses right on the floor. I agree with AnnReid that there really aren't any other viable solutions.
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Beatty Aug 2021
Yep agree. Crash mats next to bed or wheelchair would be my suggestion.
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In regard to the alarm. Maybe check into the alarms that sing a lullaby - my friends husband was in rehab and she kept hearing a children’s lullaby type song played - she finally figure out it was the alarm on the bed for someone whom had dementia and that the woman would go from yelling and trying to get out of bed to singing the lullaby song and calming down? I had never seen or heard of it but maybe the staff would let you use an alarm
that was more soothing but still able to alert them?
I cannot for the life of me remember what song she said it was but it might have been Mary had a little lamb? Or something like that and that it gave the staff - Cna - nurse an alert with a song and didn’t disturb others.
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Momheal1 Jul 2021
You could also look at a pommel wheelchair cushion it’s meant to help someone not slide down in the wheelchair - it may keep her from getting up so easily and they may allow that? You would have to look at them to see if it would be safer or more of a danger (depending on her abilities to get up - maybe it could help - it’s worth looking at them - only you will know her mobility and if it could help. Best of luck
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Mats on the floor would help

It is literally impossible to stop a senior from falling unless you have someone staring at them from no more than a meter away 24/7. Stand up from the chair you're sitting in. Took like 3 seconds right? That's how long it can take for a senior to try and stand and fall.
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BarbBrooklyn Aug 2021
Zippy, my mom fell in Memory Care with 2 aides in the room...close but not close enough. Old people fall.
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Move her to a different nursing home. Mats on the floor are not going to do any good if she falls out of bed. If she's old and frail a broken hip can happen easily even with a mat on the floor. The 'No Restraints' movement in facilities has gone to the point of absurdity.
Side rails on a bed are not the same as being tied down to the bed. A tray attachment to a wheelchair or a posey (a type of vest or waistband that kept a person from slipping out of a wheelchair) are not the same thing a straightjacket.
If you want a better chance at keeping your mom safer, move her to a nursing home that has some common sense and knows the difference between immobilizing someone against their will and taking the most basic safety measures that a person with dementia won't even notice.
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bundleofjoy Aug 2021
totally agree!!!
it’s crazy what the current nursing home is doing!!!
almost asking for/wanting accidents/falls!!!!

hugs to all of you.

i wish your mother well jcarna. hug!! :)
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BarbBrooklyn,

If your mother fell and had two aides with her, then they were not paying attention and doing her job. There is no excuse for that.
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This will certainly sound cruel, but when my dad was staying with my sister and BIL, I bought them a vest that loosely secured him to the bed. His arms and legs were free to move. He really didn't mind at all, he had advanced dementia and even though he had a fall mattress, they would find him under a table or on the floor mattress. A sundowner for sure. Once he knocked over a wood stove (luckily they didn't light any fires in it!). My BIL told my dad he didn't pay his heating bill and the vest was to keep him warm. He had freedom of movement, the vest stopped him falling out of bed. I'm sure any AL home wouldn't allow it, but it did work.
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Cover99 Aug 2021
So like a turtle on its back?
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Restraints aren't allowed to be used in nursing homes.

My father had vascular dementia in the balance center of his brain. He was falling before he went to assisted living, He fell often in AL and continued to fall in SN. I got increasing calls from AL and weekly calls from SN that dad had fallen again. Once he went to rehab from hospital - he not only fell the 1st night in rehab, he fell again the next morning. His falls usually resulted in superficial injuries - scrapes, bruises and minor cuts. Also at work with dad was being so stinking stubborn, weakness and AD.

Dad had a power lift chair that he loved, it went with him to SN. He'd hit the button and the chair would lift him and he'd just slide on down to the floor. I asked if they couldn't get him comfortable then unplug the chair (it was in his room at the time) but no, that was considered restraint by the state. However, shortly thereafter, they moved the chair to the common area; get him comfortable and unplugged the chair; when they noticed him trying to get out of the chair they plugged the chair back in and move him to his wheelchair.

Unfortunately there is nothing that can prevent all falls but the staff should be taking action to reduce the risk of falls. They can lower the bed closer to the floor and place mats down to cushion a fall. You may check into better chair pads or other wheel chairs that prevent falls that are better at keeping the person in the chair.

It is horrible to get those phone calls - it got to the point if a call came before 8AM or after 9PM, I was pretty certain who was calling and why. I wish you the best.
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I’ve seen and read about wheel chairs that tilt the person backwards with their feet elevated in the front, and with armrests at each side. It’s virtually impossible for them to get out of it. (And I sincerely hope that the wheelchair itself wouldn’t be considered to be a restraint)
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Have them lower her bed to its lowest position and use the mats. It's about the best you can do.

Yes, they have the tilted wheelchairs, too. My mom had one near the end of her life. They're extremely expensive and intended to keep people from slumping forward, but it would likely work.
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MargaretMcKen Aug 2021
Recliner chairs can sometimes do the same thing as titled wheelchairs, and may be more affordable.
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The bed should be lowered as much as possible and mats should be placed on the floor. Placing a pool noodle or even a towel rolled up next to her might also make it more difficult for her to get out of bed.
Getting a wheelchair that can be reclined a bit will make it more difficult for her to try to get out of the chair. NOT impossible but more difficult.
There are also gel pads or membranes that can be placed on the chair that make it m ore difficult to slide so that scooting out of the chair would be more difficult.
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jcarna Aug 2021
Mom does have a gel cushion in her chair but she still gets out. Once she does, she falls and hits the floor. Bed is placed in the lowest position close to the floor. Pool noodles are not allowed- It is a restraint in their eyes. Its a no win situation. Thank you for your ideas!
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That’s pretty extreme rules for someone that is a high fall risk. They don’t know when she falls, refusing to alert themselves. She could lay there with something broken or be unconscious. It’s also not good for an elderly person to lie on a floor for any length of time. Are there necklaces or wristbands that can send alerts somewhere letting someone know something abrupt has happened? Can you install your own camera to check on her? Mats are good but hard to walk over. Are there free standing railings you could put a couple feet from the bed for her to grab onto when she gets up? That nursing home is really making it difficult & their extremes seem like a fall producing environment 🤔
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cweissp Aug 2021
Its not just her nursing home but all nursing homes and based on state laws.
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When my 94 year old mother with dementia was in short term rehab, in February, I notified them that she was a fall risk & they lowered her bed & put high fall risk bracelet on her. In the other nursing facility she was in before I took her home..they had bedrails & bed alarm…with song …she’s home now..so I have bedrails on her bed & keep one side of bed against wall. When in wheelchair, she has belt that buckles in back in addition to ankle wraps that are attached to the legs of wheelchair. Her last fall in February, she unbuckled her seatbelt that was in front & lifted her leg over wheelchair..& fell face down on hardwood floor. …requiring stitches..Perhaps the increase in medication to prevent agitation helps prevent her from falling…since she can hardly move or bear any weight. She forgets she’s unable to walk & hasn’t walked in 5 years.

I hope they can keep your mother safe ..talk to administrator & Nursing Supervisor about your concerns. Hugs 🤗
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