How do I protect my dad in the nursing home? - AgingCare.com

How do I protect my dad in the nursing home?

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My dad has fallen 7 times in the past 2-1/2 weeks. One of them sent him to the hospital in the middle of the night requiring stitches to the back of his head for a nasty gash and a huge bruise. He has lived at a nursing home for the past 3 years. He is 87 and does have Alzheimers, which is progressing acccording to the CT scan taken after his worst fall. I realize that the nursing home is not allowed to restrain him and I would never want that. I have asked about putting an alarm on his bed or chair so that if he begins to get up they would be notified. I was told they do not have anything like that. I am finding this unacceptable. How in the world is falling and slamming his head into the floor considered care? Is it going to take a fractured skull before they realize that he is at risk? I don't know what to do. I do not have medical POA, only financial. I live 2 hours away and cannot get there every day. I call but get different nurses and different answers. I don't know what options there are for him to be properly cared for or to prevent his falls. Suggestions of what questions to ask would be most appreciated.

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Gabbisgram,
I know this continued falling can be so scary. I went through this with my cousin in regular AL and then later in Memory Care. No place can totally prevent them, but attempts must be made to address it. I feel very strongly about it.

I would ask for a team meeting with the director and staff. They should review his case before the meeting and put their minds together to develop a plan. Falls are quite common and they are challenging to address, HOWEVER, something should be tried. They need to see what, if any common themes there are for his falling. Do they occur only during the night? Only at certain times? Is the same staff member on duty when it happens? Does he fall in the halls? Is he trying to get to a bathroom when it happens? Is he trying to leave a certain room when he falls? Try to see if there is any rhyme or reason to it, so that the situation can be avoided. There are many questions that can be asked to determine if measures can be taken to slow down the falls?

Also, is he taking Xanax, Ativan, etc. These meds can cause fall increases. Sometimes, you have weigh the risks and benefits. Maybe, the dose needs to be adjusted. The doctor, director, nursing, and others need to put some time coming up with some possible reasons for the fall and a PLAN to address them.

I never heard of a place that doesn't have bed and wheelchair alarms. Odd. I'd ask his doctor for an order for alarms or you can order them online. They are simple to operate and can be effective. We were fortunate and the wheelchair alarm and bed alarm worked quite well for my cousin and she hasn't fallen in a quite a while now. Knock on wood.

If the falls are occurring during the night, then, I'd consider if he has to use the bathroom. Maybe, no fluids after dinner would make a difference and maybe he needs meds to help him sleep during the night.

I'd also ask about a gerichair. It's like a recliner on wheels that tilts back and has a tray on the front. It's difficult to get out of it. So, while restraints are not normally allowed, in some jurisdictions, a doctor's order for a gerichair are allowed. I'd check the rules in your jurisdiction.

Good luck. I hope something helps.
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The only way to stop a fall is to have someone glued to the hip with the elder... but that's impossible as then nothing else would get done in the household. You go to answer the phone, they fall... you go to the bathroom, they fall.... you look out the window for a second, they fall. When a bed or chair alarm goes off, the patient has already fallen by the time the Staff gets there.... Staff could have been dealing with a triage situation that needed more attention.

If Mom's budget can afford it, you could hire a "companion" to sit with her during the day.

My Mom [98] was Harry Houdini, and she was always falling at long-term-care. Her brain didn't realize that she was unable to walk or stand. She was always trying to climb out of bed until the Staff came up with a plan to place pillows around her.... forget the wheelchair, she was always tumbling over trying to pick up some imaginary things on the floor, so she was placed in a geri-recliner and the Staff put pillows under her knees which make it impossible for her to get out of that recliner, until she learned to remove the pillows. When Mom was awake, she spent her day at the nurses station. The Staff even tried a seat belt, but within seconds they heard "click", the seat belt was opened.
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I too am struggling with this. My grandma has a broken ankle that was repaired but is now considered nonweightbearing for the next four weeks. They are not allowing anything at all to help her be this. But even more so I'm having issues with them not providing her with what I would consider reasonable equipment to help her be maintained in the facility because it's being considered a restraint and I'm being told 'she has a right to fall' even if this has nothing to do with her right to fall which is not right if you ask me. She has to roll herself over and to roll yourself you need leverage. So when changing her they ask her to roll herself over. She reaches for a rail but there is none so she cannot do it so annoyed they do it for her and she's screaming, "Help me. Help me. Im' going to fall" because all she sees it the floor when rolled over. She has even demanded that someone brings back her railing but again it's considered a restraint so she is not answered. I have one on her bed at home so she is used to having one to help her move around freely and to make her feel safe even though she can definitely get out of it as she uses it as an assist more so than a restraint.

I'm also struggling with bed alarms. I get where they are annoying but they offer a call bell for rehab and she instead yells for me not knowing about the call bell (having dementia she does what she is used to). I use a baby monitor with her at home so I can hear her calls for me but they cannot hear her in another room despite the fact she is at the nursing station. She first yells, then sits up and yells louder thinking she isn't being heard. Then finally she will stand up. She cannot so if she does this she will fall. They have refused bed alarms stating she has the right to fall but in her case I feel she has the right to be able to request help when needed. The bed alarm would alert them she was needing help as she was sitting in bed waiting for help to arrive. It's so frustrating and heartbreaking and I wish there was a better way to handle their rights other than just let them fall and break things and have the nursing home and rehab people say, 'its their right to fall." We protect babies so why can't we try to protect elderly with things that aren't really restraining but instead can assist. I'm so sorry you guys are dealing with this and having to watch this. It's terrible. I for one cannot wait to bring her home so I can go back to monitoring her on a one on one basis.
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Alarms are only as good as the response time from staff and overnight there's usually one floor person who is responsible for up to 9 patients. When I worked in the hospital with people who had brain injuries we had alarms on everyone but we could be down the hall and unable to answer an alarm as soon as it went off.

A low to the ground bed with a mat on the floor can deter some people but not everyone.

I've seen elderly folks climb over a bed rail to get out of bed.

We would put "one on one's" on our greatest fall risk patients but hospitals and facilities can't always spare the staff members so they could sit at someone's bedside all night.

My grandmother had Alzheimer's and the last few weeks of her life she fell any time she got up. She had 2 black eyes from 2 different falls, stitches in her lip and a broken arm all from falling. It was awful, it looked like she had been beaten. After the broken arm she was in the hospital and mercifully died soon after. We had to have a closed casket.

In hospitals, facilities, and private homes there is always a fall risk especially when there's dementia. There's only so much that can be done to prevent a fall but if a person is conscious and vertical there's always a fall risk. You can use grip socks, eliminate certain meds, insure the person is well fed and hydrated, eliminate any other health factors and anything else you can think of but just being elderly with Alzheimer's renders a person a fall risk. It's a horrible, helpless feeling to watch our loved ones experience this.
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One possible approach is to ask for a meeting with the Director of Nursing (DON), explain your concerns, and ask how you can work together to address each of the items of concern in your list (which you would prepare before the meeting).

You probably would be told that the action and potential solutions lie with the facility staff, which you can then use to ask how they do plan to address the issues.

Be specific as you have in your post. If someone tells you nothing can be done, raise the suggestions Pam posted, and share with them your concern that he's not getting the care you feel he should have.

In addition, what are other medical factors that might contribute to his falls? Does he get any therapy? Is he anemic? Is he eating properly? Does he have a walker or rollator to use?
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Nursing homes are forbidden to use rails or restraints, by both state and federal laws. The only acceptable work around is to lower the bed as far as possible and put a soft mat next to the bed. My MIL had an ankle bracelet that alarmed when she got out of bed. Those things do nothing to prevent a fall. At the nursing home the bed was very low. She could not get up out of it; no more falls. Her wheelchair was the tilting type with a headrest. She could not get out of it; no more falls. Ask for those.
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