Can the state of New Jersey force a long-term nursing facility to remove patient alarms?

Dear Lucy,

I would talk directly to the nursing home about this ruling if it exists. Your dad's safety is your number one concern.

From what I understand, it's Medicare/Medicaid. Since 2007 they've been doing studies that "prove" that patients are safer without alarms. Maybe some patients, yes, but to make a blanket statement that all are better is a mistake. I think they should take each individual into account. In my Dad's case...yes, he needs the bed alarm.

I don't know about your state, but, I did some reading about it, when my LO, who has severe dementia, was falling a lot. It seems that I read that a doctor could prescribe certain things, but, I don't know the details. Basically, the alarms that I am aware of do not restrain. They alert staff of the resident's movements. The resident is free to get out of their wheelchair or out of their bed. It's just that the staff are alerted when it happens and are able to assist them, so that they don't fall. If anyone knows different, please chime in.

You're right, they do not restrain, that's what is so upsetting. The reasoning is that if the patient "decides" to stand up from the wheelchair or try to get out of their bed, the noise will scare them and cause them to fall. If a patient is physically able to remove themselves from the chair, there should be no need for them to be in a wheelchair in the first place. I'm about to go nuts with this!

I live in NJ and my Mom is on a wheelchair alarm and bed alarm.

JoAnn29...no talk about removing them?

Mom has been n long-term since May first. She even has a wrist alarm if she wanders. I just had a meeting and nothing was said about doing away with alarms. None of them interfere with their freedom. Used to alert staff.

Lucysmom, I admit that I worked in a nursing home a very long time ago (50 years), but my remembered experienced is the problem is individuals can be physically capable of getting out of a wheelchair but not capable of walking independent without the risk of falling.

This story sounds like nonsense. Bed and chair pressure pad alarms do not make any noise audible to the person getting up: they set off an alarm on the pager held by the caregiver. Hence my mother's consistent astonishment when I always arrived promptly in the room a few seconds after she'd decided to set off on her travels.

There are, or at least were, some types of pressure pad that could be programmed with a voice prompt reminding the person to sit down again and press her call button. They always struck me as a terrible idea: how would you expect a person with dementia to react to a disembodied and unfamiliar voice suddenly barking instructions at her?

So I'm sure there is ongoing research into falls prevention and the effectiveness of the various strategies and technologies available. But I would be astonished to learn that the state of New Jersey is trying to outlaw pressure pads. Does anyone want to call them up and ask them if it's true?

I can't comment on New Jersey, but where I live almost anything is allowed as long as you sign a waiver. When I was admitting mom to the NH I had to agree to allow the 1/3 bed rails - which are really more reassurance that restraint - and astonishingly to me mom's own tilt wheelchair, which in the recline position is also considered a restraint.

I went thru the same thing in the state of KS last summer with my mom. This is a national trend that does indeed ignore what is best for patients with dementia prone to falls. That's my mom. I slept on the floor on one side of her and put the wheelchair and another big chair on the other side of her. There were no alarms or even rails. She managed to get up, anyway! The facility gave me doublespeak.

I did a little quick Google research on this, and it's very interesting, depending on which side is talking about it. The most recent talk, it seems, of removing alarms is in Wisconsin. The nursing homes themselves say that it will improve patient care by making the staff pay better attention and "learn the patients' routines" -- as if these people are robots who will choose to get up at the exact same time every day. But, they claim that the alarms let the staff become more apathetic, and taking them away will force the staff to be more attentive. The lawyers claim that the homes want to take away the alarms because then there will be no evidence of how long the alarm was going off with no response before a patient fell, and therefore the NH will not be responsible for paying medical costs, etc. after a fall that they are responsible for. For my mom, when she was in rehab after brain surgery, and was completely unpredictable, I was really grateful that there were alarms in place.

I hadn't heard of this until recently - that "the right to fall" is an actual thing. All these stupid things as we're standing on the threshold of the baby boomers are crossing the "senior" line...And when it comes to dementia and Alz - forgetting that you can't walk unassisted...Let's see...right to fall or right to life outside of a body cast...And staff being more attentive by this? Great theory in a rainbow/unicorn world...Until the staff to patient ratio explodes! Our society is so going to go over a cliff.

I dealt these type of excuses from NHs on many subjects such as this and the amount of physical therapy they should receive. Even when privet paying the bills.

I think the NH does not want to invest in the equipment or the staff required.

Ask the NW for a copy of or to quote the specific law, study or regulation they are talking about they research the subject on the interned your self. Hint if they don't have a copy of such on hand it probably does not exist or does not really support their position.
I think it's just an excuse for the NH to not spend the money and increase expenses of sufficient staff to response quickly and possible law suits when they don't.
Doctors can write orders for anything they think will benefit the patient. However, most NH doctors are employ's of the NH and will not write orders that their employer has instructed them not to.
In addition, the equipment has the monitory risk to the NH because some system can record how long before the staff responds and if they respond at all.
That would document their care-giving shortcomings.

Believe it or not, most every state has a "Right to Fall" Law. This makes restraints illegal. It is my understanding that alarms are not included in this law as a restraint and are allowed. The right to Fall law can be a very harmful and/or death sentence to the elderly - particularly Alzheimer's and dementia patients. I'm not sure what makes me angrier, the danger and stupidity of this law or the abusers that created the need for such a law. If you look this up you will see all kinds of praise for the humanity of giving patients the right to Fall. Really? My mother has probably fallen 30 to 40 times in the last 8 months. Bruises, torn skin, scrapes, black eyes, you name it. She can't remember she cannot walk and tries to stand up. I read somewhere the congressman who sponsored the law said "even if they fall, hit their head, and it kills them, they have the right to Fall". Even things like lap trays on a wheelchair are prohibited.

Well as a current patient I am considered a fall risk which of course is true.
Two hospitals I have been in have used bed and chair alarms that go off like a fire alarm even if you just lift your butt up a couple of inches to reposition
Now I am of sound mind ( in my opinion anyway) so I find it quite handy to set the alarm off when they take too long to answer a call bell. That will usually bring at least three nurses running.
I live in NYS so don't know what the current thinking is here. The NH where I was sent for rehab did not have the alarms so I had to resort to calling the front desk on my cell to get some attention.

Of course we have the right to fall but do we have the right to expect someone else to put us back together??????????

I have that issue right now. My husband has ALZ but broke a hip two weeks ago. He is healing fine and receiving therapy but they have the no restraints etc. on him but an alarm that he has figured out how to disable. How crazy is that with Alzheimer's patients. So now I had to hire round the clock sitters to make sure he does not get up. They just notify the nurse if he needs the bathroom etc. Do they not understand the disease and how it affects the brain?

Yes, the tilt makes it hard for residents to get out o the chair. In my opinion, they can have my permission to use restraints to keep Mom safe. Yesterday when I went, she had a new chair with a seat belt loosely around her. A big red button saying "press here". My daughter says belts can be used as long as patient can get out. Which Mom could but with her Dementia may not be able to figure it out. For me alarms are a safety tool. RNs and CNAs can't be everywhere. Better these tools than I ended up being called that Mom is in ER again.

Just printed out the Health Law Bill 85 and it does allow restraint if a doctor feels it is needed. Guess I need to get that in writing on my next visit. He was restrained in the hospital and since the ALZ is not going away I need to get the permission for the nursing facility to restrain him. Already paying for round the clock sitters. Makes sense to restrain someone who can't remember he just had a hip replaced. He has already fallen at least 10 times in the rehab place but did not break anything else YET

See, I am not crazy! Just this morning I received a call from NJ DHS. I had emailed them my concerns and they were nice enough to call me. First, IT IS NOT their regulation. It is up to each facility to not restrain. However, it is also dependent upon each individual patients safety. I also private pay for my Dad. I told the Dir of the facility that under no circumstance will his bed alarm be removed. She also told me about some systems being able to tape a loved ones voice and " asking the patient to lie/sit down"...sure that'll work....Dad is very hard of hearing! What should happen is that a silent alarm should go off at the nurses station. We all know about that one! The person who posted above that they didn't need an alarm....absolutely right! You indeed are of sound mind and can convey your wishes. Now, another area of patients rights......what would happen, theoretically, if a patient on a pudding pureed diet, like my Dad with swallowing problems and prone to Aspiration Pneumonia, decides they don't want this diet any longer....does the facility abide by the patients rights and give them what they desire? This can open a real can of worms! I mentioned this to DHS and she agreed! So...sorry for the long post here, but it is each facility determining this restraint option and as POA, I can tell them I want him safe....if these alarms keep him safe...they will remain! Thank you each and every person who reached out to help......God bless us all!!!

As a gerontological nurse and daughter of a late parent with dementia, I can say that alarms are not necessarily a solution for fall prevention. There is evidence, based on extensive research, to support this. Alarms are often called psychological restraints. Consider this typical scenario: the individual moves and sets off the alarm. Staff (sometimes more than one) respond, often telling the individual to "sit down" or "don't get up". The individual, although confused, becomes conditioned to not move, lest they cause the noise. One of the ideas in support of avoiding alarms is that the staff should check the resident frequently, learning what's causing the individual to want to get up: maybe they have become restless from being in one position too long; perhaps they're in pain; maybe they need to toilet; are they hungry/thirsty? Other reasons for avoiding alarms: noise can be overstimulating for some residents; staff become desensitized to frequent alarms, leading to "alarm fatigue", causing inadvertently ignoring the alarm (that can happen in any environment where there are frequent alarms). Alarms can be especially irritating to an individual who wears hearing aids, as the noise is amplified and can be painful. I had a patient who had begun falling, and we used a chair alarm. He was able to rise so quickly that he would fall before staff could reach him. Although he had some confusion, he complained about the alarm, and he became more anxious with its use. We are required, by nursing and medical standards of practice to try to determine the cause(of falls). In this one patient's case, we had to remove the alarm to decrease the agitation that it caused. At the same time, with investigation, we found that his blood pressure was dropping when he stood, causing the falls. After medication changes, he falls stopped. In yet another case, a patient with a bed alarm asked me if he was in jail, because every time he tried to get up, an alarm sounded. Various interventions helped, and we stopped the alarm, and he was more content.

I was not always a believer in the "no alarms" practice, and used a motion alarm at night on my father who had dementia. I used it to alert us that he was on the way to his bathroom so we could assist him. The noise was so irritating to him that he tried to hide it (the alarm) from us, and was able to say it bothered him.

As for other forms of restraint: by federal regulation, doctors orders and family requests are not sufficient reasons to restrain a resident.

I have many years of nursing experience with the elderly. The problems and solutions are not always clear-cut. Not all falls can be prevented. Even if a physical (or psychological) restraint keeps the person's body from injury, restraints are known to contribute to depression, pressure sores, incontinence, loss of physical functioning, isolation, constipation...

I do sympathize greatly with family members who want only the best for their loved ones. On the nursing side (and administrators and DONs), if family members CANNOT be persuaded on acceptable professional standards of practice, they often revert to telling them that regulations do not allow whatever practice.

Finally, when the "revolution" to eliminate physical restraints came about, many medical and nursing professionals were saying the same as now: "We have to let them fall??!!" Studies showed there was a small increase in falls, but no increase in injury. I would say to those of you who are pro-alarms: The facilities that are caring for your loved ones are demonstrating interest in providing care according to professional standards. Just think: if not for advances in medicine, we would have only penicillin to treat infections; patients would still be hospitalized for days for cataract removal.

My wish is this: that family members be open to discussion for the best treatment plan, and allow professionals to help. I am still in the profession, and want nothing more for my patients than for them to be safe and have a good quality of life, just as family members do.

I am speaking about a restraint for a wheelchair now. They do not allow one even though the surgeon who did the hip replacement said he needed one to prevent another fall. He has ALZ so I had to hire round the clock "sitters" so they can notify the staff if he gets up. We would be arrested if we didn't restrain a young child or baby to prevent harm. In reading the Health Care Law it does allow restraints for those that need it and ordered by a doctor however facilities are choosing not to do so. Guess it makes it easier to have someone else watching - yet they charge more. So very depressed over all this. We need to find someone in Government to support our cause.

I understand that each patient is unique in their needs. There are no cookie cutter solutions. Dad will be 97 in Oct. He is washed and dressed and eats his breakfast in his wheelchair in front of the nurses station. Sometimes he self feeds, other times he has to be fed. He's an aspiration risk, on pudding thickness pureed food. His liquid has to be given with a spoon. After breakfast he is taken to the activity room. There his chair is positioned against the wall with the table in front of him. He would stand occasionally and the chair alarm would sound. Did he hear it? No because he is almost deaf. He is safe in that room without an alarm. He is incontinent. He has to be taken to the nurses station for care. He can't be left alone there because if he tried to stand he would fall on his face. There the alarm is helpful. Lunch and dinner are in the dining room. Same scenario...chair pulled up to the table. Sometimes he eats by himself, other times he needs to be fed. No alarm necessary there. Bedtime is another scenario. More than once that bed alarm saved him from a fall. How he got to the bottom of the bed...who knows, but the alarm alerted the staff and they got him before he fell. They do have a crash mat by his bed. He is pretty much non-verbal now. He stands up in his wheelchair less and less. His skin tears very easily from any little bump. He is becoming rigid. He used to be walked daily, now his knees are bending so that he is a fall risk. That is pretty much finished. His days with us are numbered. I wanted those days to be safely spent. If that bed alarm will make them safer, so be it. In a perfect world the staffing would be one on one but we know that isn't possible. I was more concerned that they left him in a soiled diaper for 90 minutes. I was there and sent him to be cared for. He was brought right back. Why? They were too busy. Unknown to the staff I was there. 90 minutes later they came to get him for bed. The aide almost fainted when she saw me there. Bed sores? I had to be more concerned with skin breakdown from sitting in feces for 90 minutes. That required a grievance to be filed. I wish more nurses and aides were of Melittas mindset but they aren't. Every patient is unique and should be treated as such. If that bed alarm and/or wheelchair will keep him from a fall he will have it. Peace....

My spouse has just been placed in a facility that has "no restraints" however the Health Care Law which I was given a copy of does allow their doctor to order one. When I spoke to a nurse she said she would ask his doctor to order a "seat belt" for the wheelchair. Perhaps it depends on the wording. I am beyond thrilled with what I have seen so far in the facility he was placed in. Don't give up trying to protect your loved one. Ask them to show you the official Health Care Law and right in the center you will see the exception option. Don't argue but do get a copy and than follow up with a letter to your State Department of Health. You will need to get the doctor who is responsible for their health in the assisted living or care facility to write the order. I would imagine that failure to do so might end up in law suits. We pay extra for memory care, than they ask for "sitter's" who can only notify a nurse if the they stand up or start to fall.

For those that agree with "no restraints" please explain how you can protect your love one who has dementia or ALZ? They cannot remember a minute later that they can't walk because of a fall or in my case a broken hip. The first few hours in the Nursing home he fell 3 times. I had the first call about an hour after he arrived informing me they would do X ray's and let me know. Phone rang again in a half hour to tell me he fell, I said yes I know was the X ray OK? I am calling to say he fell again, we do not have the results yet. OK so a few more hours pass and this time they called my son to tell him that he had fallen again. Really and the solution was "please hire a sitter right away". That makes no sense to me because even a sitter cannot hold up a person for a few seconds to stop a fall and the nurse can't be expected to be sitting outside the door.

Oh MsPatS, that is just awful! Hire a sitter when he's in a nursing facility??? No!!! Really puts your mind at ease, doesn't.... I have been looking for this Health Care Bill to no avail. According to the NH there isn't one. I went to my Assemblyman, who in turn called them. They evidently gave him some story about alarms scaring the patients. He said that until I can provide a copy of the Bill, it's my word against theirs and he can't do anything. The one good thing is that they know that it was me who alerted him...I told them.....so far Dad has been fall free. His roommate fell 3 times over the weekend. Not knowing the circumstances I can't comment but I do know that his daughter is just as anal about her Dad as I am about mine.

I thought about moving him, but I think it would be in his best interest to stay where he is. I spoke to another patients daughter and she has been fighting with them over her mothers care for a year and a half. They seem to be afraid of her now. I guess maybe that is the answer. If they know you will speak up and contact the right agencies, your loved one gets better care. It shouldn't be that way!

If someone can direct me to a site on the internet where I can print out this "law" regarding falls I will be greatly appreciative.