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My Mother in Law has been in a nursing home for a year, she’s got dementia, she had trouble walking when she went in, but is now pretty much just in a wheel chair now. She’d had falls in the beginning when she was there. The NH’s solution was to move her to sit in front of the nurse’s station during the day and night. I understand the day part, even if she naps crunched over in a chair, but she doesn’t sleep in a bed at night either. I understand it’s because of the fall risk if she wakes at night. But isn’t there some better way to address the fall concern and still let her sleep in a bed?

This is not acceptable!!
First - she shouldn't be "crunched over in a chair", there are good supportive tilt in place wheelchairs, or geri chairs that can allow her to comfortably recline, nothing makes my blood boil like seeing people stuck in inappropriate simple wheelchairs!
At night there is no reason she can't be in bed, although rails and restraints aren't allowed there are several other things that can be done to minimize her risks:
*lowering the bed and placing fall mats on the floor
*bed alarms
*mattress covers with "wings" that discourage getting up
like this.....https://www.spinlife.com/Drive-Medical-Defined-Perimeter-Mattress-Cover-Fall-Prevention/spec.cfm?productID=113093

Aside from quality of life concerns sitting in the same position day and night puts her at high risk for pressure ulcers, in fact if I were you I would be checking that she doesn't already have one.
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NeedHelpWithMom Mar 5, 2020
I totally agree. This situation is incredibly sad.
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Well, my mother is 93. She's lived in an ALF since 2014 and has fallen 36x. She's been in the Memory Care building now since early June & has fallen 6x, with the most recent fall this morning after trying to get into bed by herself from her wheelchair. She hasn't been seriously hurt yet, but it's only a matter of time before she is. I will then meet the ambulance at the hospital, what else can I do? With dementia, judgement flies right out the window. So while my mother has always been as stubborn as an ox WITHOUT dementia, now, with it, she can conquer the world, in her mind. We visited on Tuesday; I waited 20 minutes while she insisted she could use the bathroom herself and did not need help. All sorts of things were falling on the floor in there while I waited, teeth gritted, until she came out. She went right back in to make sure the maintenance man had patched up some imaginary 'hole' she'd put in the wall with her wheelchair.

My point is this: There is no way to prevent falls with the elderly. You can't ask the NH to use bed rails, they are federally prohibited. You may be able to install a bed cane which is a device that's used to help the resident pull herself up from bed. My mother has one on her bed. Will it prevent her from falling out of bed? Nope. Only God will prevent that from happening.

https://www.amazon.com/s?k=bed+cane&ref=nb_sb_noss

Mats on the floor around the bed which has been lowered is another idea that we use the in the Memory Care community where I work. If the resident falls out of bed, at least they fall onto a soft surface which is not high up.

We are trying too hard to extend the lives of the elderly by employing too many 'safety' measures. Let them alone to live what's left of their lives on THEIR terms. Everything I've tried to help my mother has failed. Every technique the MC has employed has failed as well (bed and chair alarms; by the time the alarm goes off, she's ALREADY on the floor). I am not a 'bad daughter' by not having figured out The Answer for preventing my mother from falling. The ALF is not a Bad ALF for not being able to prevent my mother from falling. Her age is what's making her fall. Her balance issues; her dementia; her poor judgement; her weak muscles; her forgetfulness (that she's not capable of walking) is at the root of the problem and nothing short of God Himself is going to 'fix' this problem with these elders.

Let your poor MIL sleep in her bed at night. Ask the NH to put the mats down on the floor and to lower the bed to the lowest position. Some people even put the box spring on the FLOOR and the mattress on top of it, to keep the bed at THE lowest possible position.

Then hope & pray for the best. Really, what else CAN we do? It's kind of like trying to prevent the rain from falling. It's going to fall, one way or another, no matter HOW much we hope it doesn't.
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NeedHelpWithMom Mar 5, 2020
My mother would never be able to stand from the floor, even without Parkinson’s. Yeah, it’s a sad situation. Even with help, getting up off the floor is an ordeal.

Unfortunately, falls are common in the elderly. It’s heartbreaking. So sorry that your mom has fallen so many times. It’s so hard, constantly waiting for the other shoe to drop.

It terrified me every time my mother fell. The firemen knew us. I couldn’t get mom up by myself. She couldn’t lift herself.

It makes me cry to this day thinking about how awful it is for them to fall. I would tell mom how scared I was afterwards and it always broke my heart when she would say to me that she was scared too. It was terrifying to her.

Parkinson’s disease is horrible because their body won’t cooperate with their brain. I pray to God that I don’t get it!

Sadly, mom’s brother had Parkinson’s disease too. He died at 96 and his quality of life towards the end was just awful. I would rather be dead than to live like that.
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Patients can no longer be restrained nor can they have bars on their beds. Nursing homes usually have beds that lower almost to the floor and put down rubber mats around the floor in case the patient rolls off. Please meet with the nursing home and discuss this issue.
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Juaticedog Mar 5, 2020
Thanks for your response. My husband is flying up there to participate in a care plan meeting tomorrow. I knew restraints were bad. We were thinking of suggesting the bed rails. We understand the reason they keep her out there is to prevent falls. I wasn’t able to come up with an alternative. Maybe I’d the has some weight shift sensor that would alert them that she’s trying to get up.
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Right [rolling up my sleeves, metaphorically speaking]...

As I was just this morning looking up care regulation in Florida for different reasons, I thought I'd see what the same state agency has to say about restraints, specifically bed rails. Here is a clip from a current discussion paper...

"6. Restraints. Restraints are prohibited. Are restraints being used? Examples of restraints: Buckle or Velcro seat belt in the wheelchair that resident cannot release, Geriatric Chairs with lap trays and, the use of sheets tied to a chair to support resident. Family request is not justification for the use of restraints. Only half- bed rails are allowed with a physician’s order every 6 months.
An ALF resident who is also on hospice care can have full bed rails if the health care provider and interdisciplinary plan identifies that the resident needs them."


What this boils down to is this. It is NOT true for an NH to whine 'oh we can't use bed rails they're illegal we're not allowed it's the law...'

What they actually mean is: 'the use of bed rails (and other safety equipment) is hedged around with protocols and guidelines and we can't be arsed to train people to do the paperwork.'

So. When you have a situation that is *manifestly* detrimental to a person's quality of life and physical wellbeing being blamed on care regulations, it is time to take it further. It will be a slow and painstaking process, though. Are you feeling patient???
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NeedHelpWithMom Mar 5, 2020
In my state, in Louisiana I specifically asked in the nursing home where my mother did rehab if bed rails could be used because mom has Parkinson’s disease and needs to grab onto a rail to get out of bed.

The staff adamantly told me no because bed rails are considered to be restraints. It’s terribly sad for Parkinson’s patients and others with mobility issues that rely on having an object to grip onto so they can move.

Mom felt like her independence was robbed. No bed rails caused her to have to totally rely on staff. It’s sad but the staff had to abide by the regulations. Before these laws were in place they used to provide bed rails.
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I would question the nighttime. She should not be scrunched over in a chair to nap. My Mom had a great geri chair. It reclined and had cushions next to her head to keep it in place. Also, the seat reclined a little towards the back making it hard to get out of the chair.

Sitting in a wheelchair should not be an all day thing. I would think it would cut off circulation. Hospital beds can now be put down lower to the floor. Pads can be put on each side. They gave Mom a concaved mattress, making it hard to get out. I was told one side can can be put up leaving the other down.

As her representative u can ask that she be put to bed.
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NeedHelpWithMom Mar 5, 2020
Using that type of mattress is an interesting solution. I am glad it worked for your mom. I don’t think it would work in all cases, such as someone who had back issues if they needed more support.

The recliner sounds great. Your mom’s home made an honest effort to make her comfortable but keep her safe. I applaud them.

Thanks for sharing this info, JoAnn.
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You know, it’s so sad. Restraints are not allowed. Not even bed rails because of mishaps that have occurred but people use bed rails at home all the time. They are commonly sold on amazon. People who have Parkinson’s or other mobility issues use them to help maneuver getting in or out of bed.

My mom with Parkinson’s disease had one on her bed in our house. At the nursing home for rehab they did not allow it. So mom had a really hard time getting in and out of bed.

Awhile back though, end of life hospice facilities allowed restraints because my brother had to be restrained.

I personally don’t feel like a bed rail should even be considered a restraint. We put babies in cribs. Some elderly people become as helpless as babies.

Best wishes to you. I hope that you are able to find a suitable solution. It’s sad that she can’t stretch out in a bed instead of being forced to remain in a wheelchair.

What about sores? Is she sitting on the recommended cushion because if not her skin will break down and she will have to deal with sores.

Sores need to be treated to heal and are painful. I would look into that. Just remember the elderly get embarrassed. That generation is extremely modest.
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kdfo90 Mar 8, 2020
Great reply. I agree that rails should not be considered restraints. Just about anything is preferable to having your loved one fall and break a hip and/or get a brain bleed. When my father was in a nursing home, I finally understood the practice of having them sitting in chairs in the halls -- there simply was never enough staff to constantly monitor the patients if they were semi-mobile! I don't know the solution, but your remark about bed sores was right on. It happens so easily, and usually in places that we don't think to look at.
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Just understand that if they use bed alarms, the staff does hear them but usually the person is already on the floor when they get there. The MC my FIL is in has a smaller cottage style and staff gets in there when they hear the alarm but they never stop him from falling. But the combination of low position bed and rubber mats has so far kept him from getting hurt . You literally cannot prevent falls in the elderly with dementia. I am a nurse and have worked in neurosurgery; in the past when restraints were allowed, those patients would get out of bed by climbing over the rails and more then once, I found people who had flipped themselves partially out of bed wearing posey vests and wrist restraints. I would like wheelchair seatbelts to be still available so they could be kept from falling out of chairs but those are not allowed either.
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Need, *exactly.* The NH said no, they're restraints, not allowed. Meanwhile your mother required the bed rails to help her mobilise. And, so, what did the NH do about it? Anything?

There are other mobility aides such as bed sticks, which are not considered restraints and do give the person something to hold on to: did the NH at least consult an occupational therapist?

And, just suppose for some reason it absolutely was necessary to use bed rails and there was a clinical and/or safety justification for it: then there will also be a mechanism by which a home or facility needing to use them can apply for exemption.

Some reasons they don't want to go there are:

it's just a lot easier not to;
they don't have to provide staff training in the process;
no one can get it wrong and cause an accident;
if they did the application for one resident and installed a bed rail, sure as you're born the next day there'd be five other families demanding the same for their loved ones - and, as seen in the excerpt, a family member hopping up and down in your office is not a justification for the use of bed rails.

So you get this form of learned helplessness from them instead, and your poor relative is left to struggle. It drives me nuts.
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NeedHelpWithMom Mar 5, 2020
Yes, I agree with you CM. They didn’t do anything. When I questioned the situation I was told again nothing would be done to help my mother help herself to move. They assisted her movements. That is all that is allowed in Louisiana.

Everyone has lawyers these days that advise them. They can’t disregard the stipulations and open the door to law suits.

The nursing home says their hands are tied. The residents feel helpless. It’s sad all around.

This was a rehab situation for my mom but it’s the same for permanent residency. No restraints ever. In rehab they are working with patients to recover so they have to be extra cautious. Also, mom is in her 90’s.
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You talk about using power recliners. Anything is a restraint if person cannot remove it so if they are in a power recliner and cannot use controls to put it down that is still a restraint. Yes I have worked in long term care many years in the activity department. you have one staff person in there and they bring everyone that is a fall risk. I have has 40 patients to 1 staff and they tell me don't let anyone fall. Sure. I feel that if a tray table is put on a wheel chair and they are happy being provided things they like to do should not be considered a restraint as they are happy and content have things they enjoy and not falling. They used to have a walking thing they called a merry walker I think it was called that. it was made of pvc and had a seat was on wheels so they could stand and move around if they lost there balance it would stop moving they would end up going on the seat. I felt these were great but they now consider them restraints too. Wish you the best in getting your mom to be in bed at night. About all they will tell you that you can pay for a private aid to be with her in her room.
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She should have a bed at night. They can move bed into lowest position. Most places have thick mats to place on either side of the bed in case she rolls out. Most beds have alarms when the client tries to get out.
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Bjwalters Mar 7, 2020
Exactly. No excuse for being in wheelchair all night
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