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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?

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This is a common problem in long-term care communities. I would ask the home to lower the bed and put a mat on the floor next to the bed. This way if she does roll out of bed she is close to the floor and lands on a mat next to the bed avoiding an injury.

Families should NOT have to pay for a private duty caregiver for their loved one in a nursing home. If a family is going to do that they might as well keep them at home. The nursing home has options when a resident is a fall risk, making a resident sit at the nurses station 24/7 is NOT one of them!
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My husband fell from bed many times in the nursing home. The low bed and a mattress on the floor prevented injuries after the first couple of falls. It took 4 staff members to lift him back into bed each time, so often they let him stay on the floor for hours, which was actually okay with him.

We took him home, bought a very low electric bed, and pay for 24 hour care. Someone sits at the bedside or watches him with a baby monitor if they need to leave the room; they sleep on a mattress on the floor next to bed. He rarely tries to get up since he's been home, but if he does the caregiver offers to help him sit on the edge of the bed or transfer to the wheelchair.

Fortunately, after a year he qualified for Medicaid and their In Home Supportive Services program, so they now pay for some of his caregiver hours. After another year, he also is about to receive more paid hours through the Home and Community Based Alternatives waiver program ("Waiver Personal Care Services"). If your MIL would qualify for these services, you might consider 24 hour care at home.
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Well..well... someone else has FINALLY stated the truth. Sooner or later, your person with dementia is going to fall and it is NOT going to be someone elses fault. I have been in home health care for 20 + years and for so many years just so responsible for making sure they did NOT fall. Used gait belts...encouraged them but this is where I drew the line. Had a patient... female in 60's....overweight... pretty big around the middle... big buttocks. She had care 24/7. She used a walker, had to assist her to a standing position, walked behind her to the bathroom. She refused to wear gait belt. The bathroom? Tiny door, just able to get the walker through the door. This was the tiniest bathroom I had ever seen. Walker went through door, then her and me barely fit into the room. She would turn and insist on pulling her own pants down and we were to keep her standing. Problem with this? Nothing to hold onto to keep her standing. Of course, while pulling her pants down, she would take her hands off walker for support AND while doing this her whole body would move...I call it "wobbling". If she fell, she would fall on either the toilet, the little cart in front of her that was in there holding her items...or... she would end up falling on us. Again, she would always refuse to wear gait belt. I quit this job after two 12 hour shifts. And that was also when I realized.....and stopped feeling guilty because I realized we cannot control everything with our clients. She refused gait belt which then meant that if and when she fell, her fall was NOT our fault. SHE made that choice and all we could do in that situation was just do the best we can. And no more. I quit mainly because I did NOT want her to fall on me! Who is going to pay my medical bills? And other bills? Who is going to take care of me if she hurts me? She should have been in a facility and NOT at home. Remember, dementia clients are NOT thinking about you. When people get to a certain state in their dementia, they need to be in a facility. Staying at home... they won't take baths, change clothes... won't wash their hands, brush teeth...etc... and one person taking care of them at this point is just too much. They sometimes get angry even when you try to clean them up after soiling themselves. They won't even let you check their undies for soiling. Yes... at some point.... they need to be admitted to a facility not only for their sake but for the sake of everyone else.
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She should be in a bed at night. Speak to Head of Nursing.
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why don’t they have a sensor mat in place by her bed on the floor at night to alert the staff if your mum attempts to get out of bed .
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amoeba Mar 2020
Thats a really bad idea. The sensor mat wont catch a falling person and staff who aren't 5 feet away wont get there fast enough. My mom fell and got seriously injured in precisely this circumstance. Dont do it.
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Hello

I don’t have experience with nursing homes however that doesn’t sound ethical to me at all.

My 83 yr old mom is a fall risk too she has unsteady gait among other health issues one being vascular dementia. She lives at home with me. I sleep in the same Queen size bed, I’m on one side and a small hand rail is on the other side so she can’t fall out of the bed and she also lifts herself up with it, she used to pull my arm/shoulder too much when I used to assist her in & out of bed. I take her to the bathroom throughout the night and once in awhile I’ll have her use the commode by her bed. It’s a very tough life for the both of us.

However if I left her in a chair all day and let her sleep in a chair all night...I think that would be considered elder abuse, so I’m not sure how that nursing home is actually getting away with that. She needs 24/7 care, but unfortunately they don’t have staff for each resident throughout the night. The lowered bed sounds like a good idea what others suggested.

Please check your mother’s body for any pressure sores/ulcers as well. I would definitely speak with the highest individual possible at that nursing home with your concern that she’s in a chair for 24 hours and then contact an elder attorney too if it doesn’t get resolved immediately.

good luck!
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To address this issue with my mom, who also has these symptoms and fall risk, she has an awake, paid caregiver 24 hours a day, at her bedside, no matter where she is. She is now at her home, but has been at a long term care facility. This may seem and is costly, but prevents further falls and injury, costs, and family burden associated with that. You can possibly have restraints in a home, which we don't, but not at a nursing facility, at least in my mom's State. There are a lot of falls in nursing homes because there isn't constant observation.
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There is 'no best way.' My MIL was ordered to have a 'sitter' in the evenings - as much for her being afraid as for falls. Don't remember the $$, but it was a lot!
...and she was afraid of 'that person who comes into my bedroom.'
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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 2020
Exactly. No excuse for being in wheelchair all night
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My mother also started out in a wheelchair, but always tried to get up and would stand on the footrest, which was dangerous. Since she was so active, the nursing home changed from a wheelchair to a gerichair. She is more comfortable in the gerichair and doesn't try to get out of it. Lot better than a wheelchair all day. She would also slump over in the wheelchair and have her hands hanging over. The gerichair is very comfortable, she thinks she is on a couch recliner and seems very happy and comfortable. She sits in it all day, since she can't walk anymore. At night she is in bed. The nursing home also put pads on the side of her bed in case she falls, but it hasn't happened in a long time.
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Yes, there are other options. We lowered the bed as much as possible and put carefully folded blankets and pads around the bed so that if my granny fell, it would be a "softer" landing. We also eventually used side rails, which are not always prohibited, especially if you can legally state an adequate reason for using them. Near the end, we tied strips of fabric across the side rails so she could move around but not get up. It did take getting legal help from the Senior Living Center to accomplish this - all help was free.
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The bottom line is that nursing homes are prohibited from using anything that is deemed a "restraint." Therefore, they are prohibited from using side rails on a bed. Also, side rails are deemed a safety hazard because many elderly have choked to death when their clothing or bedsheets became tangled in the side rails and around their necks.

A bed in its lowest position plus padding on the floor next to the bed is the best alternative. The staff do make regular "rounds" of all of the rooms, so someone will find her should she roll onto the floor pads.

Some nursing homes have recliners that residents may use for daytime napping. However, this depends on state regulations, because a recliner can be deemed a "restraint" because a patient is unable to get out of it without staff assistance.

There is no easy answer. When a person's health deteriorates to a certain point, there is no way to totally prevent falls.
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I worked as a cna for 20 years beds on the floor,geri chairs are great suggestions but I'd also Having a one on one, ,Your Mom could have one cna dedicated to her each shift. Just a thought.
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cleo1730 Mar 2020
Nursing homes won't pay for a one on one. This would have to be out of pocket. I currently have this exact problemwith my parent, as the former nursing home listed her as a one on one and wanted her out because of that reason. No nursing home within 45 miles would take her because she was listed as a one on one. I finally found a place; not aesthetically the greatest, but they do have her sleeping in a lowered bed instead of a chair 24/7 and they are much nicer to her.
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My Mother did fall but now she is afraid if walking I when I would put her
in respite when I went to pick her up I would find her bed on the floor I didn’t understand at the time why they did this but know I understand if it was on the floor then she couldn’t get up to fall. Wish my bed at home was as low.
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Dollie1974 Mar 2020
hi,

did you try researching an air mattress, some of them are very low and comfortable too, I use it for my mother’s grandchildren (adults) when they come over and visit.
good luck.
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During the last year or so my father was still living at home, he slept on an overstuffed chair in the family room. I'm not certain as to why, but I suspect it was in part because the bedrooms were upstairs and he didn't want to risk falling while using the stairs, and over time he started using a walker. Downstairs, he was close to the bathroom and the kitchen, and apparently it worked well for him. He probably found it easier to get up from the chair, grab his walker and then go.
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What kind of chair? A geri chair is somewhat comfortable. If it's a wheelchair, I would be pretty concerned about getting a pressure ulcer and shortening of her hip/knee flexors, neck etc.. She should be able to lay back and stretch her muscles and shift to relieve pressure.
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Yes put railing and bed cushion & a soft floor cushion
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Again with not reading the post!. She can’t put a rail on the bed. The facility is following state and federal regulations & doesn’t allow them. The mattress can be and should be lowered to the floor. Problem solved!
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They can try and put mattress on the floor by her bed and lower the bed as far down as possible. It wouldn't prevent her from rolling off the bed but she wouldn't roll very far or hard.
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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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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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Need, from the horse's mouth:

FREEDOM FROM RESTRAINTS AND ABUSE
Residents shall have the right to be free from verbal, sexual, physical or mental abuse; corporal punishment, involuntary seclusion; and any physical and chemical restraints imposed for the purpose of discipline or convenience and not required to treat the resident’s medical symptoms.

12 Nursing Home Care Louisiana Department of Health and Hospitals

I repeat: "...required to treat the resident’s medical symptoms."

These regulations on residents' rights were never intended to prevent the *appropriate* use of what are in fact aides rather than restraints. They just require that the equipment is justified, and can be shown to be justified, as being beneficial to the resident. It's the process of justification, and the additional duty of care demanded by safe use, that are the NHs' headache.
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Interesting, isn’t it? Thanks for sharing your wisdom and information, CM. Appreciate it.
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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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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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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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The NH my Dad is in took the bed rails away because they said patients were getting hurt trying to get over or through them. They also did away with bed/chair alarms. I think the alarms were so sensitive that they were going off whenever there was any movement at all detected.
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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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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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I have the same problem. My mom has dementia and limited mobility. She had several falls when she first got there and is now seen as a fall risk; but now she's in a wheelchair when she's not in bed. I agree with the many suggestions about making the bed as fall-proof as possible. While you're talking to the NH staff about this, I suggest you find out how well it works to have a person sitting by the nurse station all day. Given the staffing levels, can they truly have staff monitoring these residents all the time?
The people who sit there have no call button to let someone know they need a bathroom visit, a sweater, a nap, or anything else. They tell me mom verbalizes her needs, but that just means that they hear her sometimes. Many times she drifts into her own world and doesn't speak or even open her eyes. Did I mention she can only hear if they put her hearing aids in? Also, sometimes the staff sit behind the desk at the station -- out of sight of the residents. How are they supposed to ask for help if they can't see anyone?
Also, I've seen the nurse station empty and these were residents trying to get into the bathroom on their own! If there's no one at the station, anything can happen. I might ask them to either get her a cushioned reclining (multi-position) chair or switch her often between chair and bed.
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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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Bed rails don't keep people in bed. My FiL is also in wheelchair, he can stand but only just barely to transfer to chair; he cannot bear weight. But that does not stop him from thinking he can walk. He is in Memory Care so he spends his days in a wheelchair or transferred to chair or couch in common living area. He has a chair alarm so if he gets up, it helps remind him and then staff also alerts and he is instructed to sit back down. In bed, he has an adjustable bed that is placed in lowest position when he is in it with rubber mats on the side he gets out of. They do find him on the floor about once a week. He wakes up, tries to get up, and cannot stand so he sort of collapses on floor. He is not injured because bed is low and mats absorb fall. They find him right away because his bed alarm goes off. I don't think it is humane to keep people out in the hall in front of the nurses station 24/7, even if there is a recliner. There is light and noise all night and I think even dementia patients benefit from being in bed. They could use a reclining rolling chair, like a padded geri-chair for her so sometimes she could be placed in reclining position to take pressure off her buttocks and then rolled into her room and put in bed at night.
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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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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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Would you feel better if she were made comfortable in a recliner with an attached table, or are you thinking that chairs are for being awake and beds are for being asleep (both reasonable perspectives)?

I would have felt safer having my mother as near to the nurse’s station as possible, whether in a chair or something else, IF she was getting a reasonable amount of sleep while she was there.

That said, it can be very tough to accept that “unusual” solutions can sometimes be more comfortable for our LOs in the grand scheme of things.

She’s truly Blessed that your devoted to finding a solution.
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cwillie Mar 2020
Just and FYI - just like seat belts an attached table is considered a restraint unless the person can remove it themselves.
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The nursing homes I have been in have power reclining chairs in front of the nurses' station. That is a better way to do this. In fact, many elderly people prefer to sleep in those power recliners in their homes. Easier to get in and out of and no risk of falling out. I don't know their rules, but maybe they would allow it if you brought in that type of chair specifically for your mom? She may not need to be in front of the station with that chair.
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