My mom is 94 years old with moderate dementia. She broke her hip last week, a displaced femoral neck. We have opted not to repair with surgery due to risks with anaesthesia and her dementia, a recent heart event, and her risk of falling again.
She's back at her home in a memory care unit in a level 6 assisted living home, and in the first 24 hours she has already used the commode on her own and got herself halfway across the room before falling. Thankfully she did not further injure herself. She did join the other residents in the common area and was quite jovial, and we know she gets good care at this place.
How do we keep her safe from falling again? There is usually an aide within sight if she's in the common area, but what about when she's in her room? Even if we pay a sitter, they only need to turn their head or blink and she can be off again. There are no restraints or alarms allowed where she lives and I think that goes for skilled nursing facilities also.
Any similar experiences or advice?
Restraints cannot be used in any facility, even SNF. Some types of alarms can be used at SNF, but not ALF. Bed rails cannot be used at ALF or SNF for dementia patients as there have been instances of them putting their head through the railing and getting strangled. Who would even think of that?
There are other devices used to "protect" the patient. There are hospital beds that will lower almost to the floor. The elderly patient, especially one with a broken hip will be highly unlikely (but not impossible), to be able to get herself up off the bed to go anywhere if it is that low. Someone has to ensure there are no chairs, walkers or sturdy furniture near the bed to be used for pulling up. There is also a mat that goes next to the bed in case she does get up and then takes a tumble.
In SNFs I've seen wheelchairs that sink way down in the rear of the chair, almost impossible for even a young, agile person to get out of. The person is still able to scoot the chair around. SNFs are allowed to use a type of lap pillow that sounds an alarm if the patient tries to get up and the pillow falls.
You are correct that a sitter cannot prevent every fall. That is where people need to just learn to let it go. Unless you are sitting there 24/7 holding onto your mom, she IS going to find a time when nobody is looking and will get up.
Even patients who don't really have dementia will fall. My granny did this several times. Her thinking "I just hated to bother anyone. I just wanted a glass of water at midnight."
You can only do so much - clearing obstacles from the floor, using the tools mentioned above, protecting corners of furniture so she won't bump her head if she falls (my aunt did this).
My Mom was always falling because her mind told her she could stand and walk, but in reality she couldn't do either. The Staff tried a variety of things. Mom even would fall out of her wheelchair when she was trying to pick up something on the floor [there wasn't anything on the floor]. Finally a geri-recliner would slow down my Mom when the nurses put a pillow under her knees, worked fine until Mom learned to pull out that pillow.
Alarms do ring, but by the time a nurse or aide hears the alarm and races to the room, the resident is already on the floor.... [sigh].
One positive note, your Mom enjoys being around others. That is super great :)) So many residents refuse to socialize.
Mom has severe arthritis and has had a stroke, and she can barely stand up and take a few steps with her walker, but she either forgets she can't walk unsupervised, or else she is stubborn and tries anyway.
At the nursing home, when they didn't answer her call bell soon enough, she tried to take herself to the potty. She talks about getting up and going herself when she's home. It's a constant fear. So all we can do is the best we can, and Amy is right, we have to let go. I tell Mom over and over that if she falls and has a hip fracture, or a severe brain bleed because she falls, then she will have to live in a nursing home permanently, but she refuses to listen. They can't even use chair alarms in the nursing home now, but at home I'm seriously considering using her gait belt as a seat belt and strapping Mom in the wheelchair. At least she can't get the rails down in the hospital bed, so when she is down for the night I can at least sleep.
They fall all the time in nursing homes. It sounds like you're doing all you can.
I'm going to tie a string from her wrist to the walker, so she can't move without it.
Chair and bed alarms CAN be used in nursing homes. There are pad alarms that sound when the resident attempts to stand up; and alarms that clip onto the resident‘s clothing and when the resident tries to sit up in bed or stand up from a chair, the string is pulled away from the magnetic pad activating the alarm.
One time Hospice was allowed to use side rails on a hospital bed because the resident preferred to lie on his right side and he would lean his body into the railing. Because the railing was used more as a body support than as a restraint, Hospices was allowed to use it in our facility. They did have to put a long body pillow between the resident and the bed rail to cushion the resident's body as it lay against the bed rail.
FYI: Medicare and Medicaid say that "the resident has the RIGHT to fall." That is the response our Nursing Director got when she asked why we couldn't use bed rails or restraints.