My mother in October recently spent 13 days in the hospital after a fall. The memory care aide came into her room one morning and found her out of bed sitting in her recliner with a bruise on her temple eye area. So unattended fall,evidence of head injury, have to get it checked out. Long story short, after cat scans was that she has 3 broken ribs.
After admission, she developed a fever, pneumonia, and became non responsive. Really they were talking palliative care. I didn't think she was going to live; I would show them a picture of her on my phone of her on her 90th birthday a few days prior and they would say Wow!
She pulled out IVs, they put her in these huge gloves, she would just murmur help me, it was awful. But her neurologist stopped by to see her, and luckily it was right then we I was having to make a decision on a temporary nasal gastric tube, or just accept palliative care , and he made the following statement. Right now we are at the point of doing things FOR her, not just TO her. Made the decision to do the feeding tube for the weekend and reassess on Monday. That was a rollercoaster of a weekend where they had to redo the tube 3 times ( it clogged, nurse took off moms glove off to scan bracelet and even barely coherent mom pulled the tube, and then did it again, so had to restrained). But she rallied, got rid of the tube and was released from hospital. Was uncooperative with PT most of the time, was extremely sleepy, but finally let them help her up to sit in a chair and walk a few steps. She lost 16 pounds in the hospital. So now had to make a choice. Discharge to a nursing home rehab facility until her mobility/strength better and then go back to rehab, or back to her Memory Care with extra aides until mobility strength better. Her memory care has an in house PT.
I decided to take her back to Memory Care, as she suffered delirium in the hospital, and really has a lot of anxiety issues with transitions and I felt it would be better for her to be in a facility that I knew, and she would be in her room with her things and pictures. She had a negative covid test on her discharge and she had a second one the next day so she was only in isolation for a few days.
So for 31/2 weeks she has had aides 24/7. Memory care still does medication management and showers. Her aide helps her with dressing and toileting, and sits with her in her room, or is nearby when she is in common room eating or watching/participating in activities, and helps with reminders for hydration, and making sure she has assisif she tries to stand up. This week the memory care manager said she felt she was doing well enough that we could cut back to night only 7pm to 7am. Which is nice since $28/hr plus the usual Memory Care rent and fees is expensive
PT has been working with her trying to use a walker, but its hit or miss if she cooperates. She of course thinks she's fine, even though she is very unsteady on her feet still. I don't think that even if the walker was sitting in front of her she would remember to use it. I can see her setting it aside and trying to go somewhere. They've still been using a combo of a wheelchair/walker to get her around. I don't know maybe if she had gone to rehab it would have been faster.
So currently her care plan is assistance with dressing and bathing, and medication management. Plus the usual prompting about choosing meal and hydration. It says they check on her once a night, and don't wake if asleep, but assist if awake.
I guess my question is while I agree that leaving her in her room alone all night right now is a bad idea, since if not watched will get up and probably fall because she won't remember she needs help. But its not reasonable financially to pay someone indefinitely to stay with her either. I asked about bed or floor alarms, and they don't do that. They said they have done a fall matt by the floor, but that could be a fall risk.
What do people do ?
1 - Bed: in lowest position (almost on the floor), with bed rails down (since folks climb over them anyways), and wheels locked. That way she is more likely to "roll out of bed" than fall.
2 - Floor: Thick mats on both sides of bed (or 1 side if bed against a wall) so any fall is cushioned when trying to get out of bed.
3 - More frequent checks (most folks void every 3 hours while awake) when in bed to make sure she is toileted or helped if she is awake. This may not be feasible with COVID pandemic and staff are all stretched thin.
4 - "Eyes on supervision:" staff member keeps visual check on "fall risk" clients at all times during the day, especially if given medications that impair judgment or cause drowsiness.
5 - Restraints: this used to be a big thing decades ago. Thank God they are discontinued for the most part since it puts folks at risk of skin problems and didn't really prevent falls.
6 - Tables: avoid bedside tables that clients may fall against or use to get out of bed as a crutch, wheelchair, etc.
If your mom gets a sleeping agent in the evening. She should be checked on for 1-2 hours after administration until she is fully asleep. Groggy clients tend to fall more easily.
.
After several falls in the shower that looks literally like a fortress, and that the caregiver helps her in and out of, I bought her water shoes. She hasn't fallen since.
She has chair alarms and bed alarms installed by the AL. By the time the alarm goes off, she's ALREADY on the floor. Then the team has to come in to pick her up, or else the night nurse who's a marine & weighs about 250 lbs and stands 6'
4" is called in to pick her up. She once fell TWICE in one night and he came both times. She weighs in at 190 lbs so he has quite the stamina.
Believe it or not, she's never been to the hospital for one of her 50+ falls (that we know of; God knows how many falls she's taken in REALITY). She hid a few falls from the staff by getting back up by herself and not calling for help. During a couple of those falls, she broke a few ribs & some sternum bones. We had no idea why she was constantly asking the staff for Icy Hot patches day & night, for 3 months. When she had a CT scan for pneumonia about 18 months later, we learned exactly WHY.
She went into a wheelchair in May of 2019 and I thought, AHA, the falls will stop now! Nope. Since then, she's taken about 12 falls, at least, because of not playing by the rules.
There is no way to prevent falls, as evidenced by this comment. If there was, by golly, we would have found it by now, after 50+ falls in 5 years at the same AL! You can put her mattress on the floor, but she can trip over it. You can put padding down on the floor around her bed, which is yet another tripping hazard. That's about all you can do, that I know of, to perhaps ward off SOME of the falls, depending on which types of falls she takes.
Good luck. I know how it feels to keep getting these calls.
My BIL is a hospice chaplain and told us "old people fall, it's just a fact of getting old."
The decision was made to just have her use her transport chair from that point on. It was just a matter of time before she became wheelchair-bound, and I really didn't know how we'd know when that day would come, but the fall made the decision for us. Mom can get up out of the chair with assistance to transfer to the toilet or to her bed, but for all intents and purposes, her days of walking are over. She did manage to fall out of her wheelchair last week while leaning over to try to pick up something off the floor, but she just rolled out and onto the floor instead of splitting her head open.
As far as nighttime trips to the bathroom, she is now in diapers and gets changed at night rather than the aides trying to get her up and to the bathroom in time to avoid an accident. It's sad to have to make those decisions, but honestly, it's made her life much easier as well as that of the caregivers. She can be cared for in a more scheduled way, and she's much safer from falls in her chair than she was on her feet.
She would never remember especially after waking from sleep thar she shouldn't get up if she needed to the bathroom. They had her on a pure wick in the hospital and it was drama and distress every time ahe needed to go and finally couldnt hold it anymore.
Prior this she often paced around, she was never in her life a sit around all day person, and now that she has all these memory problems, she just doesnt remember she even Had the fall, let alone that she needs help.
With my family member, we got a call from MC almost every day/night about LO falling.
I was determined to find the "cause". It was actually the medications. After some adjusting meds ..... the falls ceased.
Even with a bed lowered to the floor, I've had residents roll out of the bed, push themselves into a semi standing position and then fall over. Rubber mats on the floor beside the bed sometimes help but had a number of residents trip over them .... and then fall!
Balance generally becomes an issue as we age, sometimes even for athletes who keep up their daily regime, so falls become a much higher risk.
Is there any medication or combo of meds that could be contributing to her fall risk? Worth asking her physician.
Being in a LTC facility is less than 24/7 private care. It's all expensive!
First thing I did was buy a SMART complete cordless bed exit monitoring system
from Amazon. I put the pad part under the mattress pad near his shoulders. The alarm is at the nurse station with his name and room number.
It uses batteries or electrical which is extra. When he sits up the alarm goes off and they can go check on him. It can also be put in their chair and alarm when standing. The last fall my dad broke his arm. He was put on hospice for pain management etc. They put a fall mat by his bed. And replaced his bed with a hospital bed. They raise the rails at night and lower the bed. Two things: Get the pad for safety and check to see if she qualifies for hospice. She should get her own CNA for bathing and feeding.
My dad takes zero meds but does not want to eat. He is alert. But wonders why all these people are in his house.
He wandered too. Doing ok for 95. Hang in there. One day at a time.
See All Answers