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?
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.
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.
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.
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???
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.
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.
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.
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.
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.
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.