My (step) mother was admitted to hospital on the early hours of Saturday morning following a fall - she had gotten out of bed and was unsteady on her feet and fell. My dad immediately helped her called an ambulance and she was admitted to hospital with a fractured pelvis - this turned out to be a stable fracture so apparently did not require surgery but over the course of the coming weeks she would be receiving physio and other therapy to help with the healing process. My mother is 90 years old and also has Dementia and Alzheimer's which has shown quite a deterioration over the past 12 months - however while in hospital it really took on a whole new level - she now suffering from hallucinations alongside the other 'memory loss' and confusion, and repetitiveness. She was put on enhanced care while in hospital due to the risk factors of her trying to get out of bed and we were told she mustn't be left even for a moment. Dad has been at the hospital the majority of the time and won't leave her side he was already distressed but then things got a whole lot worse. On arriving at the hospital this morning she had another 'fall' after being left unattended for 8 minutes during the night - she had gotten herself out of bed and fell - after further x-ray the fracture is now a full break and would require surgery to fix it - the problem is because of other high risk factors she can't have the surgery - so my question is what happens now? If it's not fixed what is the risk of infection? She can't come home and the plan was for rehabilitation for 4 weeks before coming back home ...... I need some straight honest answer no matter how bad it is - if only to start to try and support dad better and prepare him for a terrible outcome. She is now having to wear 'nappies' as the nursing staff will not let her use the toilet which she was able to do with supervision before today. We are all distraught - I have helped dad to take care of her for the past year with personal care etc but he is her sole carer really (he is younger than her by 15 years). We are so worried to leave her in the hospital in case of further neglect injury but if we discharge her to home dad would not be able to care for her on that intense level. Due to me being in full time work there are some limitations on what time I can give to help. We are also still waiting on social workers to make a decision which will no doubt change following this second 'fall'. Has anyone had any similar experience of this?
In the NHS hospital where my mother is there is what is called an Enhanced Care Plan - this is a 1-1 care plan when people are considered to be at high risk of causing injury to themselves or others due to other conditions such as demential/Alzheimer's etc. The care plan stipulates quite clearly that the patient is not to be left at all - there are regular breaks for the person doing the 1-1 and a stand-in auxilliary will take over for toilet breaks, lunch/dinner breaks etc. The shift is for 24 hours and the family are not required to be responsible for the care of the patient while in the hospital.
Someone had posted that we 'had been told we were responsible for her' - this is not the case and in the UK the family are never responsible for patients while in hospital although in cases like my mother my father is allowed to stay with her during the day.
Two things happened that shouldn't have done - she was left for a minimum of 8 minutes unattended during the night and the bed guard had been removed which allowed her to get out of the bed and fall.
I want to make it clear that we have no intention of trying to pursue any kind of claim or lawsuit but some acknowledgement that a mistake was made would be appreciated. Some of the staff are clearly inadequately trained and this became evident when a couple of them were joking about the 'incident' and laughing saying that my mother does enjoy to go walkabout - well I'm not so sure if they would find it so amusing if it was their mother lying on the floor with a broken pelvis. This lack of professionalism and empathy astounds me. The nursing staff in the UK are very overworked but there is no excuse for this appalling response.
She will be moved to an assessment bed over the coming days which is located in a residential care home and we understand that once here she will not have the 1-1 care and the risk of another fall is fairly high - However, there will be other things that can assist such as better bed guards, sensors etc to reduce the risk.
I personally believe now that we are entering into the EOL phase and my focus is to try and ensure that she is as comfortable as possible, that she has her family around her as much as possible and that her distress and confusion is kept to a minimum - although I do understand this might not be possible. She has had the condition for 10 years and the deterioration over the past year has increased - the past few days is a whole new level which were did expect following the trauma.
My other priority is my dad and supporting him through this awful time.
Once again thank you all for taking the time to let me know your thoughts I really appreciate it.
I hope that you will find the best solution possible. Most likely, this is hospice. Do your research on providers and choose one that will best suit your needs.
Wishing you peace.
I would ask for a Hospice referral.
Hospice will arrange all the equipment needed to be delivered and set up at the house before mom is discharged.
If mom is is pain that can not be managed at home she would be taken to the In Patient Unit and pain management would begin there. (If the Hospice does not have an In Patient Unit generally the hospital has a Hospice wing and she would be taken there)
I agree this is not negligence even if there was someone in the room with her there is still a very real possibility that she would have had the same fall.
there is also the good possibility that this may have been a break and fall not a fall and break.
It’s the price we pay for being bipedal.
Hospice evaluation seems the best option.
My mother fell 95x in AL and then Memory Care Assisted Living. Rehab could not "rehabilitate" her with dementia, so they just tried to help her learn to use the wheelchair to ambulate herself around a bit.
Stepmom needs long term care now with hospice on board. Dad cannot possibly care for her at home by himself, it's too much, imo.
There is no hospital negligence here, just as there would be no negligence involved if step mom fell under dad's watch. It happens.
Best of luck.
Now I’m in my mid 50s and I’m starting to slip so DH is sending me away this weekend on a me time trip so I can put my oxygen mask on.
OPs father can’t be her caregiver anymore.
I went through this in 2022 when my 100-yr old Aunt with advanced dementia who was not able to walk without a walker or support, shimmied past her bed barriers in her home, fell and broke her hip. We declined surgery due to all the risks at her age.
She went to rehab, where she continued to attempt to get out of bed. The plan was to do PT to get her to pivot on that leg, then she could go back home where we had family caregivers and could still be "mobile" with help. But rehab is also not a NH, and her sister and niece had to go there every day to encourage her to eat and make sure she was drinking enough fluids because she wouldn't keep an IV in. After about a week and my family keeping close eye on her, she passed away in her sleep. We'll never know exactly why, but with large bone breaks there is the risk of passing a deadly clot, which may have happened. I was in the process of figuring out if she could be transitioned into MC or LTC since she wasn't cooperating with PT but continued to attempt to stand up (which makes any level of facility care tricky).
I think your realistic options are either to bring her back to her home and hire in-home aids. But if she continues to get out of bed or chairs, she will continue to fall and fall and fall. It is illegal to restrain someone, even in your own home.
If she is immobile, I would talk to her doctor about assessing her for LTC, which can be covered by Medicaid if she also qualifies financially. If she continues to get out of bed, I don't think she's a hospice candidate -- but I'm not sure since I haven't had this experience. You're not imagining that this is a tricky spot to be in with her... I totally get it.
You should maybe test her for a UTI since her behavior has deteriorated so quickly. This is treatable and very common in elderly women. If left untreated, could lead to sepsis. Also, a broken bone that doesn't break the skin is unlikely to cause an infection. But, if she's in pain, then she needs palliative care.
My goal for my Aunt was to keep her pain-free and comfortable, and to NOT have expectations of recovery at 100. Quality of life, not quantity.
Sadly, what you're experiencing here is the dementia coming on full-steam.
And people with dementia FALL. I can't count the # of times my DH would leave his mother all tucked up in bed, and be 5 minutes away and get the call that she'd fallen. It was never his fault, not by a long shot. She could fall with one of the kids or her hospice crew standing 10 feet away.
Aging ca be depressing and sad. You're seeing that up close.
Is it time for Hospice? A broken pelvis that cannot be fixed is going to render her bed bound--and to heal 'naturally' likely won't happen.
I'd personally spend my energy with dad, supporting him in the days ahead when she is not home and he can't really DO anything to help her.
I'm so sorry. She doesn't remember not to get up--and she will try it again and she will probably fall again.
No, this is not the fault of the hospital.
I don't see hospital negligence here.
What I do see is a very ill 89 year old fitting a very unfortunately common pattern. And I will be stone-cold honest to tell you that the type of fall your mom sustained is inevitable in the aging. It's not a matter of strength but of brain-- balance is the thing that takes us down (at 81 I assure you this is correct).
I'll add to this the other bad news that hospital pyschosis is almost to be expected in someone of this age with this injury.
What DOES amaze me is that she even could manage to get out of bed to sustain another fall, because quite honestly a broken pelvis is so painful that one almost cannot MOVE whatsoever.
No hospital can afford 24/7 aids at bedside so fall prevention often goes to an order for Q15" checks.
Cost of an aid would be passed to the patient when their insurance will not (and most will not) provide this care. Bed alarms don't work. Restraints are not allowed.
I am also going to be so honest at to tell you that for many seniors falls this serious are the beginning of the end (and it was so for my own mom, 90s).
It means more and more debility, skin breakdown, catheters, UTI infections, pneumonia (once called "the old person's friend" because the patient died). Appetite, mentation, poor healing, pain, pain medications, all play a part and the eventual outcome is bedridden with sepsis and all systems start failing.
If mom manages to beat the odds, and they are not good, then she is going to need rehab, and almost certainly placement. I don't think in home care will be possible again, but she may prove me wrong, and you never do know for certain.
You want someone to level with you, and I just did. Your mom may now be in the last fight for her life. Palliative care and Hospice should at least be discussed with the doctors. For me it would be the option I hoped my family chose.
It's unfortunate today that as part of the division of care, hospitalists/PCPs, there's no continuity of care and knowledge/understanding of the patient in the bed as a whole human being with a family. The hospitalists are seeing an elder with a very bad history on paper, very severe injuries. If you mention the dangers of further falls, of UTIs, of failure to thrive, of pneumonia they will acknowledge that I am correct.
It is time for the family to have discussions with the doctor, the social workers, the case manager and one another. I am so very sorry. Watching the dire progression of happenstances a step at a time is very painful.
I hope your mom proves me wrong. I would NEVER bet against luck and surprises in medicine. I just need to know you consider the possibilities and try to prepare .
I wish you so much luck.
In days of yore most patients had a PCP who actually knew them and oversaw their care. I recall my orthopedic surgeon visiting my bedside regularly during my 3 weeks in the hospital following a spinal fusion in the mid-1960s (now that's often an outpatient procedure, I understand). Today's hospitalists know hospital care, but most likely the patient is just another number.
In this situation preferred care (for me) would almost certainly be hospice. Hopefully, the s'mom has a specific healthcare directive that provides for comfort care but NO "heroic measures" at EOL. The realities of the situation will be very hard on OP's father but, barring a miraculous improvement, prolonging this very disabled old woman's existence given the current circumstances is doing her no favors IMO.
My question is why do you think there is hospital negligence?
My daughter currently has 4 fractures on her pelvis from a car wreck 6 weeks ago. She is in her 20s and couldn’t use the bathroom for a week— had to use nappies while in hospital. They tired a pure wick but those don’t seem to work well on young women. So nappies were the best solution.
(I hadn’t told the group about the accident yet, so surprise… I have been a caregiver again since April. I’m exhausted all over again but she is my daughter so I’m doing it as a mama bear).