How to prevent falls in rehab with a dementia patient?

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How to prevent falls in rehab with a dementia patient?

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My mother has increasingly severe dementia, had 2 TIAs and is now in the rehab section of her living facility. She is not able to walk on her own. She either forgets this or she is non-compliant and was found on the bathroom floor this morning at 5:00 am with a large gash on her head.

The staff tells me they cannot restrain or use bed alarms, but check on her frequently. Obviously this is not enough...

I don't know what to do next.....

Fall Prevention Falls Rehabilitation Center

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Hospitals use bed alarm - a clip is placed on patient and when trying to leave the bed, it sounds an alarm at nurse station. M-L-M fell in exercise class at elder community and broke her hip. Anesthesia made her dementia worse and elder care community is relocating her to a sister facility that has a memory care section. She fell in January, hip is stable, she's being relocated May 1st.

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moved.

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Restraints seem inhumane to me and I would hate to see that with a loved one albeit the risk of fallin is awful...My father had moderate dementia in his final years and was up all night....he had a few bad falls in the last few years - last summer fractured hip...ie he went outside at 3am to pickup a fallen garbage can......looking back, i probably should have had special locks on the doors leading out but since mom lived there also, was afraid if there was a fire they would both be trapped.....he eventually had surgery and rehab but in rehab he would have to have his bed low, a cushio/mattress next to bed if he fell and bed alarm....i can tell you those bed alarms go off all the time and are horrible and many times no one comes anyway....leaving the bed low is the best option...he fell a few times trying to get out of bed and landed on the mattress.....but then he developed mrsa/sepsis/heart infection and all his hard work for 8 weeks went out the window and he died...end of life SUCKS!

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I do not understand why they can not use a bed or chair alarm.
There are methods to make getting out of bed more difficult.
Concave mattress
Wedges on the mattress, under the sheet so it is more difficult to get out of bed.
Positioning the bed as low as possible and a mattress on the floor so if someone were to get out of bed they are cushioned more in the event of a fall. (tell the truth with a very low bed and a mattress on the floor I don't think I could stand up!)
And I am sure with a Doctors order they can circumvent the restrictions on the use of restraints. (When my Husband was in the hospital for a short time he tried pulling out IV's and I gave permission for restraints to be used.)
Even the soft mittens on the hands while not a restraint will make it more difficult for a person to use their hands for stability that might also work as a deterrent to getting up.

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What quality of life it is to be restrained in bed? What about bedsores?

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That is unacceptable. Speak to the Ombudsman as your mother cannot fall again, God forbid.

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At my Mom's NH, they ordered a special type of mattress that makes it harder for her to get out of bed on her own. Ask the staff and see if they can order such a mattress.

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Yes, its concaved so makes it hard for them to get out of bed.

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Good Morning,
You will likely have to go to the head of the facility and visit with them about the laws in your state concerning that particular facility. My mom was a bad fall risk, (broken hip) but with dementia!!!! So the higher level of assisted Living that she was in got a Dr.s order for a chair restraint.. This was curious to me... She had to know it was there and be able to unfasten it, which when first showed, she could do. Then the staff who got her up and dressed, etc, just put a light blanket over the strap.. It worked. But she got to where she though it was her belt to hold her pants up. bgolani, Please do whatever it takes to keep her safe!!
God Bless you for being her advocate!!

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As my daughter told me, they are going to fall. She has worked rehab for 20 years. She thinks the laws are stupid for the majority. She says someone did research and found that some elderly got their head stuck between the guardrail and mattress or they climbed over the rails causing death or injury soooo no railings. Remember the sit your child backwards in their carseats after infancy because it was safer. Have you seen the picture of a 3/4 yr old sitting backward? No place for the legs to go. Looks very uncomfortable to me. It was ONE person who suggested this and everyone went with it. TG it was never made a law.

But even so, with the laws in place no restraints, then what is staff to do but check on the patient. My daughter has turned her back in a secound the resident got up and fell. Sorry, but they can't be there 24/7.

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Hi bgolani
This is a tough problem and I’m sorry about your mom’s fall.
I think it’s a rule everywhere about the inability to use restraints.
There are bed alarms that alert staff that your mom has gotten up. They are very sensitive and noisy but I’m not sure they would help with a dementia patient. The desire to not pee your pants is a strong one.
Sitters are sometimes hired to call the rehab staff to come for when a patient wants to get up.
As expensive as care is, it seems inadequate for elders who can’t be easily managed.
My mom, who didn’t have dementia, fell in a rehab.
She was told not to get up
but up she got and down she went.
I was in the room with her. Hurt her pride.
She couldn’t believe how easily she fell.
Elders fall.
Dementia or not.

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I get the no restraint rules but why no bed alarm? That was common where my mother was. There’s no amount of “check on her frequently” that’s good enough.

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The dementia patient does not remember the alarm is to remind them that they are not supposed to get up and the staff that hear the alarm cannot get there fast enough to stop them from falling.

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She cannot comply. She is at risk of serious injury. The facility needs to escalate the issue, it is not enough for them to say 'hey, what can you do.'

Go to your state's website and start investigating the regulations there. I do not know, and it varies, and this is an uphill struggle; but what you are looking for is the statutory process laid down for using alarms and restraints when they are demonstrably necessary for the patient's safety. Where I live it's called a Deprivation of Liberty order and getting one is a massive pain in the butt; but it sounds as though in your mother's case some kind of restraint or continuous monitoring is essential. I will place a modest private bet that there will be some kind of similar procedure where you live, it's a matter of finding it out and then holding the facility's feet to the fire until they act on it.

Good luck, I hope your mother recovers okay this time, poor love.

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How to prevent falls in rehab with a dementia patient?

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