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My mom is in NH in NY state. She is in a wheelchair, dementia and almost 100% blind due to shingles, and subject to falls from rolling out of bed. We have put these (authorized) precautions into place: Wider bed, fall mats on both sides, lowered bed to the floor, moved furniture away from bed that she may hit, padded the corners of A/C unit, 15 minute bed checks. When I am here and putting her down for a nap, I pack pillows around her and place her big call disc near her bum so she may roll onto it if she wakes up and is on the move, she may accidentally activate it. She is blind and can’t see it, and with the dementia doesn't use it in the normal way. These 2 last procedures are considered “restraints” in NY so are unauthorized, so the aids do this on the down-low and I can’t get them documented into her care plan. This is more than frustrating to me and the nurses. They’ve asked me to consider moving her room across from the nurses station where they think they will be able to spot or hear her and intervene. I hesitate to take this step as she’s been in the same room since moving here 2 years ago, it’s bright and pleasant and her roommate watches out for her and calls for the aids if Mom has a problem. Not her responsibility but she’s a lovely caring person who I try to help as much as possible too. The potential new room is depressing and roommate sleeps 99% of time and is noncommunicative. I want what's best for Mom, but I’m not sure what to do. I don’t want this to be about me, but I sure don’t want to be any more depressed when I’m here than I already am! Before I take this step does anyone have more ideas on bed fall prevention that we could try? They won’t move her unless I agree, and it’s the only thing left in their bag of tricks, although they are not familiar with dealing with blind residents, she's the only one here!

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I think some of you may have touched on this type of 'prevention' monitor, but not sure, so will describe what I recently found for my 90 yo dear AD wife, who can't walk and resides in a wonderful 4-bed residential type ALH with hospice oversight. Turned out when I started looking I discovered a simple ~10" x 30" smart pad system on the internet that's placed under fitted sheets and across the bed under the shoulders...where it reports if both shoulders lift (normally a necessary prep to getting out of bed), but not for roll-over position changes. When detecting a 2-shoulder lift, it transmits an alarm signal up to 100' to a small battery powered portable remote receiver which has an on/off switch plus a volume settable pleasant chime alarm that providers can mount on an appropriate wall or move it around depending on who's the 'monitor for the night'.

Simple, effective prevention, that really works...at less than $110! My only constant regret is that I didn't think to research and buy one before her recent attempt to get up in the wee hours and, struggling past the hospice provided side-barred bed, managed to fall...breaking her left hip in the process!

Just think, a mere $100 might have saved the $50,000+ surgery needed to repair the break, never mind the pain and lengthy recovery she's now still having to endure. As a retired engineer, I've simply no excuse for myself for not having thought of the possibility and had installed such a simple and effective system in place in time to have prevented all that.

p.s. For anyone interested, the monitor is marketed with the name "Smart Caregiver Wireless Bed Alarm." Just googling that will identify numerous sources. Hope this helps.
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Thanks everyone for your thoughts! Just to follow up, I did start raising the foot of her bed up moderately while she took her naps the past 2 days, ( in addition to the bed already being lowered to the floor). When she woke up, I said Ok Mom let’s get up, and watched her flounder, unsuccessfully getting her legs and feet moved out of the well in the bed. The nurses were happy to get another tool to use, and it’s going on her care plan today.
I will research the fall alarm that rings at the nurses station.
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When my dad was in the hospital they had bed sensors that rang at the nurses station to alert them when my dad was getting out of bed.
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With the Alzheimer Mat the alarm does not sound in the patients room , it would sound at the nurses station.
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wondering why in the world a bed alarm is banned? Craziest thing I have ever heard of.
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Tlkent I am afraid that an alarmed floor mat may be viewed as a restraint in NYS

Comuter girl have you ever been a patient in a nursing home?

Yes this lady is blind and can not see her surroundings but I don't believe she is deaf.

Her room mate is a plaesant and careing person and the patient's family visits with her too
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I agree it is the staff job to look after patients but that does not include one on one care 24/7. I would have loved to have had room mates like that when I was in hospital and rehab

Imagine someone who never sleeps constantly poops the bed and waits hours to be cleaned up while you are trying to eat, or comes from a large family who talk loudly in their native language.

I would opt as I said in a previous post to not put Mom close to the nurses station and the constant noise and commotion that goes on there. Pleasant room keeps the room mate in good spirits and looking out for Mom gives her something positive to do with her life.

This familly's problem is stopping Mom falling and getting round the over zealous restrictions on restraints, this is a major problem with many elders blind or sighted.
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She can't see! A pleasant room is unnoticed to a blind person and her roommate isn't there to care for your Mother, that is the staff' job. What is best is to closest to the nurse station as possible. Who cares about her roommate. Maybe she should be in a facility that has more experience with blind residents.
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Smart Caregiver - Floor Mat Alarm System for Preventing Falls & Wandering amazon.com/dp/B00YHQVPK2/ref=cm_sw_r_cp_api_T49XAbPDRB8YE
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I think that the baby monitor is the most genius solution I've heard! Great idea!
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Peppersmom, thanks, she has the simple music player that I purchased on the dementia website. It came preloaded with peppy big band music which she used to love but I removed that and replaced it with soothing music for sleep like piano music etc. It’s now part of her care plan for the aides to pop it open at night to turn it on. It may help a little , but when she wakes up, wow she’s on the move!
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Have you considered getting her some earphones that fold around the head and cup the ears and an Ipod that you can put her favorite music on. She might need some stimulation. I found this to work very well to curb restlessness during the day for one of our residents.
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Thank you all for your ideas. JoAnn29 you’ve concave idea just gave me another thought to raise the foot/leg positioning on the bed moderately. This may form a slight well that would inhibit her movement slightly. And since it’s part of the bed provided, they can’t call it restraint. I’m going to start that ASAP.

Last night we were just discussing the baby monitor idea since some family members just installed one to monitor a newborn via cellphone. Assuming I would have to sneak it in, after consideration I think it would just add more worry/helicoptering to my stress as I would be glued to it. I am already at the NH 4 hours/day so it probably wouldn’t be healthy for me (or my DH).
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To keep my Mom in bed they used a concave mattress. That and the pads on the side, just in case, seemed to work. Her "wheelchair" was actually a Geri chair that the seat slant backward slightly. Was hard for her to get out of.
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On the question of restraints check ( For additional information, see 42 CFR §482.13) a doctor can order some forms of restraints to prevent harm. Some facilities still may refuse. The surgeon who operated on my spouse was furious when his request was not accepted. The law does allow it when needed. There will be lawsuits.
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While we can *understand* the issue with a baby monitor/nannycam (invasion of privacy, but seriously, what privacy does someone in a nursing home needing so much on-hands care have left?? Same stupid people who object to the alarms - I can see where bed rails can be an issue, but all other fall aids should be on a case by case basis.)

That said, is it against rules for YOU to install a camera and have that camera alert YOU? With that in place at least YOU would know and could call the nurses.

We had several at the condo (non-invasive areas) for checking on mom and anyone who showed up, when she was still at home. Motion activated, length of recording can be programmed, those who get the alerts can also be programmed (one alert when camera was triggered, one when the recording was done - these can be viewed in the app, and it also has "live" capability, so if you wanted to peek and see what's going on, you can. I opted for the email with a recording static image/access to recording as well when my brother set it up.  More was better, except when the OCD sun-downing nightly marathon of checking things over and over and over started!)

If no cameras are allowed at all, that is just plain stupid.

Perhaps we are enough on AgingCare to mount a protest to get these rules removed or amended?!?!?!
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I'm with you, Karsten, tight-lipped and holding my breath at the notion that pressure pad alarms are a "restraint." Like buggery they are. And, as you point out, the alarm is audible only at the monitor end, not at the caree's end, which is why my mother used to wonder how I always knew when she was off on her travels.

You do honestly have to wonder what bright sparks are figuring out these principles, and long to make those people have to try them out personally, in practice.
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the NH here also rejected the idea of alarms, saying they cause more harm than good as it scares the patient., I said not an alarm in the room, an alarm at the nurses station. They insist it is bad
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Maybe this is what Garden Artist meant, but for my dad they put this mattress that make his bed look like one of those half pipe set ups they use for Olympics snow boarding (not quites as severe as slope). This way it supposedly prevents him from climbing out as much, though he has manged anyway

I am with everyone who say these anti restraint laws have gotten so out of hand.
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The restraint law in California is the same and I disagree with it. My mother with advanced memory loss and cognitive function fell several times resulting in some minor injury. The nursing home put pads and mattresses on the floor by her bed and "monitored" her via camera because they could not be next to her all the time. But getting calls that she had fallen again was distressing and unsafe for her. I think the ruling should be changed. Just my opinion.
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My mom was a huge fall risk, not because she was old, though. It’s an genetic flaw that’s inherited by all the women in our family.

Let them move Mom. They moved my mom and it was no big deal. It was actually a nicer room!
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My dad is a fall risk and has a lower bed against one wall and the floor mats. He sits on a chair alarm and has one in bed as well. I don’t know why your state has banned the alarms as it’s been so helpful.
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It's unfortunate and sad to hear such frustration in your post. I definitely agree with using a baby monitor would help a lot in this situation. As a Homecare agency provider my other suggestion would be to hire a private duty around the clock caregiver to be your second pair of eye's for your mom and the nursing home staff to make sure this facility is doing what they need to do to decrease the falls.
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The topic of reviewing her medications is an important one to look into. My 97 yr old Mom, also in a long term care with vascular dementia and ALZ, has been falling for years. I did all the things the risk manager suggested to prevent more falls, yet they kept happening. Until 2 months ago when I spoke to the doctor and he minimized the milligrams of her meds. A surprising miracle happened....she is not falling as much anymore and she is more energized now. Talk to the primary physician.
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At my Mom's Memory Care Facility they use bed and chair alarms. It is a bit disturbing for her roommate though because the slightest move sets it off and someone has to come to turn it off. I got my Mom a hospital bed and it has half rails on it. These seems to help.
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If a Doctor orders "a restraint" one can be implemented. At that point you could do 2 side rails. Or place the bed up against one wall so one side you would not have to worry about.
A wedge bolster or pillow might also help. It would make it more difficult to get out of bed.

I doubt moving her to a room across from the nurses station would help. There is no way anyone can have eyes on her at all times.
At some point a fall will happen, it is despite all the ambulance chasing lawyer ads on TV, no ones fault. Anymore than you can prevent a toddler from falling. Or yourself for that matter if the circumstances are right.
At that point you have to make the decision to have any breaks surgically repaired or call Hospice for Comfort Care. I say this because she would probably not be a good candidate for surgery and more importantly participating in rehab.
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What about a motion detector that is a sensor beam (like the automatic garage door beam) the if she swings her feet over the bed it would alert staff? May not provide enough warning for staff but maybe if it also tones locally near mom she might not try to get up.
I understand the video baby monitor, because of privacy, what about a two way voice only one that if they hear her try to get up they can start moving that way and also talking to encourage her to stay in bed?
Another way is to hire an outside home care company to be there one on one when she is most at risk. I’m assuming that is at night. Expensive, but very effective if that person is in the room or sitting right outside the room if the door can stay open.
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Falls are going to happen no matter what anybody does. If they sundown--they become dangerous.  I try to minimize sundowning by keeping my mom up all day (I give her coffee in the morning and afternoon, but stop there) and she stays up all day and mostly sleeps all night.  Then again I do not have her in a nursing home.  There are ways to help prevent falls but still they happen.  When they have end-stage Alzheimer's their balance is impaired and they have a shuffling gait. Arthritis also takes its toll. If the doctor puts them on any kind of psychotropic or narcotic their risk for falling increases considerably so I never give my mom anything other than her routine medications for diabetes and high blood pressure.  I try to keep her moving during the day. Constant bedrest is the WORST thing to do and actually makes falling worse! I do my best to keep her moving.   In nursing homes, be mindful restraints are not only illegal in long-term facilities but also dangerous. They manage to climb over side rails which will worsen the injury. Nursing homes tying them to the bed can also cause severe injury and death such as strangulation from the vest in addition to the cruelty aspect since it worsens agitation. Bed alarms may be employed but you will have so many false alarms they are practically useless. They can go off just by turning over or moving their leg. Sometimes they go off after they fall. 
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When I had my step father in a nursing home he also was a fall risk. There is a bed alarm pad that you can get. When ever my step father would get up a alarm would go off and they would know that he was out of bed. This helped a great deal, maybe this is another idea that could help you. Good Luck..
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My father fell out of bed about a few weeks ago. The next day a new alternating pressure pad was added. It still "moves" to avoid the situation of sitting on a stationary pad, but the sides are curved upward, to minimize the danger of slipping out and to provide something to grab or hold onto if he begins to slip out.

Given that it's difficult for him to move at all b/c he's so weak, we still haven't figured out how he fell out of bed.

Bed rails wouldn't be used b/c of the danger (worse than falling on the floor???). I've meant to ask if bringing in his Medic Alert pendant would be appropriate; it has a sensor that activates at the monitoring company if a change in position is detected. It's activated when he's fallen asleep and when he falls forward or onto the floor.

I don't know if there really are any good solutions, in part b/c of the ban on some possible constraints. If I could have gotten bed rails, I planned to pad them either with one of the fleece comforters or with the soft padding used in cribs.

It amazes me that technology is wasted on things like VCRs in cars, cameras for backup, yet something as necessary as a decent and safe bed rail apparently isn't on the drawing board. But then, funds for R & D probably aren't allocated by the companies that manufacture products for the aged in the same magnitude as those companies that manufacture vehicles and tech devices.
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Rocketjcat,
Why no baby monitor?
Surely THAT can't be a restraint. So, is it an "infringement" of privacy?

Who the h*ll made these dumb laws anyway? Maybe their loved ones never had dementia and died young.
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