My Father is 91, he was in assisted living but had to be moved to Memory Care in March of this year because of night wandering. Since 5/23/18 he has fallen in the facility five times. He’s broken bones in his face, but he feels no pain. He has a walker and a wheelchair. They make him use them, but the second they or a family member turns our back he just gets up, or walks away from the devices. Also, they say he’s up all night walking the halls of the facility. We’re in Michigan and we are being told it’s illegal to restrain memory care and/or Alzheimer’s patients. No seatbelts for the wheelchair or night restraints. They have a motion detection pad on the floor next to his bed, but he avoids it.
Any suggestions?
Give Being Mortal by Atul Gawande a read. It's all about nursing homes and end of life issues. I really would prefer for mthr to be happy and have a shorter demented life than for her to be struggling against restraints and live longer with a broken brain. Looking at her advance directive, I think that is what she would prefer as well. If she falls and injures herself in what could be the beginning of a cascade towards the end because of the drug she takes to make her happier, I am fine with that. It's a question of tradeoffs. We will never have them back like they were before.
At 97, Dad is becoming too weak and fatigued to get those bursts of energy and increasingly the above measures are unnecessary.
When I toured ALs and NHs, it was very clear that they cannot truly provide one-on-one monitoring 24/7. It was sobering to me to realize that falls are inevitable without being constantly with one's LO. I turned my back for maybe 20 seconds, and Dad had bolted up from the toilet and fell hard, requiring a trip to the hospital and rehab, which treatment itself triggered a marked decline.
It's impossible to "do the right thing." I am so sorry about how exhausting and heart-rending this is. It seems that some of the suggestions regarding medication may be the most humane way to get these souls through the night,
I'd likely start with his doctor to ask about meds for sleep disorders. That is very common with dementia, and often the patient will be up most of the night. After, my LO went on a nightly medication, she would sleep more soundly and only occasionally, would she awake and be restless.
I'd also explore a bed alarm to alert if and when he gets up, but, if he's sleeping more soundly, he might not be up as often. (Is he getting up to go to bathroom? Is he incontinent? If he is in Depends are they being kept dry before he goes to bed? I'd confirm that his bed is dry and that he's not up due to having to use bathroom or due to being wet or soiled.)
I'd also meet with the facility and explore ALL options to keep him in his wheelchair. My LO had an alarm belt. This was not a restraint, because she was able to undo the thing and get up anytime she wanted. BUT, it would buzz and alert them that she was up. It was rather funny, because she would unsnap the belt and let it buzz, laugh and snap it back on! lol Eventually, she stopped doing it though and stayed in the chair. Thus, decreasing her falls. Make sure they are providing you the correct law on the matter. It varies by state as to how it's applied.
If it's a federal issue, I'd think now would be a good time to start getting it changed--start by calling your Congressman.
At home, we don't allow her a bedskirt (she'd catch her foot and slip) throw rugs, cords across the floor---a grab bar next to the bed...beyond that, I do not know what we can do. She wears a fall pendant, but half the time she loses it in the wash or misplaces it. A bed rail she HAD to have lasted one night as she slid between it and the bed and was trapped fer several hours. Those, unless part of a hospital bed, are just too dangerous.
Sadly, thinking she can walk the 10 feet from bathroom to closet, she has still fallen several times.
Short of 24/7 hands on care, you are going to have seniors falling.
The easiest solution is probably a change in medications so that he sleeps through the night and has at the end of day adult overnight pad placed at bedtime. For daytime, perhaps he’s wheelchaired over after his breakfast in dining room to pass the day with the group of residents that sit in front of & around the live theatre that is the nurses station. At least it gives more eyes watching him than alone in his room.
but whatever the case, invariably they are going to fall unless they are in 24/7 1:1 caregiving situation. And one of those falls is going to be life threatening.
My mom finally had hers and it was the time she was once again pulling her wheelchair from behind that she fell forward & shattered a hip at her NH. Before this she was a pretty spry nonagenarian with Lewy Body Dementia. Went onto hospice & bedfast. If you as DPOA and your siblings and your elder have not had a discussion as to end of life options & decisions, please try to do so now & before an incident happens. It can be brought up at your dad next Care Plan Meeting with an DNR or other orders updated into his chart.
There comes a time when there is really nothing that can be done to make sure that our LO is doing what he/she is supposed to do. As far as I can figure out, they are either in denial or just not used to being dependent on an apparatus to get them around safely. It's just something that you will have to come to terms with. If not using the walker makes him fall....so be it. Maybe, after a number of falls, Dad will realize that he really needs the walker. I've told my Mom over and over again that she needs to use her walker. I've also told her that she's going to do what she wants, but that maybe the next fall will make her a vegetable in her bed and other people will have to bath and toilet her. One of her greatest fears. She now uses the walker 95% of the time. A lot different than it used to be. Mom will be 95 in a couple of months. And, I'm sure, like your Dad, no one is going to tell them what to do.
Hang in there and pray/hope for the best.
Unfortunately what happens in most/many instances is the resident falls, breaks a hip, a leg and can not participate in rehab or worst case does not survive reconstructive surgery or the anesthesia itself becomes a problem. (Dementia patients do not do well with anesthesia, it fogs the brain far longer than a healthy person.)
Have a care plan meeting and ask that they get a Doctor's order for restraint. Start first with side rails on the bed and get an alarm that clips to the person and to the wheelchair. Adding wedges to the bed so it is difficult to roll up and over them to get out of bed also works.
Also if the back of the chair adjusts tilt it back so it is more difficult to get out of the chair. If the alarm does not work and tilting the back does not work ask that the order include a belt for the chair.
It sounds like he is not a good candidate for a walker so that should be removed.
My dad forgot he couldn't walk anymore (lack of muscle tone) and hit his head a few times. He even got a skull fracture in the hospital. They had him in a room in the back bed with curtain hiding the bed with the sign falls risk. His room wasnt near a nurse station. If I hadnt asked why his memory was so bad they werent going to tell me he had a skull fracture.
He also tried to get up at the nursing home. It finally stopped. Maybe he finally remembered or was too weak to try.
Always be proactive in your dad's care.
They can give your dad something to help him sleep to get him back on days, altho it's not a guarantee.
Can you ask him why he is getting up? Maybe he has to go to the bathroom. Maybe he is looking for something. It might be a simple answer. Then again he might not know. He can have a urinal put next to his bed. He might have gotten up at home to go to the bathroom at night due to enlarged prostate. And now doesn't remember he is too weak to walk there.
I can't imagine why they would not have personal alarms. Clients wander. That is a given. Good luck
See All Answers