My 91 year old Dad has vascular dementia and lives in the Memory Unit of his AL facility. He fell and broke his hip and shoulder. He had surgery to repair the hip fracture last Tuesday; then was discharged to a skilled nursing rehab facility. I accepted the best rated facility I could research that would accept his insurance plan. The care coordinator assured me the facility was very good with dementia patients.
When we moved him to the rehab facility, I was concerned that there were no bed alarms. (I understand the "no rails/restraints" issue). Their approach is the lower the beds to the floor, so if anyone falls, it's a short distance.
Dad doesn't understand the concept of the "nurse call" button and he can't remember that he just had hip surgery. If he wants to get up out of bed, he's going to try. The admission nurse said that if I was concerned, I should hire someone to sit with him 24/7. Is that the only alternative?
This morning I got a call from the rehab facility that he had fallen trying to get out of bed. They took him to the ER to get checked out. His xray and scans were all normal, so he survived this fall.
I've researched other facilities and they have similar policies. Apparently, this is the acceptable "standard of care".
The ortho doctor who did his surgery said there is a good chance that Dad could regain most of his strength and mobility if he can get through rehab. I'm hoping there are other facilities that have a better plan. I understand there's no place that is "fall-proof", and that falls have happened with nurses/assistants standing right next to them.
I hope he can survive rehab.
two days ago I heard him yelling in his room. He lives ina 6 pack 6 residents, 2 caretakers...Private home structure..
He is a few years younger...my point being, everytime something happens like this, a little or a lot is taken away physically or mentally....They will not recover to be 100% as they were before the incident. Its our bodies and our mental attitude.
The key words are: COULD REGAIN.
So do your best to help him regain most of what he lost int he accident. And keep him happy. Treats, milkshakes favorite movies, songs, ..
You could put up half a railing to keep him in. I think that may be ok. He is not fully locked in.
PUt up a mobile wheeling bed stand tray or a few chairs up against the bed that lock in place so they don't move... may be a way to get around "no rails" rules.
No rails rules mean they are kept in that spot against their will. from what I was told.
Having a night stand butt up against the bed seems to work well in locked position as well as a couple of chairs locked in place...
So glad to hear your dad is doing so well and is holding his own.
I hope his wish comes true and he gets to go home for a visit as soon as you are able to handle it and he is strong enough. Good job on the appeal!
Thanks for the update.
I asked for "reconsideration" when my appeal of his discharge decision was denied. I got a call about a week later from the "Quality" bureaucrat who said a different doctor had reviewed the case and decided to reverse the denial and keep him at the rehab hospital. So, Medicare paid for the entire stay and treatment.
Cognitively, he's back to where he was before the fall. The staff at the memory unit said he still gets confused, asking about dead family members, but is still able to read, watch tv, and talk to the other residents and his visitors.
I spent most of April and May with him when he was in the hospital and rehab, but I had to get back home for work (and my own medical issues). I got one of the sitters to visit him every other day at the memory unit to see how he is doing.
So far, this has worked out, but it's only been a week. He hasn't fallen, and there haven't been any medical issues (UTI, etc) come up (yet!).
What he wants most of all is to visit his house, like we've been doing each month for the past two years. I'm afraid to do that until he's stronger.
He has made lots of progress; he wasn't even able to stand when he got there. Now he can stand and walk 30 feet (with a chair in tow...his leg buckles sometimes). Still, his progress has leveled off the past two weeks. He has days when he can't wake up, either because of the pain meds for the surgery or the anti-psychotics for the dementia, or just because he's 91. It's only every 2-3 days, but it's kept him from progressing. I was notified by Medicare that his funding for staying at the rehab center was being cut as of this weekend. I appealed this decision, and the appeal was denied. I asked for reconsideration, which keeps his therapy treatments coming, we might have to pay for them if the reconsideration is also denied.
In the meantime, we're paying for two places; his apartment at the memory unit in the assisted living facility where he's been living, and now the skilled nursing rehab room. We can barely afford one, let alone two.
The admissions staff from the AL is coming to evaluate him tomorrow. I think they will have to stretch their standards to allow him to return to AL. Even if they allow him to return, I'm not sure that's the best place for him now. So, I'm back in the hunt for another facility.
This hip injury really changed our lives.
Take care and keep us informed.
That was the reason I was given for NO RAILS....
Really? but it's okay they roll over and hit whatever is in the direct path to the floor...which is usually not carpeted.
I've seen a cognitive decline in him; he can't speak as well, and speaks rapid-fire like he an auctioneer. I can only get 20% of what he says. He doesn't remember he's hurt and he wants to move around, so it's only a matter of time before the next fall and we're back on the hospital merry-go-round again.
I got him moved to an "Alzheimer's bed" for the rehab place that lowers almost to the floor with padded mats around it, so that if he falls out, it would not be far. It will also be difficult for him to attempt to stand if he's that close to floor level, so he should be OK when he's in bed at night. During the day, I'm hiring sitters to stay with him to keep him from getting out of bed or his chair without help. I met the first one tonight and she is wonderful.
Thanks everyone again for all your thoughtful comments.
With dementia of any kind participation in rehab is VERY difficult and the chance for a recovery is slim.
There is
1. The fear of falling again that will make him resist rehab.
2. Not having a grasp of what is trying to be done and following instructions.
I do hope the people doing the rehab are well versed in doing rehab on/with people with dementia. Very different doing rehab with a 50 year old with a broken hip or a hip replacement and a person with dementia and a broken hip.
At this point maybe the very best thing for you to do would be have an evaluation for Hospice done. If he is not compliant with rehab Hospice will help immensely for pain and symptom management.
If he is compliant it is still very possible that he would be eligible for Hospice and they will help you with supplies and equipment that he may/will need.
Sorry to be a "downer" on this but dementia and broken hips do not go well together. Not even mentioning the broken shoulder.
Best thoughts to you and your dad.
That's exactly what the admitting nurse suggested to me today, although I want him to give rehab a try for a few weeks. He has no fear of falling, because he can't remember that he just fell. and he's determined to stand up and walk. If he could channel this properly during his therapy and exercise sessions, he'd probably be back in the AL facility in a few weeks. At the hospital, he followed the PT's instructions while she was there, but of course forgot all the instructions as soon as she left.
Thanks for the advice. I hate it, but it's probably near future.
selves and is just uncooperative due to dementia or old age**
I found a licensed, 6-person board & care, private home "15 mins" away...best thing I did for parents, me & my marriage. You're always the "advocate"; observe / oversee
(in partnership with facilty owner & caregivers) seek the best care for your loved ones; it is a process - For me, I choose to show up unannounced during visiting hours (10am-7pm), different
days & times to observe what's happening. I "openly" check for bruises, injuries, issues & ask parents if they are in any pain while putting lotion on their arms/ hands/legs/feet. I attend 1 meal daily (my mom must be fed; it's our bonding time) or every other day so I see food types, quality & amounts being served. I pass on occasion from feeding mom to observe how various caregivers feed my mom; I offer tips or show them better ways. Overall, every-
one's intent at facility is very good ...Yet, I don't believe in just blindly accepting practices / methods that don't make sense to me (as a novice or not) I ask questions!! We each have a brain; research online & learn) In any industry, it's human nature to become compla-
cent, but my job as an advocate is to be alert & bring attention to the facility owner if best practices are lacking for my parents & other guests in home -Note: must be done with a humble heart, spirit & tone! I have challenged Hospice management regarding practices that made no sense to me; after calm discussion using fact-based reasoning, we found agreeable practices that board & care iwner / caregivers would and could
implement. (Often board & care owners get stuck "between" laws they MUST follow, the hospice directives, and family member wishes - "It takes a village" of cooperation & good will. As an advocate; important to create the atmosphere of Win-Win-Win
(Patient/Family - Board/Care Facility - Hospice/Med team of doctors). I appreciate ALL they do; I am so grateful as I cannot do this alone (I earnestly tried and I was ineffective, destructive to my own health, body, marriage & finances)
Pray, Ask for & Get Help, Take Action; don't over think, Don't be afraid, Have courage. Good luck.
How is it going with your dad?
How are you?
Thinking about you.
I don't understand why hospitalbeds are not allowed...
Perhaps doctor and prescribe a hospital bed, and then he can have the rails on.
Unfortunately this is the "standard of care". They are not allowed to restrain him. That's deprivation of liberty. Although they did this once to my grandma in the ER. They have a device for it. It's something they attach around the torso and then it's leashed to the bed. In that case though, I think the nurse did it more for his own convenience than for her safety. I had another problem with that nurse since he claimed to be too busy to help grandma with a bedpan yet had more than enough time to be chatting in the hall. His response when I asked was "She has a diaper on." Let's say he and I didn't end up on good terms.
All the other times I asked for both bedrails to be up, they told me they couldn't because it was illegal.
A bed alarm is no real solution either. Many times when that goes off they don't show up for minutes. A rehab or nursing home has even less staff. By the time they get there, they will already be on the floor.
As other posters have pointed out, even with professionals in the room, they can fall. That's why it's a pet peeve of mine when people say someone needs to be watched 24/7 to prevent falls. IMO, there is no preventing falls. You can reduce it but you can't prevent it. They can't even do it in a professional facility. Falls are common in rehab or nursing homes. Why do people expect someone miraculously to be able to do it at home? The people that say that have no idea what they are talking about. Generally it comes from people that no experience.
Can dad understand and cooperate with PT and OT instructions?
We were in a similar situation with my mom. We did hire a full time sitter. Mom fell with the sitter in the room; in fact there were TWO aides in the room . ( I'm told this happens frequently).
This fall broke mom's hip which immobilized her, and rehabbed well. She then lived in her NH for another 4 1/2 years.
I'm sorry you are in such a difficult and painful situation. I remember the angst all too well. ((((Hugs)))))))
i am so so sorry. Unfortunately it does seem to be very common, this level of care in rehabs. And yes, sitters (who are well named) are about all you can do. My understanding is that they call the staff if the patient needs something. They don’t actually help the patient.
Does his hospital have a rehab that you can get him in?
You might be able to get hospice to provide an additional layer of care. I’m not sure that he could get hospice and rehab. Probably not. Talk to the doctor.
I know you will make the best decision for your dear dad. I’m sorry you are in this position I hope your dad’s pain is being controlled.
Hugs