My 91 year old dad has Parkinson's and dementia and is in hospice. We are currently caring for him at home with a live-in caregiver. But things are getting more and more difficult and we are looking into transferring him to a nursing home. He has been bedridden since being released from the hospital in late August. Hospice has supplied a bed with full rails but he tries to get out of bed a few times a day. He can get his knees over the rail but then wears himself out. He does not remember that his legs can't hold him. We have applied to a nursing home with really good ratings and recommendations, but they do not use full bed rails or alarms because they are considered restraints. I have read that more and more nursing homes are moving away from restraints. The good news is that the nursing home will have the ability to get him out of bed and into a chair. Should we be worried about the lack of restraints?
I bought a netted cover at a specialty baby shop for my daughter’s crib. My youngest daughter was an escape artist!
She was a tiny little thing but was very agile and climbed out of her crib. She was too little to put in a ‘big girl’ bed so we had to do something.
I didn’t realize that they made those for adult beds. Good idea!
Alarms are not considered a restraint but they are often not reliable as they go off very easily. What is used more is an alarm that is attached to the chair and the resident and when they try to get out of the chair the alarm will sound. Less likely to go off with just normal movement.
The use of restraints in Facilities have not been used in many years. (thank goodness)
Even the use of hand protectors to prevent scratching at wounds can be considered a restraint.
I would not be concerned about the lack of restraints, I would be concerned if they used them
I know that hearing about a fall after-the-fact doesnt ease worries about falls and injuries, but it does give you a way to monitor safety.
Ask about their falls and injury reports to get an idea of their safety record. You certainly don't want to see a high number of falls and injuries, but you also dont want to see absolute zero. If it's 0, most likely they are doctoring their stats, because unfortunately, falls arent 100% preventable without restraints.
My dad has fallen out of bed at most rehabs he's been in. Luckily, he never got hurt. He tends to fall more in placement than he does at home. THe plan to fix things for him is usually to put the bed down as low as it can go and put mats on the floor when in bed.
No more falls.
The biggest problem was
climbing OVER the rails & then falling.
Floor-lowered beds are used instead. Often placed against one wall with a 'crash mat' on other side.
I'd look at that. Hospice hopefully can provide this bed type.
if assisted most states won’t allow
if memory care they do
I don't like restrints or full rails because going over them is 😥.
If there is an iv, feeding tube , catheter then weigh risk / benefits
I work in a nursing home in PT rehab and hope my post will be helpful.
About full length bedrails, they are not used in nursing homes due to evidence of increased deaths and entrapments associated with their use. This is a very real danger. About alarms, evidence has been that they do not effectively reduce falls. Hard to believe, but true.
Restraining nursing home residents is not allowed unless deemed medically necessary and then only with doctor's orders. Many facilities are going "restraint free" so what you are encountering is not unusual. That said, there are other ways to increase safety if someone were to attempt getting up (some of which may require doctor's orders):
-- low bed near floor
-- padded mats at bedside
-- scoop mattresses with built up sides
-- moving the resident's room closer to the nurse's station
-- out-of-bed schedule that gives the patient position changes and allows for social interaction
-- activities to address restlessness and boredom
-- medical management and nursing interventions that will address restless associated with pain and discomfort
You should have this conversation with any facility you are considering and do independent checking of their safety record. Every facility has a yearly survey and rating from the Centers for Medicare and Medicare Services (CMS) that is available online. Each facility is required to display and make available their yearly survey. You can ask to see it.
Unfortunately, there is never a completely fool-proof method of preventing falls, especially as one's physical and cognitive impairments decrease their safety.
It's not an easy decision to make, but many families find that caring for a loved one with an advanced degenerative medical condition is more than they are equipped to handle. Best of luck in your search for placement of your father!
Also, determine if the facility is using chemical restraints as in heavy sedatives. Not a good solution ever.
If he is already on Hospice Care, if at all possible, you should continue with the Live In until he dies.
No matter how great a Nursing Home seems to you, your Dad will probably be miserable, depressed, scared and sad.
My Grandmother lasted 1 month.
If it were my Dad, I would continue letting him stay where he is, where he will be the safest.
She BEGGED me to buy her guardrails and I kind of fought her on them-they seemed more dangerous, but I hit Amazon and the next am there they were (am I the only person who feels slightly creeped out that you can order something and get it before you even have time to regret your purchase?)
ANYHOW-the rails came, I went right up and installed them. That night she slid down in between the rails and the bed and was stuck.
Rails came down less than 24 hours after they were installed.
We took her bedskirt off (not an issue in NH's) and lowered her bed as far as possible and had her PT work with her specifically on safely getting up. IF she 'fell' it was more of a gentle slide to the ground. We didn't use pads, there was no room.
If she were on a mattress on the floor---not one of us 'kids' could deal with her care...we're 57-66 yo and sore knees and backs won't allow that.
That is about the only legitimate way to get permission for them anymore.
Also, the rooms have motion sensors so if the staff detects unusual movement in her room at night an aid is sent to check it out.
The staff tried to help her but, it wasn't to be. She didn't want anyone to bother and refused all help. In a way, I am glad she didn't have to hurt any more and definitely didn't have to go thru this Covid mess.
In some states a restraint is anything that could prevent a patient out of or off of whatever they are on/in ie chair, bed . If fact in some states or large cities
geri-chairs are considered a restraint if they are even used, in others only if it is reclined, and still others any use is o.k.
Or find a night stand or something and place it as close to bed as possible.
and go to home depot or lowes and find pipe insulators. or pool noodles and cut and place on bed rails. use duct tape to hold insulators in place (not dad)if you feel it is necessary.
pipe insulation is pretty cheap and so are pool noodles. pool noodles has colors, so it may be prettier to look at.