95 year old mother falling repeatedly in assisted living

[Anonymous]

Anonymous wrote:OP here. Exhausted from last night and haven't had a chance to read all replies yet but wanted to share that we learned mom was prescribed a med by the ER doctor after her second fall. Not blaming the sibling who was informed but that sib believed the med was for anxiety. Turns out it was a pain med, narcotic category that has side effects such as increased anxiety, restlessness and frequency of urination/urge to urinate. All things mom was experiencing. She can't be her own patient advocate any longer so we need to be and to pay more attention to meds and research them. Trying it with her off of the Tramadol. More later and thanks again for all of your input. Siblings and I were not prepared and we feel bad about everything. We'll do better.

Hang in there. You do need to be heavily involved. We had to get court legal guardianship as the nursing home fought us over everything with the POA. (if you have to do it its an easy process and the court was great about helping us through it). A lot of these medications have even worse fall risks and its pretty common to offer heavy medications. Go head and put in a referral for hospice. If she broke anything at her age it may be a qualifier. Worst case they say no, best case, they say yes and get you through a few months of navigating all this and then they pull out (which they did for us). I'm sorry she and your family are going through this. Its impossible to really be prepared in less you have done it before. It was a huge learning curve for me.

[Anonymous]

Anonymous wrote:I'm one of the early PPs who pointed out to the OP that hospice isn't 24/7 and that it requires a prognosis of 6 months to live or less. I know from our experience trying to get hospice care for my father when his Alzheimers was very advanced (unable to walk, unable to self-care, unable to eat solid foods, etc.)

Dementia and/or old age alone will not qualify a patient for hospice. I forget the precise qualifiers but a google search will turn them up. One was a certain percentage of weight loss, another was being able to speak less than 6 words. My dad was rejected when we first investigated and then somehow qualified a few months later. He was in an excellent memory care facility, part of a much larger continuing care community, but the hospice services and personnel were a godsend. Unlike the nursing staff, their entire focus is on the patient's comfort. But as a visiting service, hospice doesn't fill the role of regular medical or nursing staff - they consult with the doctors and nurses and may take over some responsibilities like bathing on occasion, but visiting hospice isn't a substitute for nurses or nursing aides or doctors.

I don't have much direct experience with hospices houses, although I know that other relatives w/terminal diagnoses had excellent experiences in this setting. We investigated that for my dad, but it made no sense to move him from an environment in which he was well cared for.

Final point on the fall issue: as a rule, nighttime is a really really difficult for the elderly. Falling is a big problem, but so is wandering and sleeplessness. Other than paying for a 24/7 "sitter" it's a really tricky issue to solve - medication doesn't always work, it can compound the fall risk, restraints are illegal in many places because of the risks posed &/or ineffectiveness, etc.

The best advice I'd give someone with an elderly parent in poor condition is to speak with a palliative care specialist. Even if your parent isn't ready for hospice, they can help you think through what kind of care is best aligned with your parent's needs and preferences, and how to make sure the focus is on quality of life.

It may depend on the hospice company and state. For us, like you said dementia was not a qualifier but the weight loss was (until hospice came in and helped with the feeding and food issues and she gained weight) but lack of verbal communication was not a qualifier as people with dementia can go years without talking when its advanced.

If OP mom had a sprain or fracture or anything remotely justifiable for medicare she should apply as worst case she is turned down. Given mom's age alone it may be a qualifier. Best case, she gets help, even if its temporary to guide her through.

[Anonymous]

Anonymous wrote:95 year old mother was hospitalized again after a fall. The highly rated assisted living facility she is at checks on her every 2 hours at night. They claimed to have checked on her at 2am and she was asleep but they found her on the floor at 3am. There are restraint laws in Virginia that prevent her from being belted into the bed. The staff seems helpful but not overly concerned. Anyone have experience with using fall mats next to the bed to prevent injury? We are starting the process of looking for a night aid to hire to ensure that she does not get out of bed on her own but that may take a week or more to get into place. Any ideas appreciated.

It's time for your mother to go to a nursing home, where she can be supervised more closely.

[Anonymous]

Anonymous wrote:OP here. Exhausted from last night and haven't had a chance to read all replies yet but wanted to share that we learned mom was prescribed a med by the ER doctor after her second fall. Not blaming the sibling who was informed but that sib believed the med was for anxiety. Turns out it was a pain med, narcotic category that has side effects such as increased anxiety, restlessness and frequency of urination/urge to urinate. All things mom was experiencing. She can't be her own patient advocate any longer so we need to be and to pay more attention to meds and research them. Trying it with her off of the Tramadol. More later and thanks again for all of your input. Siblings and I were not prepared and we feel bad about everything. We'll do better.

Sorry to hear this OP. As I posted earlier, it's really tricky to find the right solutions for an elderly person who is prone to getting out of bed. My dad was in the best facility I can possibly imagine and we struggled with this. Meds can have different effects on different people; sometimes they seem to wear off after a few months and you're faced with finding a new solution. Also be aware that hospitalization alone can impact cognitive abilities; it's called delirium. It can wear off but for some people (like my dad) it essentially careened his mental and physical capabilities way down from where they were before what should have been a short hospital stay for something relatively minor that was quickly resolved. We had one sibling who was intensely present and the rest of us pretty intensively involved but we still experienced plenty of crises and had to learn as we went. Good luck.

[Anonymous]

Anonymous wrote:They need a bed with side rails, not fall mats.

Assuming side rails are permitted (not typical as others have described) they are not the best option in every case. For a patient in their right mind who only needs protection from accidentally rolling or sliding out of bed, they are a good safety measure if the patient is willing. They can be a good safety measure for a patient who is fully sedated and, again, needs protection from rolling or sliding out of bed. For a demented patient they can be extremely dangerous. Patients get caught up in them and try to climb over, increasing their fall height. The fact that a rented hospital bed might come with rails is meaningless.

[Anonymous]

Anonymous wrote:

Anonymous wrote:95 year old mother was hospitalized again after a fall. The highly rated assisted living facility she is at checks on her every 2 hours at night. They claimed to have checked on her at 2am and she was asleep but they found her on the floor at 3am. There are restraint laws in Virginia that prevent her from being belted into the bed. The staff seems helpful but not overly concerned. Anyone have experience with using fall mats next to the bed to prevent injury? We are starting the process of looking for a night aid to hire to ensure that she does not get out of bed on her own but that may take a week or more to get into place. Any ideas appreciated.

It's time for your mother to go to a nursing home, where she can be supervised more closely.

It may be better and cheaper to hire caregivers to come in given the difference in costs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:They need a bed with side rails, not fall mats.

Assuming side rails are permitted (not typical as others have described) they are not the best option in every case. For a patient in their right mind who only needs protection from accidentally rolling or sliding out of bed, they are a good safety measure if the patient is willing. They can be a good safety measure for a patient who is fully sedated and, again, needs protection from rolling or sliding out of bed. For a demented patient they can be extremely dangerous. Patients get caught up in them and try to climb over, increasing their fall height. The fact that a rented hospital bed might come with rails is meaningless.

Standard bed rails are not permitted but Halo Rails are. The ones we ordered are $400. Hopefully they help when well placed.