Can AL facility force someone to be wheelchair bound because they are a fall risk?

[Anonymous]

Unfortunately, they can set whatever guidelines they wish; it’s all about what’s in the original contract and if they don’t feel that they can safely care for your dad, they are within their rights to ask him to leave. It’s possible that another facility will handle things differently.

[Anonymous]

OP here - thanks for all the responses. To answer some of the questions. he is in memory care unit. It’s AL where we pay extra for memory care programming. But I am getting the sense that the programming is all geared toward Alzheimer’s and not other forms of dementia so there’s a bit of a gap there.

He has a one-on-one aide but the facility will not allow that aide to take him walking.

I’m heading off today for a several day visit to try to see whether I can make any headway on this issue where he is, and tour 2 other places to see whether there are better options out there (although the idea of moving someone with dementia is not very attractive). Wish me luck!

[Anonymous]

Anonymous wrote:OP here - thanks for all the responses. To answer some of the questions. he is in memory care unit. It’s AL where we pay extra for memory care programming. But I am getting the sense that the programming is all geared toward Alzheimer’s and not other forms of dementia so there’s a bit of a gap there.

He has a one-on-one aide but the facility will not allow that aide to take him walking.

I’m heading off today for a several day visit to try to see whether I can make any headway on this issue where he is, and tour 2 other places to see whether there are better options out there (although the idea of moving someone with dementia is not very attractive). Wish me luck!

Good luck OP, but you are right, moving someone with dementia can be a huge problem. If you can afford, you may want to hire an aging care expert to figure out how to advocate for him where he currently is and/or to advise you regarding a move.

[Anonymous]

Anonymous wrote:I would find another facility for my father. That's just me.

Same. Former nursing home nurse here. If the place is unwilling to keep him more mobile they're just lazy or understaffed. The term "use it or lose it" applies most here. Find a place that works with him or hire a private CNA.

[Anonymous]

"He has a one-on-one aide but the facility will not allow that aide to take him walking."

OH, HELL no. NOPE. No way. Move him ASAP. This is not typical at all OP. Is the aide certified? There is no reason they wouldn't allow this.

[Anonymous]

Anonymous wrote:"He has a one-on-one aide but the facility will not allow that aide to take him walking."

OH, HELL no. NOPE. No way. Move him ASAP. This is not typical at all OP. Is the aide certified? There is no reason they wouldn't allow this.

This place is not looking out for his best interest its time to move him op.

[Anonymous]

Anonymous wrote:"He has a one-on-one aide but the facility will not allow that aide to take him walking."

OH, HELL no. NOPE. No way. Move him ASAP. This is not typical at all OP. Is the aide certified? There is no reason they wouldn't allow this.

He's a fall risk who refuses a rollator. The aide may break his fall slightly, but it's reasonable for the care facility to reject that proposal

[Anonymous]

Anonymous wrote:I can't believe I'm asking this question because it seems absurd to me. My father has advanced vascular dementia and lives in a memory care/AL facility. The dementia does affect his balance and ability to follow instructions and he never mastered using a walker. Because he won't follow directions consistently they won't give him any more PT and OT. I think he could use one of those "roller" walkers because he always was great with a shopping cart, but they don't allow those.

He clearly has the strength to stand up because he keeps doing it on a regular basis when the aides are looking the other direction. The facility says he is a fall risk and because its unsafe for him and for his caregivers, they no longer will let him try to stand up and walk. They try to keep him all day in a wheelchair that is reclined back so that he can't get up. He so wants to get up and walk around and the lack of exercise is contributing to his anxiety.

I have been arguing that since he's going to keep trying to stand up each chance he has, they should be working to try to make that safer for everyone - not trying to stop him. But I have been hitting a brick wall. Am I unreasonable here? Any other suggestions on strategies to take here would be appreciated. I recognize that falls are a big issue and these facilities are risk adverse, but this seems like both a cruel and unproductive approach (I guess until he loses the will to live and just stops trying to stand?).

I’m sorry, OP.

They should not be pushing this as an intervention for his fall risk. In fact, forcing him to be in his wheelchair is considered a type of restraint, which is generally against regulations. As well a good ALF should have a restraint free policy.

As a first step, they should be doing a standalone fall assessment to evaluate his risks and root cause what is leading to his falls. Only then, can the proper interventions be determined. As someone involved in your father’s care, you should be a part of determining the proper interventions and care planning.

Assuming you use their house pharmacy, you could also push for them to have the consultant pharmacist do a medication review and coordinate with your father’s doctor to see if that is contributing to his falls.

Another avenue is bringing in PT or OT to provide an assessment and recommended therapies for your father to improve his gait.

Finally, their activities or life enrichment person should do their own assessment and evaluation of your father and come up with enriching activities such as once he can do with a group in the dementia area that he can do outside of his wheelchair. The AIDS should be transferring him from wheelchair to chair and the activity will keep him busy and engaged with what’s going on.

But practically speaking, if their solution is to require him to sit in a wheelchair reclined back all day that is a huge red flag. I suppose they think wounds and bedsores are better than falls? You really don’t want that clinical leader who sets the tone for the entire building, floor, and shift responsible for doing the best thing for your dad.

[Anonymous]

Anonymous wrote:OP referred to the facility as “memory care/assisted living.” These terms get thrown around a lot and can be confusing. The response to OP’s question may depend in part on what category the facility actually is and who is paying for it.

“Assisted living” typically is a private pay facility that offers what the name implies — “assistance” with activities of daily living, laundry, housekeeping, medication management, an in house dining facility, etc. They generally offer at most only a lower level of what qualifies as “skilled care” and if the person’s needs exceed that (or if the person or their family become too much trouble or a liability risk) they typically send them away. I haven’t checked lately but my sense is that “assisted living” facilities are less heavily regulated than higher level facilities.

I think “memory care” is a cynical marketing term, but it seems to take place in skilled need facilities, i.e., “nursing homes.” These can be private/insurance pay, Medicare and/or Medicaid. They are heavily regulated, and patients typically have rights at least on paper. If a patient becomes a “problem,” however, it is far from unheard of for them to be manipulated into a hospital stay and then find that there magically is no space when they are ready to be discharged.

If I had a person in the situation you described, I would start by finding out precisely what category the facility falls in. Then I’d research the patient’s rights in that kind of facility under federal, state and local law. There are professional care managers who might be able to help with this. An attorney affiliated with the National Academy of Elder Law Attorneys (NAELA) could be helpful. If you want to claim that the care provided is inadequate, you’ll probably need one or more outside doctors who agree with your treatment preferences.

Even with all of this, you’re probably better off as PP’s have suggested, trying to find a different facility that is a better fit. If you can afford it, you may want to pay for an outside rehabilitation/restorative nursing person (or as a PP suggested you may be able to go walk your person around yourself).

This is a very tough situation. Allowing an ambulatory, continent person to become chair/bed bound and in diapers, and not infrequently riddled with bedsores, is not suitable care. But neither is allowing a demented person to stumble all over, falling down and getting hurt.

I think the most obvious problem here is that you don’t feel like you’re being heard or getting any effort to meet you half way. That can be a hallmark of a not great facility. Getting some independent advice should be helpful in clarifying whether what you want is reasonable and if so where you might be able to get it.

You’re wrong about memory care. Usually and in all states near DC, it is simply a secured area within the ALF

From a regulatory standpoint, it is nowhere near a skilled nursing facility. Some providers, such as Sunrise (HQ’d in Tyson’s), Brookdale and maybe Brightview (HQ’d in Baltimore area) take a high level of care due to their clinical capabilities. But that can vary location to location and is dependent on the nursing staff in house.

[Anonymous]

Anonymous wrote:I would find another facility for my father. That's just me.

me too. They are basically proposing to restrain him which is not ok.

[Anonymous]

If he has dementia he may not be able to use a walker and doesn’t understand the risks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Please keep arguing or move him.

My father just passed. I know exactly what you are going thru except my dad was at home with home caregivers.

We had to consistently push back on this sh&t. Unfortunately we did not understand the dynamic. The agency brought in a geri chair and had him sit in at all day long and did not let him stand up or walk. Reason being they did not want to deal with the liability of the risk of falling. We did not understand what was happening exactly. By the time we did, he was so disabled from the lack of being allowed to stand or move that he could not walk. He also had bed sores from being in the same chair all day long. Then they insisted on bed level care and Hoyer lifts. We had to push back against that and insist they move him between a broad wheelchair, a recliner, and his bed (only at night).

It is awful. They literally disabled him out of fear of his being a fall risk.

We are pushing back more with my mom and making sure they continue to allow her to stand and walk.

Hugs. It is very hard to argue with these damn people. They just care about not having a fall liability risk but I would have rathered my dad kept walking and fallen than waste away for years in that damn geri chair, which I did not realize at the time is effectively a restraint.

Don't listen to the poster who is assuming the best of the agency, saying it is to keep him safe. it is BS. It is to keep the agency or care facility from having a lawsuit and a fall AND it cuts down on the number of people they need to hire to care for people because they don't need to help him transfer, stand up, etc.

I'm sorry. it all sucks.

I'm not clear on what you wanted them to do instead of Hoyer lifts. Were you arguing for patient care providers to lift him themselves, or to stabilize him themselves (this is a frequent cause of rotator cuff and back injuries in the provider when the patient falls unexpectedly)?

No, I did not phrase it well. They wanted to just leave him in bed all day and do bed baths and feed him in bed even though he was an aspiration risks, even though we had paid out of pocket for an electric Hoyer lift and special shower chairs and wheelchairs. The caregivers absolutely wanted to keep giving him that level of care - they thought it was mean to leave him in ned all the day. it was the agency that kept trying to insist on keeping him in bed. We pushed back at that. it was awful.

[Anonymous]

OP if he can afford it or you can, I would hire an aging care professional to assess the situation, assess your father and review medical chart and make recommendations. You hire someone who has worked with all the area facilities, knows how to assess your dad, knows what can be requested and can advise you if a move is needed. Even if posters on here are professionals or have experience from their own families, they have not assessed your father.

Also keep in mind even if there is an aide, once a fall happens it's an ordeal. There is risk in just helping your dad up. He needs to be assessed to make sure there isn't a serious injury that can be made worse. If they don't have the medical staff, then they need an ambulance/fire department to come out and determine if he needs to go to the hospital.

We paid extra for a large and very strong aide for dad who had some medical training to assess after falls, had the strength to help him up and once he truly could no longer walk, could carry him.

[Anonymous]

Anonymous wrote:

Anonymous wrote:"He has a one-on-one aide but the facility will not allow that aide to take him walking."

OH, HELL no. NOPE. No way. Move him ASAP. This is not typical at all OP. Is the aide certified? There is no reason they wouldn't allow this.

He's a fall risk who refuses a rollator. The aide may break his fall slightly, but it's reasonable for the care facility to reject that proposal

He has memory issues. He cannot remember to use a walker NOR is capable of it. The facility is still responsible for anything that happens.

[Anonymous]

Anonymous wrote:OP if he can afford it or you can, I would hire an aging care professional to assess the situation, assess your father and review medical chart and make recommendations. You hire someone who has worked with all the area facilities, knows how to assess your dad, knows what can be requested and can advise you if a move is needed. Even if posters on here are professionals or have experience from their own families, they have not assessed your father.

Also keep in mind even if there is an aide, once a fall happens it's an ordeal. There is risk in just helping your dad up. He needs to be assessed to make sure there isn't a serious injury that can be made worse. If they don't have the medical staff, then they need an ambulance/fire department to come out and determine if he needs to go to the hospital.

We paid extra for a large and very strong aide for dad who had some medical training to assess after falls, had the strength to help him up and once he truly could no longer walk, could carry him.

Don't waste the money. He needs to be in a memory unit and get more care.