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Reply to "Can AL facility force someone to be wheelchair bound because they are a fall risk?"
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[quote=Anonymous][quote=Anonymous]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?).[/quote] 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. [/quote]
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