I understand this is frustrating. Often times having a fall leads to more serious consequences than being in a chair for most of the day. A rollator is much more unstable than a traditional walker, that’s why you rarely see OTs or PTs using rollators in hospital or rehab settings. I would advocate for you dad to participate in his ADLs as much as possible - going to the toilet instead of briefs if he is continent, getting dressed as much as he can on his own, standing to do his morning routine if he can.All of these activities are balance exercises in themselves for older adults. Maybe talk to his aides if has one or two consistent ones. With advanced vascular dementia I’m assuming your father does not have awareness of safety and potential fall risks, even if he looks relatively steady on his feet it’s often the cognition that puts older adults with dementia at a higher fall risk. Their perception is off

OP, if your dad is exhibiting anxiety I think that is more important than walking or not. I would speak to them about a low dose of Ativan or similar to calm him.

I will reiterate that I am certain this is about the facility not wanting to get dinged for a fall, especially if the fall risk has been documented. So they are unwilling to take the risk.

Anonymous wrote:

Anonymous wrote:OP here - My dad has one on one supervision all day every day (at a tremendous extra expense). I believe that a qualified person should be able to walk with him but I fear these people are unqualified. We are only permitted to hire aides through the facility owned agency - it’s a huge scam that no one realized until after the fact.

My mom wants to consider moving him to another facility but I fear they will have the same ridiculous policies. She also talks about bringing him home (with help) but I fear that will kill her .

I was going to say not reasonable until this. With one on one care he should be able to be assisted walking.

Yep. I am the fall risk grading PP. If you are paying (through their contractors) for one on one care, then they absolutely need to let him stand and walk. Why are you paying for it not for that. This makes no sense. I would reach out to other facilities and explain that you are willing to provide one on one care. I will say that it probably has to be an approved contractor for liability reasons.

As to bringing him home, you might have to if you are set on him being able to get up and walk. Spend the money on 24 hour care through an agency, but you would need to facilitate this. Once he becomes immobile, then you can replace him in care if the set up at home is too difficult.

Sorry you're going through this. There is nothing easy about eldercare when there are challenges.

Anonymous wrote:OP here - My dad has one on one supervision all day every day (at a tremendous extra expense). I believe that a qualified person should be able to walk with him but I fear these people are unqualified. We are only permitted to hire aides through the facility owned agency - it’s a huge scam that no one realized until after the fact.

My mom wants to consider moving him to another facility but I fear they will have the same ridiculous policies. She also talks about bringing him home (with help) but I fear that will kill her .

I was going to say not reasonable until this. With one on one care he should be able to be assisted walking.

OP here - My dad has one on one supervision all day every day (at a tremendous extra expense). I believe that a qualified person should be able to walk with him but I fear these people are unqualified. We are only permitted to hire aides through the facility owned agency - it’s a huge scam that no one realized until after the fact.

My mom wants to consider moving him to another facility but I fear they will have the same ridiculous policies. She also talks about bringing him home (with help) but I fear that will kill her .

If your dad needs one on one attention all the time due to at any second he could stand without warning and fall, then you have to hire one on one care for him.

Based on what you are saying, your father is only safe to walk with one on one supervision. You could arrange for that for parts of the day.

Also if the facility has an Ombudsman, you could contact them and see if any other alternatives exist. But I doubt you will find anyplace that will allow him to be an independent walker at this point.

Most if not all medical facilities are now graded on fall rates, which then affects funding and grading levels.

As a PP stated, the best you can do is see if they will let you hire a private care person. We had to do this for my mom.

You can also look into other facilities. But the minute you tell them he is a fall risk and you don't want him wheelchair bound, I'm not sure others will accept him.

There is so much about elder care that is frustrating and sad.

They allow my parent to keep using a walker. I understand, though, that your dad won’t use one. That might be why they are pushing the chair.

They wanted my parent in a wheelchair, and the answer was no. A wheelchair showed up in their room. The AL had ordered one via Medicare, which I found unusual.

I understand the fall risk yet think there’s a risk to not having someone move their legs anymore. Blood clots and so on.

My belief is that they’ve made it to 80 or 90 or 96. If we can avoid falls, great. But let’s not do that at the risk of causing other health issues, including mental ones.

That said, your dad can’t follow instructions and can’t use a walker correctly, so that does present a situation.

What do you want to do?

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 would find another facility for my father. That's just me.

I’m so sorry, OP. However, your dad is not going to be getting better. Would they let you hire a personal caregiver to work with him? Apart from that, they have standards that are designed to keep people safe and prevent falls. I presume he is in the facility because it is not practical or feasible for him to be at home or with you because of the level of care/expense that entails.

Dementia is a terrible thing.

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?).