Sorry for the delay in responding. He has a stroke 15 years ago and has been admitted to rehab a couple of times because he has some muscle stiffness that affected his mobility. For this most recent rehab stay, it was because he fell and suffered a brain bleed. The doctor indicated the brain bleed should resolve on its own and that surgery was not recommended. Initially we were worried he has had another stroke. So he has been quite foggy and not like himself the last couple of weeks (while in the hospital and also this week in rehab).

He’s not steady on his feet at all and is having spatial awareness issues. He is in PT and OT.

Bed rails are a choking hazard and cause death to seniors when the senior rules over and their neck gets caught in the bed rail. They have been illegal in my state for over 15 years. You do not see bed rails even the short ones OP talked about in facilities in my state.

On the rare occasion, they might be used in a hospital setting a CNA has to check every 10 minutes to make sure that the patient hasn’t choked from rolling into the bed rail. Given CNA staffing shortages bed rails are rarely used in the hospital setting.

OK, request a bed that drops to the floor and a gym mat on the floor next to the bed.

Also, why is dad having these falls? I’d request a med review with his primary care physician and get him off any meds linked to unsteadiness and falls. Many meds can cause falls and senior citizens.

We had to hire a caregiver, in addition to funding the rehab facility, to be present whenever we couldnt. Even the best of these places is understaffed.

I work in a rehab center in another state. We cannot use restraints, either chemical or physical, or bedrails. If rehab assesses that the patient requires them for independent bed movement, they get enablers, which are about 18" long and go near the head of the bed. We also cannot use bed alarms. We can put bed mats next to the bed/ use a low bed only if the person cannot walk, otherwise it's considered a fall risk. Lots of families ask for full-length bed rails and some have said "we want him to be surrounded so he can't get out."

It can be frustrating for families expecting certain things because the hospital can use them but we can't, due to different regulations.

We dealt with this when my DH was in an acute care hospital with part of his skull removed. He fell out of the bed because in his cognitive fog, he tried to get up when he should not have. So even though somebody with part of their skull missing fell on the ground, the most they would let us do is put some gym mats next to the bed. They said in the state we were in it was a legal rights issue for the patient not to be restrained. It was extremely upsetting and unnerving, so I deeply sympathize, OP.

Rehab made me pay for a one on one caregiver for my mom because she had dementia and was a fall risk. They wouldn’t accept her at the rehab without it. I’m sorry OP, it’s so hard.

Anonymous wrote:I would try to pay for a 1:1. You really, really don’t want them getting an order for a chemical restraint — which absolutely IS legal in Md, unlike physical restraint.

On that note, demand to see his current comprehensive med list since he was admitted to rehab.

Sometimes overburdened facilities will ask for and get a new order for a calming drug. from the off-site consulting MD. Really sketch and common. ie, a bedtime dose of haldol or ativan for “agitation.” Getting out of bed multiple times makes a compelling case for “agitation” to an off-site prescriber.

Good luck

— an RN

Which is terrible for those of us with a reaction to drugs. I am very sensitive to many medications, and once started to hallucinate on codein when it was administered in a hospital. Anti-anxiety meds give me panic attacks (ha!). When I reach old age, I'm just going to check myself into that Swiss euthanasia place Done and done.

When my dad was in the hospital, he was a fall risk. They had a robot machine with a camera on it that would watch him for movements and would set off an alarm with a warning to return to bed. Before that, they always had someone sitting with him.

I would try to pay for a 1:1. You really, really don’t want them getting an order for a chemical restraint — which absolutely IS legal in Md, unlike physical restraint.

On that note, demand to see his current comprehensive med list since he was admitted to rehab.

Sometimes overburdened facilities will ask for and get a new order for a calming drug. from the off-site consulting MD. Really sketch and common. ie, a bedtime dose of haldol or ativan for “agitation.” Getting out of bed multiple times makes a compelling case for “agitation” to an off-site prescriber.

Good luck

— an RN

Restraints aren’t allowed in MD. I’d talk to the social worker about options. You could probably get him a 1:1 but that’s expensive for you. They might have a recommendation for a more suitable placement.

Also you haven’t said what the reason for the fall risk is. Is there an underlying medical problem that hasn’t yet been fully addressed? It doesn’t make sense that he’s had such a significant increase in the falls absent a medical issue.

And what is the purpose of the rehab - because if it’s not addressing the issues behind the falls, it doesn’t sound like home will be a safe discharge plan.

Yes. I wanted to get a seatbelt for my mother’s wheelchair so that I could take her more places — which would involve a few sidewalks with noticeable inclines. I was told about the rules against “permanent “ restraints. I think it’s possible to get a physician’s order for using restraints in some circumstances— to increase safety. I was heartsick that my efforts to give my mom more freedom were restricted by these rules which had been imposed with good intentions— but without reasonable flexibility.

Is it possible to get a PT assessment backed by a physician to order better furniture to accommodate his present needs? Does the rehab have a social worker that you could talk with? Does your county or your Dad’s insurance have an ombudsman?

Also Maryland.

Not allowed in MD. They are correct. Ask them to keep the bed very low. He may need more superision than rehab can provide.

Restraints are not allowed in many places. They can cause as much harm as they prevent. Same with full guard rails. They will not keep a patient in bed. Patients will climb over them.

Title should have said 81 year old dad.

Hi - title says it all. We are in Maryland. My dad is in a new rehab facility due to a fall in his apartment and has fallen 3 times in the past week. This is his 4th rehab stay over several years but in different facilities (first was for a stroke about 10 years ago) and then he has had a few other stays unrelated to falling. He can ordinarily walk with a hemi walker or regular walker.

During this stay he has fallen 3 times. When I come and visit him, they have him parked in his wheelchair at the nurses desk because they say they are understaffed and they will have him parked there for hours at a time. He asks repeatedly to go lay down in his room and they will refuse because they say he is a fall risk.

Also his bedrails only extend 1/3 of his bed so a little above the waist. Two times he has fallen from trying to adjust himself and ended sliding off of the side bed (which could have been prevented with full railings on he side). They claim they cannot put him in a bed with railing along the entire side of the bed because he may hurt himself and they also cannot restrain him at the waist (as was done in the hospital) for the same reason - because he may hurt himself.

I’m trying to see if this is the norm. This was never an issue in other facilities where he has been and he has never before fallen in a facility.