Memory Care Safety

HelpingMyDaddy

This is my first time posting but I have some questions. My father is being placed in a MC facility in a couple of weeks. He's about late stage 6. He fell and broke his hip over the summer and has had 24hr care at home since then. He gets out of bed and is quite unsteady and says he wants to go to the bathroom (usually not) or wants to walk around the house. He is very strong and determined and insists on doing it. What is going to happen at the MCF when he doesn't have 24hr care? The daytime caregiver he has keeps him very busy... walks him to the bathroom to brush his teeth, gets him dressed, walks him to the dining room table where they do puzzles, looks through books, takes him to appointments, steadies him as he pushes a cart in the grocery store, etc. How does MCF work? When he wakes up, he will immediately try to get out of bed, go to the bathroom, leave the room, etc. and he's just a fall waiting to happen. What can I do or provide to avoid this happening?

harshedbuzz

This is a question for the MCF.

The short answer is that he will fall- it goes with this territory. Is he supposed to use a walker? The MCF may insist family provide (i.e. fund a private sitter) to redirect him or assist as needed.

HB

Cynbar

Have you discussed this with the MCF admissions office? You can't expect their staff to give your dad the same constant 1 to 1 attention he has been getting at home. Yes, their aides will help him with bathing and dressing and brushing his teeth, etc., but they won't have someone beside him all the time. His safety needs and your expectations need to be worked out in advance. You don't want to be asked to move him again or provide a private sitter on top of the MC charges. But with that said, lots of dementia patients are impulsive and are fall risks ---  find out now what they can handle, before you move him in.

HelpingMyDaddy

We have a walker for him along with canes and a wheelchair.  He won't use the walker.. or rather, he forgets to use the walker and doesn't know what it's for. We have a set of sensor pads that can go on the floor and bed for when he gets up but I don't know if the staff would hear them go off so I don't know if it would do much good.  What questions should I ask the staff and is there anything I can buy that would help alert the staff or keep him safe.  Thanks for the replies.

MN Chickadee

Falls happen. In every facility, good or bad ones. They just do. My mother was a bit fall risk for a time, and yes she took some spills. Fortunately none have been bad so far or resulted in broken bones. The MC did find some ways to reduce them. They learned her schedule so they were in her room getting her up before she tried herself, and kept her in the common areas during the day where they could see her as much as possible. If she was in the common area there were way more eyes on her, and they found ways to keep her seated. Often putting a weighted blanket and something to fidget with on her lap, such as stuffed animals or fidget toys. This kept her mind from wandering, and her mind wandering would literally translate to her body wandering. Some places are more willing than others to use devices. A wedge pillow to prevent getting up alone, a baby monitor camera in the room or other alarm etc. But someone who is unsteady on their feet and lacks the judgement to wait for help is likely going to fall. There are probably very few late state 6 PWD who have not fallen, it's par for the course. And may even at home with his 24 hour aide, it only takes a second for someone to turn their back and have the person go down. Bring it up with the nursing staff so they can craft the care plan to as much prevention as possible.

King Boo

" What can I do or provide to avoid this happening?"

To be blunt, absolutely nothing.  Even at home with a 1:1 24/7 caregiver which is astronomically expensive, falls happen.

What you can layer into place, since he is a high fall risk:

-make sure the MC facility does hourly room checks at night, so if he goes down, he will not lay there all night, such as what would occur in AL or at home w/o supervision.

-at times of higher risk during the day, room checks.  After a hospitalization, monitoring was stepped up since he was weakened from a hospital stay.  Ended up going back to short term rehab as a result.

-have PT assess for the fit of the walker (which can be very helpful).  Different models can make a difference.  This goes for wheelchairs too.

-assess the room for trip hazards.  Ask PT for input too.

-possibly consider motion sensor lights for when he does get up - but ones that will not interrupt sleep

-train for bedside use of a urinal.  Very helpful if he will accept it.  

-bedside alarm pads pretty much alert after the fact in terms of staff response, so although helpful, they will not stop falls

-is there a trigger for getting out of bed.  My LO went through a phase of  night time thirst.  Bedside carafe of water eliminated some forays

-ascertain what their notification protocol is for falls.  Our facility had the policy that family was called.  The nature of this disease is that at certain stages I would get 2,3 calls a day.  Kept my fingers crossed that he would not hit his head.   

It is indeed a stressful time, but accepting that falls happen and nothing can 100% stop them helped me stop stressing myself out.   Knowing that there was an appropriate clinical protocol in place for fall assessment helped a lot.   We had a wellness center on campus that had CRNPs on every day, and an MD 2 days a week, with a good nearby ER.