Risky walking and ALF/MC

SEM_BOS

How do you balance your LO's desire to walk when it's risky, with the MC / ALF desire for them to always stay safe?

Mom is in a wheelchair following a broken hip. She's done a lot of PT / Rehab but is usually only able to stand for a moment and transfer from wheelchair to bed, or wheelchair to toilet, or wheelchair to a recliner. She often gets out of bed at night and has been found sitting on the floor, leaning on the wall, or in one of the chairs. Once in a while she walks across a room.

She can do pretty well with a walker, but due to dementia, she generally forgets to use it.

She is obviously missing her independence in many ways. She's in a locked MC, and now due to the wheelchair she can't even walk away when she finds an activity boring, or walk over to someone she'd like to speak with. (She can 'drive' the wheelchair sometimes, but often seems to forget how it works, especially if the brakes are on). When anyone mentions doing anything, she is often starting to stand-up to go eat, stand up to leave the facility, stand up to go play cards until I remind her that I can push her.

When she stands, she's not super stable. So, admittedly, she's a fall risk.

All that said, she's not in jail, and she's not restrained. She's an adult with some level of agency and autonomy.

When I'm with her and she begins to stand up, I make sure the wheelchair brake is set, I let her stand, then ask if she wants to walk (to wherever), or for me to push her. But when the MC staff see her begin to stand, they often tell her to sit down, or sort-of yell if they're across the room. She hates to be told to sit, and reminded that she is so dependent on everyone.

I'm curious how people handle this. I'd like her have as much independence as she can handle, and to explore her mobility. I understand there is risk if she falls. So does she when she has a lucid moment. But the MC staff is clearly scared she'll fall "on their watch".

How do other people handle this?

terei

It is unfortunate, but a staff member taking care of multiple residents cannot be at your mom’s side all the time. They WILL be blamed if she falls + should not be standing without assistance. I am really not sure if you can do anything about it or not. As long as they are helping her when they are actually next to her, I think there is not a lot more you can expect. JMO

M1

I think the only thing you could do is pay for a one on one companion. Very expensive though.

harshedbuzz

@SEM_BOS

This is a difficult situation.

The MCF is going to put her safety first. Full stop. A fall could be catastrophic for her if she is re-injured. A fall would divert staff from their care of other residents while they assess and attend to her. I can appreciate your feelings of respecting her autonomy as an adult, but the disease has robbed her of the reasoning and cognition to parse the risks of the choices you would like her to be able to make.

We had a similar situation in our family. My aunt broke her hip and wrist while in AL. After surgery, she was sent to a SNF for recovery and rehab. She couldn't recall her injury or remember why she needed a walker and assistance to stand nor could she understand the consequences of doing what she wanted in the moment. The SNF insisted the family provide 24/7 one:one care. There wasn't money for that, so my one cousin spent most of the time at the SNF acting as a sitter.

If she can afford it, hiring a private aide for a few hours daily when she's most active might be helpful around this.

HB

GothicGremlin

Hi @SEM_BOS This is a difficult one to navigate.

My sister Peggy (in memory care), is a fall risk. She's in between "barely able to walk" and being in a wheelchair full time. The only time she's left alone is when she's sleeping, and even then there's a motion camera that detects if she's fallen out of bed (which hasn't happened).

During the daytime, she's always in a room filled with caregivers so that if she looks like she's going to stand, someone gets to her first. Often times either me or Peggy's friend M is there. I have a companion/caregiver who sits with her at dinnertime. We do that 5 days a week.

Late last spring I had Peggy evaluated by an occupational therapist. The OT was leery of moving Peggy into a wheelchair full time prematurely, because Peggy will likely forget how to walk. I can see that day on the near horizon anyway. For us the balance is how much to let her walk with us providing A LOT of assistance, and when do we use the wheelchair. For now, we take it on a day by day basis. If she's having a good day, we'll walk from the dining room to her room, with one of us on either side of her. If she's having a bad day, we use the wheelchair.

The reasons for all of this is exactly as @harshedbuzz says: a fall could be catastrophic.

SEM_BOS

Thank you all for your thoughts & input.