Falling and New Facility Decision

Marp · May 18

Hello,

My sister has been in a MCF for over a year. We know she won't be able to afford to stay there forever so we put her on the waiting list at the State Run Vet's Home.

They informed me this week they have an available bed for her. They've assessed her and believe they can take care of her.

I have one issue of concern in regard to fall prevention. My sister has developed a tendency to fall and leans noticeably to the right, even when she uses her walker.

Her current MCF tries not to let her walk unassisted very much. This has been difficult because she is a pacer. Sometimes the staff takes her behind the nurses' station with them while they do their charting and med inventory, etc so they can watch her closely. They also sometimes put her in a reclining chair to encourage her to rest.

The vets' home is a SNF and cannot do some of these things because such actions are considered a restraint in a SNF. I've talked to them about fall prevention and am still trying to understand what they do. The DON talked about stand by assistance so they might monitor her closely and have someone nearby if she gets wobbly, but they can't assign anyone to her 24/7(not that I expect them to). The Admissions Director said they would "do their best" to prevent falling.

I love most of the program the Vets' home uses for memory care - so many innovative ideas and so much knowledge. I'm just scared about the falling and sometimes wonder if I should leave her where she is and hope she doesn't outlive her money.

sandwichone123 · May 19

Make sure to ask the Veterans' home whether you would be expected to provide someone with her all the time at your own expense. I've heard of various facilities requiring that.

SDianeL · May 19

my DH was in a veterans facility. When he went in he walked with a cane. They didn’t allow canes and he couldn’t learn to use a walker so he had to go into a wheelchair. He fell once but no injuries. They do call if anything happens my DH then had to be medicated for aggression and was bedridden while they adjusted his meds. When they got him back up into the wheelchair the first day, he leaned forward to pick up something off the floor and fell head first out of the chair. The nurse was right there watching him but it happened so fast she couldn’t stop it. He had to go to the ER for stitches. Even if they have 24/7 care, falls can’t be totally prevented unless they restrain them and they won’t do that. My DH got excellent care there. I would not hesitate to place a LO there. Could you hire someone to sit with her during the day? The spouse of the person in the room with my DH did that. Does she sleep all night? Is she incontinent or does she have to get up during the night to go to the bathroom?

Marp · May 19

https://alzconnected.org/discussion/comment/243562#Comment_243562

Thank you for your response. So glad to hear your husband received excellent care at a veteran's facility. The one my sister would be going to had a horrendous reputation for years, but a lot of bad publicity and an audit by the state (it's a state run vets' home) and they have cleaned up their act.

My sister is incontinent so not too many worries about her getting up to go to the bathroom. She doesn't like the toilet anymore anyway.

I asked about me hiring someone even for a few hours a day and they said other families had done that; it's not common though. They did have an issue with one aid a family hired who wouldn't follow the facility rules so they told the family that aid could no longer come to the facility.

So they allow families to hire additional help, but it's not something they seem to expect, although I have heard of some of the private facilities in the area requiring the family hire additional care in certain situations. Funny thing about that, though, the facilities that require families hire private duty aids are the more expensive facilities in the area. Go figure. You already pay a bucket load of money for the facility and you have to shell out nearly as much for additional aids to come in.

Marp · May 19

https://alzconnected.org/discussion/comment/243545#Comment_243545

I've heard of facilities requiring families pay for additional help, but this one doesn't seem to do that. They said they have had families pay a home care aid to come in sometimes, but it's not something the facility has expected.

harshedbuzz · May 19

It seems like falls are inevitable. Staff and families can take steps to mitigate the risk, but it will always be an issue sadly.

FWIW, my first choice for dad was a state-run VA home; the care looked excellent. As a SNF, they should have a better ratio of caregivers, so they might be more able to have eyes on her.

I don't expect that any DON will be on record in terms of saying they use reclining Broda chairs as a means to prevent fails in pacers as that is a grey area in terms of restraint, but I would expect some of this is happening in practice. When you toured, did you see any residents using chairs? The rules against restraints are pretty much identical in SNFs, MCF, residential schools, public schools. Licensing typically spells out staff ratios, staff qualifications, what medical services are permitted, timing of well-checks, etc.

HB

Marp · May 19

https://alzconnected.org/discussion/comment/243574#Comment_243574

No one was in a broda chair any of the times I was there, and the nurse who assessed my sister indicated they do not use them for residents who can still walk because it's a restraint. Her current facility does use them and several residents who have lived there while my sister was there had them, but they were all very far along in the disease and had difficulty even sitting up in a regular chair.

The staffing ratio in the new place is much better than where she is at now. Where she is now has 2 direct care staff for 20 residents (meets state requirements). One of the direct care staff is also the med tech and spends a big chunk of each shift dealing with medications so, essentially, there are times there is really one direct care staff for 20 residents; the med tech steps in and helps with two person assists and emergencies. Some of the med techs do a bit more than that because they have time, but not all of them will.

The SNF she would go to has 3 direct care aides for 16 residents and oodles of different kinds of nurses all over the place doing meds and whatever else a nurse has to do. So the ratio is much better.

I was very impressed with the nurse who came out to assess my sister - very knowledgeable and had some good thoughts on how to take care of her.

Falling and New Facility Decision

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