Medsister Asked August 2022
How to keep elderly dementia patient from trying to get out of bed when they are not able to walk?
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Afraid person will injure themselves if they try to get up? There is no place we can afford that can watch person 24/7.
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I placed him in a group home that had six elderly people living there and live in aides. There was an alarm on his bed to alert the aides when he would try and get out of bed at night and during the day all the residents were in the living room where the aides were able to keep an eye on everyone at all times. This small group situation seemed to work quite well to keep him safe from falls. He did have a few falls while he was there because they couldn't keep an eye on him constantly but for the most part he was watched very closely and the other residents would also alert the aides if he tried to get up on his own. Had he been in a nursing home or assisted living I think he would have fallen several times a day due to the rules about no restraints.
The cost of the group home was quite a bit less than a nursing home but around the same price as assisted living where he would not have had the same close supervision. I had never thought about a group home for either of my parents until the hospital my dad was in suggested someone to assist me to find placement who recommended a group home and found the place where my dad ended up and I am so glad that I went with the group home for my dad.
My daughter in an RN who worked in NHs. She said a lot of these "laws" that are to protect the resident actually do more harm. A person can not be restrained in a wheelchair. This person with Dementia does not understand they can do longer stand without falling. So they stand up and fall breaking a hip. A seatbelt would have prevented this. Why no railings, someone did a study and found out of 100 people (lets say) 3 of them got there head caught between the mattress and railing and suffocated. One could have been a 90+ yr old woman who was bedbound with no quality of life. Yes, sad that she died but its 3 out of 100. Without railings she could have fallen out of bed and hit her head killing her too.
My Mom was a fall risk.
First, I found a PT person who would teach us what exercises my Mom needed to do, to be less of a fall risk. We use these exercises to this very day. I work with her to do the exercises as she will not do them on her own.
During the day, she went to adult day care where we paid for the level of care that provided a person there whenever she got up. She was using a walker. She was not in a wheelchair. Because she used the walker, she became less of a fall risk as she was constantly exercising all the muscles needed to "not fall".
At night, we hired a caregiver to stay awake and ensure she didn't fall. It was a 9 hour shift. She was most likely to fall when she was not fully awake when getting out of bed. She never remembered any of the falls or near falls as she is a sleep walker.
We previously lowered her bed (the box springs were on the floor) so that it didn't take much for her feet to get on the floor. We did not get a bed alarm because we required the caregiver to be near her at all times. We did not use bed rails as it just forced more movement by my Mom, before her feet were on the floor. She rolled off the bed more than once while trying to sit up at the edge of the bed.
I moved my Mom into Memory Care. I didn't want to pay extra for someone to be with her at all times. So every 3 hours, they check on her.
Because she got less exercise in Memory Care, she started to fall more, nearly always at night. Memory Care wanted her in a wheelchair. However, if she was in the wheelchair, that was even less exercise.
So I resumed doing exercises with her. These were to primarily strengthen her abs and legs. However, once I started adding in the balance exercises, that is when the number of falls decreased.
So, the thought here is not to prevent them from walking, but to get the right exercises so that they don't fall, should they get up and attempt to walk.
Ask the doctors for a prescription for home health and to order a hospital bed since the person is bed fast. The bed can be positioned to where it is more difficult to get up. Also full rails can be ordered. Plus a rubber matt can be placed near her bed to soften a fall. A dementia patient can be very intent on getting up and will need frequent checks. It is amazing how strong they can be at times and how weak at other times, like when you need them to help you transition.
With all of this, my DH aunt still managed to get up and sprain her ankles several times.
We used bedrails for Mom, set up so she couldn't drop them or scoot down to the end of the bed to get out.
Finally, there are bed tents. The cheapest are intended for insect protection but might be enough to keep someone with dementia in the bed until help arrives to let them out.
The sensor pad can be placed under the resident. When the resident gets up and pressure is removed from the pad the monitor will sound, alerting the caregiver.
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Couple things worked, one was the nursing home placed pillows tucked all around Mom so she couldn't move. Mom couldn't turn on her side, and I thought how painful that would be on her frail back.
Another thing that the nursing home did was place Mom in a geri-recliner and they wheeled her out near the nursing station. The Staff placed a pillow under Mom's knees. Mom would spend a hour pulling and tugging at the pillow and eventually get it removed. The Staff would replace that pillow.
Even if you had 24 hour watch, your Mom would still fall. It's like trying to keep a toddler from falling.
For my 100-yr old aunt with advanced dementia she has a hospital bed that is pushed up against one wall and on the other side of the bed are 2 short bedrails that can raise and lower. They only cover 1/2 the bedside (the from head to waist) so we have gerry-rigged some tall backed chairs for the rest of the bedside and are that are secured in place using bungee cords.
What NHs do is add a warning, like a sensor alarm mat on the bed or floor (to detect motion) so that a caregiver can quickly arrive to assist mobility.
It is hard (impossible really) to prevent all falls, but reducing falls is a very good aim.
Is your patient in a care setting or home?
Before anyone suggests cameras.. imo are not a great solution - unless someone is glued to the screen & can arrive bedside very very speedily. The caregiver would need to be in the same close proximity as to hear a falls alarm. But may work if on a computer screen for someone working from home in next room etc. Be quieter I suppose?
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You can also apply for Medicaid to fund your loved one's long term care in a Skilled Nursing Facility, but it's true that nobody will watch a patient 24/7, no matter WHERE they live. A SNF will not allow a bed rail, either, it's against the law for 'restraining devices' to be used in facilities. But it's something you can use in your home, if you feel comfortable doing so.
Your loved one should not stay in bed 24/7 either, because that's how bed sores develop, and muscle atrophy etc. Hopefully you have a way of getting the patient into a wheelchair to sit up for periods of time during the day.
Best of luck