Mum falling in care home

[JoJo2821]

Hi my mum recently moved in to a care home.

It has been difficult as she seems confused about where she is and unsure of the carers. We visit her every day and she yearns for us to be with her more. Staff tell us she is very unsettled in the evening, wandering about after going to bed. I find that very upsetting if I think about it. Mum is prone to falls and it was one of the reasons we decided with her to move to the care home. However in the last week she has had two falls the first causing her some very severe bruising on her back.

How can the care home prevent this or at least make sure she gets help as soon as she falls? She has an alarm by the bed, but if she falls when she is not near it, it is of no use. Could I get her an alarm that she could wear on her wrist? Or a bed sensor that goes off if she doesn't return to her bed after a certain amount of time has passed? I do not want to tread on their toes but at the same time I do not want mum spending time on a cold floor after a nasty fall.

 

[love.dad.but..]

In a care home or a pwd own home it is impossible to totally prevent or eliminate falls as some pwd decline. However risks should be assessed and a plan put in place to try to minimise the falls.such as placing a sensor mat next to bed...taking the bed down to its lowest level so not falling from such a height...position the bed against a wall if not already so only one side accessed...finding if there is a pattern to the falls ie same time of night so staff can be more alert to her sleeping pattern ...etc. Ask the home to carry out a fall risk assessment and discuss the measures they will put in place with senior staff.

 

[Hazara8]

Hi my mum recently moved in to a care home.

It has been difficult as she seems confused about where she is and unsure of the carers. We visit her every day and she yearns for us to be with her more. Staff tell us she is very unsettled in the evening, wandering about after going to bed. I find that very upsetting if I think about it. Mum is prone to falls and it was one of the reasons we decided with her to move to the care home. However in the last week she has had two falls the first causing her some very severe bruising on her back.

How can the care home prevent this or at least make sure she gets help as soon as she falls? She has an alarm by the bed, but if she falls when she is not near it, it is of no use. Could I get her an alarm that she could wear on her wrist? Or a bed sensor that goes off if she doesn't return to her bed after a certain amount of time has passed? I do not want to tread on their toes but at the same time I do not want mum spending time on a cold floor after a nasty fall.

In a care home or a pwd own home it is impossible to totally prevent or eliminate falls as some pwd decline. However risks should be assessed and a plan put in place to try to minimise the falls.such as placing a sensor mat next to bed...taking the bed down to its lowest level so not falling from such a height...position the bed against a wall if not already so only one side accessed...finding if there is a pattern to the falls ie same time of night so staff can be more alert to her sleeping pattern ...etc. Ask the home to carry out a fall risk assessment and discuss the measures they will put in place with senior staff.

And the hourly check at night is a must. This is a very helpful post and mirrors much of what
takes place in the Care Home where I work. Yes, falls are alas inevitable to a degree, as people with dementia must be allowed the freedom of movement despite the dementia. One sees this all the time, as cognition declines. The person-centred care which is really what should be a given, can alleviate risks to a degree , but one must be realistic and accept that such events might occur even when everything is in place.
Attention to detail (dehydration, proper fitting shoes, light etc) via that 'assessment' will help to combat any potential mishap. The word 'care' in Care Home means just that.

 

[love.dad.but..]

I learnt from experience with my late dad Hazara...he became very vulnerable especially to night falls which resulted in a few facial injuries requiring a and e. As you have mentioned he also had hourly checks and OP...something else as part of his risk assessment...dad's medication was reviewed with the GP at my request as one particular medication was known to increase falls in those already at risk. It is great Hazara that you post ...to have help and advice for TPers from an experienced dementia care home carer.

 

[Fullticket]

I would totally agree with all the above plus I think that falls with recently admitted PWD are quite common. I know that at home mum had set chairs, tables, bits of furniture she regularly used to balance herself. In a new environment it is going to take a while to identify 'safe' balancing places and I suppose furniture gets moved around more in these social settings so residents are more prone to falls. A colleague of mine, an experienced EMH nurse, told me that new admissions to hospital are much more prone to falls as they are out of their familiar environment.

 

[Sirena]

My mother moved to a care home in February, and two weeks later had a fall requiring her to be checked at A&E. She has since had several other falls, including one last month where she broke her hip. Two of her falls were in her bedroom at night, but others were in the lounge where a carer was nearby - one time a carer went to help her and my mother pushed her away and toppled backwards (no injury that time).

Her care home has a comprehensive set of checks including pressure mats and hourly checks (she was having 15 minute checks at one point). Social services safeguarding are contacted after any serious fall to check that all preventative measures are in place. Unfortunately people with dementia can be prone to falls, and they can't always be prevented. The care home want to encourage her to stay mobile, so there will always be risks, it's just a case of managing them as best they can.

 

[elvismad]

It has been difficult as she seems confused about where she is and unsure of the carers. We visit her every day and she yearns for us to be with her more. Staff tell us she is very unsettled in the evening, wandering about after going to bed. I find that very upsetting if I think about it.


Hi @JoJo2821
My mum is in Assisted Living and like yours, she is very unsettled and is in and out of bed all night. She gets distressed when I leave and I too find is so very upsetting to know that she cannot seem to find any peace. The carers, GP and MHT (and my brother and myself) are doing all we can to try to make mum 'happier' but so far we have yet to find the solution. I have no answers. I just wanted you too now you are not alone.

 

[Helly68]

Some care homes have a liaison team - usually involving an OT or similar, who meet regularly and assess those at risk of and those having falls. I am afraid those who posted here are right when they say that even in a care home facility the risk of falls cannot be eliminated - my mother is at risk of this.
The ways we discussed (and actually for the time being discounted) of dealing with this at our last meeting with the liaison team were - Mummy having a full time one to one support worker during the day - nights are not an issue. We would have to pay for this on top of care home fees - I dread to think how much ti would be. We rejected this as Mummy is a determined and independent person who would hate being monitored like this. We also rejected a recliner seat with "lap belt" used to stop her trying to get up. We all hated this idea - but depending on safety issues may have to consider it. There was also the possibility of her moving to a nursing home - again at greater cost - I wasn't clear how this would really reduce the risk of falling.
What we agreed to do was monitor the situation - actually sadly as her co ordination diminishes she can't actually walk unaided so the risk is reduced, though not in a way we would like.
You may want to look at medication issues - both in terms of is anything she is on causing or increasing the risk of falls or alternatively could there be anything that might help her to settle - Mummy had her mood stabilisers increased to reduce anxiety. It is a hard balance, but the risks of her anxiety and associated risk taking behaviour were and are very great.

 

[JoJo2821]

It has been difficult as she seems confused about where she is and unsure of the carers. We visit her every day and she yearns for us to be with her more. Staff tell us she is very unsettled in the evening, wandering about after going to bed. I find that very upsetting if I think about it.


Hi @JoJo2821
My mum is in Assisted Living and like yours, she is very unsettled and is in and out of bed all night. She gets distressed when I leave and I too find is so very upsetting to know that she cannot seem to find any peace. The carers, GP and MHT (and my brother and myself) are doing all we can to try to make mum 'happier' but so far we have yet to find the solution. I have no answers. I just wanted you too now you are not alone.

 

[JoJo2821]

Thank you all for your helpful posts and kind words. This morning I got a call telling me mum had fallen again and had been admitted to hospital. I rushed over and we spent the day there as mum had x-rays of head, kneck and chest. Nothing broken, and blood and urine clear.
When we returned to the home, the nurse took me aside and said that even with the fall sensor and a commode by the bed he felt mum would continue to have falls. He said that I should push the council for one on one care. He also told me to get a certificate from the doctor to state that mum does not have mental capacity. He said that our POA’s were less than useless without that. He seemed to be suggesting that with that certificate we could ask for a direct payment and top that up to give mum around the clock care in her own home... I am not sure I understand his reasoning. Does anyone else?

 

[JoJo2821]

Some care homes have a liaison team - usually involving an OT or similar, who meet regularly and assess those at risk of and those having falls. I am afraid those who posted here are right when they say that even in a care home facility the risk of falls cannot be eliminated - my mother is at risk of this.
The ways we discussed (and actually for the time being discounted) of dealing with this at our last meeting with the liaison team were - Mummy having a full time one to one support worker during the day - nights are not an issue. We would have to pay for this on top of care home fees - I dread to think how much ti would be. We rejected this as Mummy is a determined and independent person who would hate being monitored like this. We also rejected a recliner seat with "lap belt" used to stop her trying to get up. We all hated this idea - but depending on safety issues may have to consider it. There was also the possibility of her moving to a nursing home - again at greater cost - I wasn't clear how this would really reduce the risk of falling.
What we agreed to do was monitor the situation - actually sadly as her co ordination diminishes she can't actually walk unaided so the risk is reduced, though not in a way we would like.
You may want to look at medication issues - both in terms of is anything she is on causing or increasing the risk of falls or alternatively could there be anything that might help her to settle - Mummy had her mood stabilisers increased to reduce anxiety. It is a hard balance, but the risks of her anxiety and associated risk taking behaviour were and are very great.[/QU

It has been difficult as she seems confused about where she is and unsure of the carers. We visit her every day and she yearns for us to be with her more. Staff tell us she is very unsettled in the evening, wandering about after going to bed. I find that very upsetting if I think about it.


Hi @JoJo2821
My mum is in Assisted Living and like yours, she is very unsettled and is in and out of bed all night. She gets distressed when I leave and I too find is so very upsetting to know that she cannot seem to find any peace. The carers, GP and MHT (and my brother and myself) are doing all we can to try to make mum 'happier' but so far we have yet to find the solution. I have no answers. I just wanted you too now you are not alone.

Thank you Elvismad ---- this is so tough and it does help to know others understand and are experiencing similar problems.

 

[JoJo2821]

Some care homes have a liaison team - usually involving an OT or similar, who meet regularly and assess those at risk of and those having falls. I am afraid those who posted here are right when they say that even in a care home facility the risk of falls cannot be eliminated - my mother is at risk of this.
The ways we discussed (and actually for the time being discounted) of dealing with this at our last meeting with the liaison team were - Mummy having a full time one to one support worker during the day - nights are not an issue. We would have to pay for this on top of care home fees - I dread to think how much ti would be. We rejected this as Mummy is a determined and independent person who would hate being monitored like this. We also rejected a recliner seat with "lap belt" used to stop her trying to get up. We all hated this idea - but depending on safety issues may have to consider it. There was also the possibility of her moving to a nursing home - again at greater cost - I wasn't clear how this would really reduce the risk of falling.
What we agreed to do was monitor the situation - actually sadly as her co ordination diminishes she can't actually walk unaided so the risk is reduced, though not in a way we would like.
You may want to look at medication issues - both in terms of is anything she is on causing or increasing the risk of falls or alternatively could there be anything that might help her to settle - Mummy had her mood stabilisers increased to reduce anxiety. It is a hard balance, but the risks of her anxiety and associated risk taking behaviour were and are very great.

Helly68 - yes we are conscious of not stripping mum of all her autonomy. It was one of the reasons we chose the home option as opposed to keeping her in her flat with a full time carer. My sister would still prefer this option and feels the falls are evidence for keeping her at home with 24/7 care. I am begining to feel that the care home feel that way too...

 

[Helly68]

Helly68 - yes we are conscious of not stripping mum of all her autonomy. It was one of the reasons we chose the home option as opposed to keeping her in her flat with a full time carer. My sister would still prefer this option and feels the falls are evidence for keeping her at home with 24/7 care. I am begining to feel that the care home feel that way too...

Have you spoken to the care home manager? I find their perspective isn't always what I think it will be. We thought they would be keen to have my Mum move to a nursing home when her needs got harder to meet, but in fact I think they felt she had settled well and although there were risks she benefitted from an environment she was used to.

 

[Helly68]

Thank you all for your helpful posts and kind words. This morning I got a call telling me mum had fallen again and had been admitted to hospital. I rushed over and we spent the day there as mum had x-rays of head, kneck and chest. Nothing broken, and blood and urine clear.
When we returned to the home, the nurse took me aside and said that even with the fall sensor and a commode by the bed he felt mum would continue to have falls. He said that I should push the council for one on one care. He also told me to get a certificate from the doctor to state that mum does not have mental capacity. He said that our POA’s were less than useless without that. He seemed to be suggesting that with that certificate we could ask for a direct payment and top that up to give mum around the clock care in her own home... I am not sure I understand his reasoning. Does anyone else?

I hadn't seen this when I replied below. I am not sure I understand the reasoning here either, payments of this kind, as I am sure others with with greater experience will attest, are very complicated. I think you need some kind of meeting, with all those involved in her care attending if you can, to discuss the best way forward.

 

[JoJo2821]

I hadn't seen this when I replied below. I am not sure I understand the reasoning here either, payments of this kind, as I am sure others with with greater experience will attest, are very complicated. I think you need some kind of meeting, with all those involved in her care attending if you can, to discuss the best way forward.

Hi Helly
Yes I have just arranged that today through her social worker. At present I am not at all clear what they expect from us or mum.

 

[Helly68]

Hi Helly
Yes I have just arranged that today through her social worker. At present I am not at all clear what they expect from us or mum.

IN the meetings we have attended, because of Mummy's advancing dementia and the fact that we have medical POA, I see our role (myself and my father) as her advocates and to be as invovled as we can be with decision making, being informed by experts

 

[JoJo2821]

Hi all
Thank you for your continued support and helpful advice.
Mum was not good this morning when I visited. Hiding in her room, reluctant to come out. She had shut her door and was walking around it without her walker. She did not want to have breakfast in the dining room. I really had to coax her out as she seemed very unsure and paranoid. The care home have put in a request for one to one care but her social worker tells me they are unlikely to get that. They say they cannot keep her safe as she will not stay in one place with them. She is quite agitated and keeps moving around. Am I totally naive? I thought this was not an uncommon symptom of dementia? They bill themselves as a speciality dementia care home yet this seems to be beyond their comprehension? I left today thinking I can't keep her there. What are my chances of asking social services to give us the money they contribute to her care in the home, to us as a direct payment? I think she might be happier back at home with a live in carer but we couldn't afford it without that money.

 

[Sirena]

I'm sorry to hear that the care home seem to be unable to deal with your mother moving around the building. As you say, it's a common feature of dementia.

My mother's care home doesn't at all mind the residents moving around and I often see residents walking around the corridors unaccompanied - there are always carers nearby. I think it depends on the management's attitude to risk, some care homes want residents sitting in a lounge together so they are easy to supervise. My mother's care home treats it as just that - their home. They encourage residents to keep mobile and if they want to walk around, that's fine. It may put them at increased risk of falls, but sitting in a chair all day is no life for anyone who wants to be more active. You should be able to find a care home which will accommodate your mother's need to walk around.

 

[Helly68]

I think th

Hi all
Thank you for your continued support and helpful advice.
Mum was not good this morning when I visited. Hiding in her room, reluctant to come out. She had shut her door and was walking around it without her walker. She did not want to have breakfast in the dining room. I really had to coax her out as she seemed very unsure and paranoid. The care home have put in a request for one to one care but her social worker tells me they are unlikely to get that. They say they cannot keep her safe as she will not stay in one place with them. She is quite agitated and keeps moving around. Am I totally naive? I thought this was not an uncommon symptom of dementia? They bill themselves as a speciality dementia care home yet this seems to be beyond their comprehension? I left today thinking I can't keep her there. What are my chances of asking social services to give us the money they contribute to her care in the home, to us as a direct payment? I think she might be happier back at home with a live in carer but we couldn't afford it without that money.

I think the care home comment about the difficulties of wandering is a bit much. Yes, it is hard to keep PWD safe from falling, you can never remove the risk completely, but if they are a specialist dementia care home, they should be well used to this and have strategies for dealing with it.

In terms of the money, I am not sure whether you could transfer funds like this - it seems logical to us, but the way social services work (or don't work most if the time) is complex and not at all logical to me. I apologise that I can't be more helpful, you may want to seek advice from local carers groups, citizens advice or even a financial adviser - though very hard to find one specialising in this sort of thing.

You have my sympathies - this stuff is so hard without all the bureacracy too....

 

[Theresalwaystomorrow]

It’s very difficult isent it, we put our pwd in homes because we think they get better care whereas that’s not always the case is it. I get the freedom bit to walk around but when there’s a danger involved like falling or going in others rooms and having access to things they shouldn’t Just makes you wonder. Personally in a home they just have a bigger space to do what they were doing at home and unless one to one their not being watched!