When care staff are unable to stop all the falls

Discussion in 'Middle - later stages of dementia' started by Teanosugar, Aug 24, 2014.

  1. Teanosugar

    Teanosugar Registered User

    Apr 28, 2012
    My dad is now in the later stages of Vascular Dementia and is now falling so often, and going to A and E so often, I wonder what will happen next? Dad is in an EMI unit, has been there for 2 years, previously in sheltered supported housing but he reached a point where he was no longer safe to be there (my judgement, the wardens judgement and eventually his social workers judgement after a lot of input from myself). Initially he was ok in his care home, and he would fall occasionally, but now it has come to the point where he falls so often, 4 times in 6 days this week, that the care home staff are struggling. Dad will not sit still, he constantly walks, and as he is disabled, walked with a stick for years due to his disability before dementia onset, he was a bit unsteady even then. Now his gait has declined to a shuffle, and very unsteady and although the staff do try really hard, there is no way they can be at his side 24/7 as he is not funded 1-2-1. I have asked for an emergency review, which will be sometime this coming week after 4 falls this week, one resulting in a fractured shoulder and hospital sent him back to CH! He has cut his face once, (steri stripped), cut his head (stitched) damaged his nose and glasses (he also has glaucoma and catarracts so vision is impaired, fractured his shoulder, bruises all over back and buttocks and his face is a mess yet again.

    The CH have upped his risk assessment regularly, he has support whenever they see him get up, and they walk with him, encourage him to sit down and rest, but as soon as they turn their backs to support another person, he is off again. As a carer myself I know none of this is their fault, care homes are not staffed to enable 1-2-1 support at all times. They work hard, they always inform me when anything happens, I do not blame them in any way, they are doing the very best they can for my dad.

    I am wondering what to expect next? Can they up his funding to provide more care, and if so to what level? I know it is down to funding, but can not see dad being given 1-2-1 support 24/7 as who would pay for this. Will he be moved to a nursing home and if so are they staffed any differently? Will they be able to use some form of low level restraint in his best interests at busy times? They say some people will fall a couple of times a year, dad falls at least weekly, and lately it is happening more and more. Yesterday the ambulance refused to attend (despite a fractured shoulder the day before from a fall) as he showed no signs of stroke or heart attack. He had cut his head again and the home have a policy of head injury go to hospital (most places do this). They triaged him and sent a doctor out, who 3 hours later examined him, pronounced him ok except his blood pressure was very low so now he has had some medications reduced, one of which was to keep him calm so he will be hot to trot even more now!

    Has anybody has experience of "where and what next" they could advise me on please.

    I feel like I am on the dementia roundabout and am getting dizzy from the constant spinning. I know one day I will get off the roundabout, but whilst I am on it, somebody keeps spinning it faster!

    Thanks for listening.
  2. Jessbow

    Jessbow Registered User

    #2 Jessbow, Aug 24, 2014
    Last edited: Aug 24, 2014
    His low blood pressure is possibly the key- It does make you dizzy and liable to fall.

    It sounds as though the care home are doing all they can and your expectations of them, in the here and now, sound realistic- they are doing the best they can.

    Would you want him restrained? That might lead to frustration, then more falls.

    Fight for additional funding, if only a few hours a day, you might get lucky.

    Would you want him moved? You know he gets the best they can offer where he is. Hard, but can you accept that because of the way he is, one day he will quite possibly fall and bang his head and that will be that?
  3. Teanosugar

    Teanosugar Registered User

    Apr 28, 2012
    I don't want him moved, if something can be worked out to make him safe but I am wondering if the CH will say they can not cope and will suggest a move if you get me? They have said his needs have changed a lot and at what point can they not cope? I am wondering what happens next? I will fight for funding, I had to fight for everything we have now, it was a hard fight and at one point I almost had a breakdown, and it was only then when I said I could not cope any more, with dad wandering and being called out day and night (work full time also) that they finally listened and assessed again.

    I know one day he will die, but unfortunately dad seems to fall so often and get injuries that I feel he is suffering. He has had 27 falls up to now since January, 16 of these have resulted in hospital treatment, 4 of them in broken bones. I accept that he may die as a result of the falls, he will die of something that is for sure, but I have a duty of care as his power of attorney and as his daughter who loves him, to see that he is as safe as we can make him until that fateful day comes.

    I want to wrap my dad up in cotton wool really, but that is not realistic I know. Sounds awful to say but it would be a blessing for him if he just went to sleep and did not wake up, as he is suffering in torment and very depressed and suicidal, wanting his mother who died in 1978. He has even shown violence towards me recently and my dad was the gentlest soul who never lifted a hand to me as a child.

    Thanks for the reply.
  4. cragmaid

    cragmaid Registered User

    Oct 18, 2010
    North East England
    Does your local hospital not have a Falls Unit that Dad could be referred to? Also perhaps he could try a zimmer or rollator instead of a stick.Has the home referred him to an OT? Unless the home actually say that they can no longer cope, and so far they have managed, I would not worry too much. Make sure, however, that all the falls are documented and if you can manage to get a snapshot on your phone just for a recorded history, it wouldn't hurt.
  5. Teanosugar

    Teanosugar Registered User

    Apr 28, 2012
    All falls are documented and OT advice was as walking stick has been in use so long they felt that introducing a zimmer with dads advanced dementia he would be unable to learn how to use it and remember. They did have a little try, dad refused to co operate - pretty standard with him lately. I will be having a review this week but was said to me that his needs have changed dramatically and they are doing their best but he will not sit down. I just wondered if anybody had been through this and what happened next. I have not seen him fall except once in his CH as not there all the time. I do think though if dad fell with me, the last thing I would think to do is take my phone from my bag and take a photo, I would be instantly responding to dad. They have put lots of things in place, but he gets by them, can be quite crafty and waits for the staff to do something else then he is off! Was just looking to see if anybody had been in this situation - I will of course do my utmost to keep dad where he is, as long as it is safe to do so.
  6. jeany123

    jeany123 Registered User

    Mar 24, 2012
    Cragmaid meant take a photo of the fall record documents not your dad x
  7. Witzend

    Witzend Registered User

    Aug 29, 2007
    SW London
    I do feel for you - it is such a worry when someone still has a 'need' to walk or shuffle around, but cannot remember to use a Zimmer or any other aid. My mother does not fall as much as your dad, but falls are still very frequent since she is so wobbly, but she would find it incredibly distressing to be restrained, so that is out of the question, and staff cannot possibly watch her every second. She has had a Zimmer since falling and breaking a hip a few years ago, but can never remember to use it.

    If there is a solution I do hope you find it for your poor dad.
  8. LYN T

    LYN T Registered User

    Aug 30, 2012
    Brixham Devon
    There could be a solution if your dad gets CHC funding. When Pete was assessed there was a falls assessment completed by the CH-he was assessed as high risk and the CHC people assigned him four hours of 1 to 1 extra funding. He still gets it even though he is virtually immobile-but can stand sometimes-therefore still at risk.

    I think that restraining him is a no no as due to the Human |Rights \act -would that be illegal.? I would never have wanted Pete to be restrained-I know your Dad' needs to be kept safe but, IMO restraint seems inhumane.I hope you have some luck with the CHC.

    Take care

    Lyn T

    WILLIAMR Account Closed

    Apr 12, 2014
    We had this problem with my step mother when she went in to care with CHC funding.
    She was wondering and falling about 5 times a day.
    There was obvious risk but the nurse said that they could have confined her to bed but she would have had no quality of life and she was quick to climb over the rails by the side of the bed.
    In the end the son took the decision to let her wonder.
    Even 1 to 1 supervision gives no guarantee.
    On 1 occasion both the son and myself were with her in the garden and she did fall very suddenly.
    Her death which happened a week later did not relate to any fall.

  10. Weary

    Weary Registered User

    Aug 1, 2014
    #10 Weary, Aug 28, 2014
    Last edited: Aug 28, 2014
    I really do sympathize with you and know how you feel. Our 80 yeat old MIL has had repeated falls resulting in broken bones all the time as she has osteoperosis. She was always an active women and now has severe alzheimers and was constantly shuffling up and down never sitting down. Combined with the fact she doesnt eat her weight dropped to 6 stone. After the last fall resulting in another broken hip and damaged gall bladder which had to be removed she was put into a nursing home. She is now restrained by a belt in a special padded chair during the day and at night has a crash pad next to ber bed. I known its not the ideal situation but the alternative is worse with her in pain and distress from operations, and she has now put on a little weight although she is still a living skeleton. There is no easy solution for this awful awful disease. I know lots will disagree with me but the sooner they bring in euthanasia the better - we dont put animals through this living hell so why do we think its acceptable to humans ?. If i get it my family have orders to shoot me!
  11. starryuk

    starryuk Registered User

    Nov 8, 2012
    My mum wandered constantly. She would only stay put for a short while if I was sitting with her. She tripped and fell constantly. The gp finally took her off the blood pressure pills completely as her BP was dropping too low when she stood up. The other thing which made her unsteady was an infection.

    All I could do was constantly think about the tread on her shoes, (shufflers need something which won't suddenly 'stick' to the floor) keep on top of the blood pressure and watch out for uti s. Probably didn't make any difference, but at least I felt that I was trying to do something.

    It is horrible waiting for the next phone call, isn't it. I wish I had a solution for you.
  12. Teanosugar

    Teanosugar Registered User

    Apr 28, 2012
    I feel the same way

    I feel the same, it is cruel and my dad wants to die, and if I am honest I wish this for him, to peacefully pass away. I also agree euthenasia in these cases where a person is in pain, in torment, wants to die, should be allowed this final act of dignity but the law says otherwise. Every night I say a silent request in my head for dad to achieve his goal of lasting peace. Thanks for the reply.
  13. Teanosugar

    Teanosugar Registered User

    Apr 28, 2012
    Thanks for reply

    Yes it is horrible and thanks for caring, we just have to keep going and trying,
  14. Teanosugar

    Teanosugar Registered User

    Apr 28, 2012
    Funded but not CHC

    There is to be a review in 2 weeks to see where we go next. Falls clinic next week. Time will tell. Thanks for reply.

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