Your thoughts on walking upstairs...

[looviloo]

I'd welcome a few thought on the following situation, please.

Dad moved to a care home in May following a fall and has become progressively more unsteady on his feet, but still enjoys going out for supervised walks etc.

His room is upstairs, with a short flight of stairs that are wide and deep. He takes the stair lift down (due to a shoulder injury), but insists on walking up. A visitor to the home told me yesterday that they saw dad walking up the stairs and thought he needed more supervision because he was particularly unbalanced and at risk of a fall. They reported this to the care home manager.

The opinion of the care home is that dad should be allowed to make his own choices regarding the stairs. If he needs supervision every time he wants to go upstairs, this will curtail his independence (in that he'd have to ask, and then wait etc.). Plus, it's impossible to eliminate all risk.

I can see both sides of this... wanting dad to be safe, knowing that he doesn't always make the best decisions (because of the dementia), but also knowing that the current situation is infinitely better than when he lived alone with a very steep set of stairs to climb everyday.

It's complicated by the fact that I have a very good relationship with the care home manager and they have been nothing short of brilliant from the moment dad moved in. But the stairs do concern me.

Any thoughts?

 

[marionq]

How would he react to being told he could not go upstairs unless someone was with him? Would it make him feel like a child or worse a prisoner? He may indeed fall but he might fall anywhere so you have to live with some level of risk or be stuck in a chair.

Personally I would let him try.

 

[fizzie]

Can he not be in a room that is on the flat so that he can keep his independence but isn't in any immediate danger? Can he go on a list for when one is available? I agree it seems a shame to curtail his independence

 

[looviloo]

Thank you both. I'd love him to be in a downstairs room but it's a small and very cosy place, and the rooms don't come free too often. Plus, his room is really lovely.

Yes, I think it would make him feel trapped or like child if he had to ask every time he needed to walk upstairs...

The manager said they would strongly encourage him to use the stair lift if he was unwell (a cold or other virus). I think they are taking quite a measured approach and it's good to hear that others think so too!

 

[Witzend]

Even if they told him he wasn't to use the stairs without asking and waiting for help, would he remember to do it?

 

[looviloo]

Good question Witzend, I don't think he would remember. He's now in a habit/routine. He can also be a bit stubborn at times, so even if he did remember he might not take any notice

Kassy, sorry to hear about your mum's fall. It's such a worry isn't it? Quite out of order for the manager to blame your mum, in my opinion - perhaps they were feeling defensive? It's all a delicate balancing act, one that needs reviewing regularly.

 

[canary]

I am reading this thread with amazement.
In mum CH residents are not allowed to use the stairs unaccompanied - the door to the stairs is locked with a key pad - and residents have to use the lift.

 

[Witzend]

The CH where my mother spent nearly 8 years was a specialist dementia home and purpose built on two floors. There was a lift, but the stairs were not locked off - they were free to wander about and many of them did, and there was a safe, flat, enclosed garden to which the door was only locked at night. I was never aware of the stairs being a particular problem and my mother never fell on them despite getting very wobbly in later years and wandering around a lot.

My aunt was in a CH on an upper floor with locked doors to stairs, but that was because upstairs was specialist dementia, and downstairs was 'ordinary' residential, and presumably they didn't want residents with dementia bothering the non-dementia ones, or wandering into their bedrooms and helping themselves to things.

 

[Witzend]

Good question Witzend, I don't think he would remember. He's now in a habit/routine. He can also be a bit stubborn at times, so even if he did remember he might not take any notice

Kassy, sorry to hear about your mum's fall. It's such a worry isn't it? Quite out of order for the manager to blame your mum, in my opinion - perhaps they were feeling defensive? It's all a delicate balancing act, one that needs reviewing regularly.

You're right - it is a delicate balance. Until very late in the disease my mother wandered a lot, and for much of that time she was very wobbly. She did fall several times and at least twice needed to go to A and E. But she had a 'need' to wander and since she was quite unable to remember any instructions, I don't see how she could have been prevented unless they had tied her to chair or bed, or sedated her into a stupor.

Even in a well staffed home, staff cannot possibly watch anyone every minute, unless there is one to one care. We never felt the CH was in any way at fault - even if she'd been at home with me, I could not possibly have watched her non stop.

 

[AlsoConfused]

Mum now wears hip protectors in case she falls (she's high risk and has osteoporosis). The hip protectors are expensive and I don't know how comfortable they are to wear (presumably very comfortable?). I think research shows the hip protectors are very useful and protective for some type of patient.

Worth investigating?

 

[looviloo]

Many thanks for all your replies... I'm just catching up .

Canary, dad's home is small, and unfortunately there is no lift, otherwise I would ask for dad to use that instead of the stairs. That would be much safer, I think, and still allow his independence.

I should probably say that the visitor who brought this to my attention was a CH inspector, who arrived unannounced. The inspector spent quite a lot of time with dad and raised two or three issues, all of which I would consider minor (especially considering the circumstances that brought dad to the CH!) but they are all being acted on. It's the just the issue regarding the stairs that remains... the inspector did tell me that she felt dad was in the best place for now. As I said in a previous post, it's important to review this sort of thing regularly, isn't it?

Presumably there'll come a time when dad has to use the stairlift for both up & down stairs, with supervision, and then possibly we'll have to look at a downstairs room, or a move to somewhere more suitable. That would be a massive upheaval though :-/.

 

[looviloo]

Mum now wears hip protectors in case she falls (she's high risk and has osteoporosis). The hip protectors are expensive and I don't know how comfortable they are to wear (presumably very comfortable?). I think research shows the hip protectors are very useful and protective for some type of patient.

Worth investigating?

Definitely worth keeping in mind for the future, thank you! Dad has osteoporosis, too.

The doctor is seeing dad in 2 weeks time so I'm going to see if I can have a private word with him about all of this.

 

[looviloo]

Another thought - like Witzend I wouldn't hold the CH responsible if dad were to have a fall. The staffing levels are high and they are very attentive, but they cannot be there 100% of the time. It reassures me though, that if dad did fall then someone would attend to him almost straight away. Which wasn't the case when he fell at home, or even if he lived with me (because there would inevitably be times that he'd be alone).

 

[Selinacroft]

I confess to be coming at this from a different angle and not trying to scare anyone but I heard my father fall down a full flight of stairs at home a few years ago, every single step and found him at the bottom expecting him to be gone, but I rang an ambulance and off he went- broken tib and fib, GA to set leg at nearly 90 and 3 months in hospital rehab. I wouldn't wish that on anyone. He has been downstairs only ever since "on Drs orders" to keep him from trying to get up and he has behaved and stayed downstairs so far.
I wouldn't wish this on anyone. As an aside, the fall was probably more due to mini stroke than dementia but still my cautionary tale.

 

[looviloo]

I confess to be coming at this from a different angle and not trying to scare anyone but I heard my father fall down a full flight of stairs at home a few years ago, every single step and found him at the bottom expecting him to be gone, but I rang an ambulance and off he went- broken tib and fib, GA to set leg at nearly 90 and 3 months in hospital rehab. I wouldn't wish that on anyone. He has been downstairs only ever since "on Drs orders" to keep him from trying to get up and he has behaved and stayed downstairs so far.
I wouldn't wish this on anyone. As an aside, the fall was probably more due to mini stroke than dementia but still my cautionary tale.

Oh, I'm so sorry to hear about your dad... what a horrible thing to happen, and all the aftermath too. And worse, that you heard it happen. I know that when my own dad fell, in his local town centre while on his own, that I felt traumatised afterwards. It was a terrible feeling, to be so out of control and see a loved one so battered and bruised. Thankfully he recovered slowly, like your dad, but we also think it was caused by a mini stroke. It was his second fall, both probably stroke related.

I'm going to keep a very close eye on my dad's situation and as soon I'm uncomfortable with the decisions being made then I'll take some action. Thanks for sharing your experience x