Anyone know much about nursing homes?

[cleller]

Fun subject, huh?
My mom is 89, and has had Alzheimers/Dementia for over 10 years. She's been at an assisted living center for a little while, and fell about 2 weeks ago, and broke her hip.
At the hospital, her arms had to be in restraint, as she would pull things loose, etc. The hospital wanted to transfer her to a "skilled nursing center" for rehab, but said she had to be free of restraints for 48 hours first.

A week ago she was transferred. On arrival there, I noticed there were no bedrails on the bed. When I asked, they said rails are considered a restraint, and cannot be used. At night, they put a rubber mattress beside the bed in she rolls out. Further, if she makes 3 attempts to get out of bed, they say she has to be placed in a wheelchair.

So, on her second day there, she got out of the wheelchair, fell and had to be sent back to the hospital. After several hours screaming in the ER, she was sent back to the "skilled nursing". Yesterday, the same thing happened again. So my actual question is: what is the deal with restraints?

I would imagine someone waltzed into a nursing home to see grandma for the first time in a few months, found her tied down, and sued the pants off the nursing home. Now, any form of restraint is viewed as a potential hit in the bank account. Better to let them fall than restrain.

We're not looking to sue anyone. Someone from the family is there everyday trying to help out. If she could at least have a bed with rails everyone would be a lot better off.

[yermom]

it sounds like you are at the wrong kinda place. i'm not an expert by any means, but i've been around a lot of those type of patients, in the last couple of years, sadly.

i'd find some support group/social worker type that specializes in this stuff and ask about options and types of facilities instead of dealing with the facilities themselves, since they may have their policies/bottom line to look at, instead of what is right for your particular case

[cleller]

We were never in favor of this facility, but got stuck with it. She is with Community Care/Medicare. They gave us a list to choose from, and asked us to choose three. We did. This was not on the list, but was the only one available to take her. Great system.
We are hoping to somehow get her back to the assisted living place she was before. If that cannot be done in the next two weeks, we'll be finding another place.

Luckily, in the immediate family we have a decent amount of experience with these issues. It was just the "bedrails are restraints" thing that surprised me.

[yermom]

i didn't mean to imply that you weren't experienced, just that it sounds like you should talk to a 3rd party, and probably would get better answers from another group than from us jackals ;)

[batonrougesooner]

The commission that certifies hospitals and other facilities categorize these things as restraints more on a philosophical basis vs practicality. It's more about political correctness than what's best and the most pragmatic for the patient.

Sounds like she needed skilled nursing for her recovery of her broken hip but it's obviously not a long term solution as it pertains to her dementia. Case management/social work should be able to direct you to a facility which is designed to deal with the dementia issues long term.

[the-rover]

Also sounds lke she's not being properly medicated

[cleller]

i didn't mean to imply that you weren't experienced, just that it sounds like you should talk to a 3rd party, and probably would get better answers from another group than from us jackals ;)

No offense taken, you're probably right about the jackals, this is just my go to place for perplexing questions.

The medication issue is another kettle. The medical people have an aim to try to get her up and out of there. We just want her out of pain. She had serious pain and rapidly declining mobility before the fall. Because she has no heart condition, etc, no one will even discuss hospice, despite the fact she will obviously never be able to be care for herself.

Hope a few of you as possible have to experience this.

[soonerbrat]

Also sounds lke she's not being properly medicated

what do you mean by "properly medicated"? as in giving her a sedative?

[KantoSooner]

You need a coach. Somebody's who been through this from one side or the other. Do you know an RN? During my dad's recent hospitalization, I had a family friend RN coaching me in the evenings. Helped tremendously when blindsided with unexpected issues/decisions.

Don't give up.

[cleller]

You need a coach. Somebody's who been through this from one side or the other. Do you know an RN? During my dad's recent hospitalization, I had a family friend RN coaching me in the evenings. Helped tremendously when blindsided with unexpected issues/decisions.

Don't give up.

I've got a sister in law that is an RN, another that is a Medical Technologist, and my mother in law is a former medical-type social worker.
The one thing they all agree on is that doctors and nursing homes are so scared of lawsuits and regulators that they will hardly consider medicating a patient into a stupor unless they can back it up with a diagnosis that the patient is unlikely to live more than six months.

That's what I find so perplexing. I'm not asking them to sedate her. Just allow her to lay in bed when she is not doing her therapy. But because the bed has no rails, she tries to get out, so they have to put her in the wheelchair. Then the cycle starts all over. Just no logic applied to the situation.

Oh well, she seemed a little better today. If only she still had her memory.

[badger]

My parents were both RNs at one time and I have been a volunteer in nursing homes for years so I am pretty familiar with the places, having seen my parents work and me volunteer at a few.

One thing health care providers tend to complain about are social workers (and I'm sure the feeling is mutual). The health care providers (doctors, nurses, hospital and nursing home personnel) think they're doing what's in the patient's best interest by limiting mobility by the use of restraints, bed rails, etc. Social workers think they are doing what's in the patient's best interests by not limiting mobility and offering patients freedom of movement or whatever.

There's been a few other examples over the years that I've heard em all complain about, but the restraint issue is the biggest one. My family's personally dealt with it, because when an elderly family member has gotten up from their own bed and walked around their entire life, what is that person's natural inclination when they wake up or are sitting in a chair, even a chair with wheels? Practically every day, we're getting a call from the nursing home saying that our beloved family member had a fall.

See if there's any way that you, as an immediate family member, can sign off on a restraint for when they are in bed or in a wheelchair or at least have alerts placed on their beds/chairs so that immediately when they try to get up on their own, a buzzer sounds (it's magnetic with a string, don't know the name of it). This will remind the person what they're about to do and also alert medical personnel nearby that they're about to deal with a falling patient if they don't run over to the buzzing noise immediately.

I recommend talking to your loved one about your concern. I know you said they have alzheimers/dementia, but talk about it often and there's a chance that perhaps it'll stick when they when they're hearing their monitor buzz or they see a restraint.

I also recommend talking to the nursing home, especially those nurses and doctors who work primarily in the area your loved one lives in. Have them call your family after falls and talk about ways that are allowed that might prevent future falls.

If you are 100 percent concerned about this and want to do what's best for your mom, do what my family did: Offer to sign any and all waivers to allow restraints. Like you said, they have probably been threatened with litigation in the past. If there's no threat of that, they might be able to do what's best for your mom.

Good luck!

[cleller]

If you are 100 percent concerned about this and want to do what's best for your mom, do what my family did: Offer to sign any and all waivers to allow restraints. Like you said, they have probably been threatened with litigation in the past. If there's no threat of that, they might be able to do what's best for your mom.

Good luck!

Now this is something I will have to look into. Don't know why it hasn't occurred to me. Too much stimulus. I know they don't like the situation any better than we do, just following rules.

[badger]

Be prepared to be extremely adamant --- restraints is something that the nursing homes do NOT like to do for whatever reason (social workers: You're taking away a patient's right to move!)

I remembered hearing the mom side of the phone conversation when mom suggested this for our family member. It was clear that the nursing home did not want to do it, but keep in mind:

1- Your family is a paying customer and those places ain't cheap.

2- You're the next of kin, the power of attorney, the decider.

3- You are doing this with your mother's interests health in mind, not for selfish reasons.

Restraints get a bad rap because of the movies and soap operas or whatever of the millionaire heirs trying to control the family fortune and the estate's matriarch/patriarch. "We're keeping Uncle Moneybags on drugs and chained up so he can't spend his retirement years in peace and prosperity while we cash in his stocks and live high on the hog!"

Not all restraints are all taboo though. I know that bed guardrails are commonly used. Don't EVER wear a stethoscope around those metal things. CLANG!

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