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Lupara

I have a relative in a elderly care facility

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He's fallen over 35 times. I suggested a strap around his waist on his wheelchair to prevent this. It is considered a restraint and not allowed. An alarm was attached from this clothing to the chair or to the bed to notify the nurses if he was trying to get up or has fallen. Now, I come to learn, the  alarms have been banned. Upon inquiring, I was told the reasoning behind this is "It takes away their right to fall." Are you serious?

Anyone else run into this?

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Many years ago, and the insanity of do gooders hasn't slowed down at all.  I don't know that there is a simple or reasonable solution,  but it would serve many people well if there were better ways to take care of our aged citizens.

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As far as I know, no straps are allowed or any type of restraint.  Not sure about the alarms.  Maybe check another facility?  Most places like that have an Ombudsman that is there for the patients.  They have their best interest in mind.  Check to see who it is and ask them.


What seems a blessing may really be a curse.

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No restraints of any kind are allowed, this includes side rails , ties, or mitts.   The powers that be feel that they must have the right to fall if they want to.    BUT, if they fall and hurt themselves and have to have treatment...medicare will not pay for the treatment as the fall should have been prevented.    Crazy?  Absolutely!  True?  Absolutely!

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You might check with the Area Agency on Aging for current rules. They used to be able to use restraints if the resident could reach them to open them if they wished. They were more "reminders" than restraints but were quite effective on residents with dementia. I have never heard this about the alarms but as I said it may be a new regulation. It sounds to me as though that it is an interpretation of the facility rather than a state regulation. 

If a doctor is willing to state that unless some sort of restraint is used the resident is in physical danger the use of things like bed rails is usually permitted. Thirty five times is way too many times for someone to fall. If I were investigating this case I would be inclined to label it neglect unless they came up with a very good explanation. Beds can be lowered to floor level and areas can be padded. Residents who cannot safely transfer from a wheelchair to a bed or the toilet should be supervised.  There is no excuse for this as there are ways to prevent it.  It sounds as though freedom from restraint is being used as an excuse for not providing adequate service. 

If you can't get any satisfaction locally report it as elder abuse.   http://www.aging.pa.gov/aging-services/protections_rights/Pages/Report-Elder-Abuse.aspx

 

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From what I am reading this is an experimental program that started in Connecticut and based on the same premise that eliminated restraints ie that patients are more likely to be injured trying to get out of them than are injured in falls. Since it is experimental I really doubt that it is a state or federal regulation. It seems that it is just something that nursing homes are trying because of some research at a couple of nursing homes. Nursing homes are responsible for a resident's safety within state and federal regulations first and foremost. Go to a care planning meeting and take along an ombudsman. Thirty five falls is ridiculous and going to kill him eventually. They need to come up with a plan to keep him safe.

Here are a couple of articles that explain the issue. I could find nothing for Pennsylvania. Nursing home regulations are on the pa.gov web site but they are not always up to date.

http://c-hit.org/2013/03/20/state-nursing-homes-pilot-alarm-free-initiative-carefully/

http://northeast-nc.legalexaminer.com/nursing-home-elder-abuse/surprising-data-reveals-alarmfree-nursing-homes-may-be-safer-for-patients/

 

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My father was restrained in some sort of a chair that he actually rocked over.  He sustained a brain bleed from hitting his head but he was extremely violent and I would rather that happened than that he hurt any more nurses.  


"The world will not be destroyed by those who do evil but by those who watch them without doing anything"

Albert Einstein

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Rules may differ depending on the type of place you describe as an "elderly care facility" (e.g., assisted living, nursing home, group homes, etc.).  Also, there are rules based upon State regulations and those  developed by the facility.  Sometimes, the rules of a facility are more stringent than the State rules. In my experience, restraints were removed by many local nursing homes years ago, and alarms are used  more sparingly.  Alarms have rarely been effective  because at one time nearly everyone had an alarm attached to them, and at any given time, the halls were filled with noise which worsened the behavior of residents. Given staff limitations, there are only so many they can attend to at any given time while trying to do their other jobs. It's better to construct an environment that minimizes the need for alarms and restraints.  Remember, an alarm is tripped after an event has occurred, and unless you were in the room with the time watching it happen, it can't be prevented.  Restraints are dangerous as people can become severely injured or die while using them.  Also, the use of restraints gives the staff a false sense of security, and restraints can be used in an abusive manner.  Doctors are more willing to prescribe medications as chemical restraints than to use physical ones.

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When I was first to told of the right to fall , I thought what else is going on here? Pharmaceuticals came to mind. I've forwarded the links above to the patient's power of attorney  to pursue. Thanks again to all for the replies.

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2 hours ago, TucsonSunset said:

Rules may differ depending on the type of place you describe as an "elderly care facility" (e.g., assisted living, nursing home, group homes, etc.).  Also, there are rules based upon State regulations and those  developed by the facility.  Sometimes, the rules of a facility are more stringent than the State rules. In my experience, restraints were removed by many local nursing homes years ago, and alarms are used  more sparingly.  Alarms have rarely been effective  because at one time nearly everyone had an alarm attached to them, and at any given time, the halls were filled with noise which worsened the behavior of residents. Given staff limitations, there are only so many they can attend to at any given time while trying to do their other jobs. It's better to construct an environment that minimizes the need for alarms and restraints.  Remember, an alarm is tripped after an event has occurred, and unless you were in the room with the time watching it happen, it can't be prevented.  Restraints are dangerous as people can become severely injured or die while using them.  Also, the use of restraints gives the staff a false sense of security, and restraints can be used in an abusive manner.  Doctors are more willing to prescribe medications as chemical restraints than to use physical ones.

Yep. Just drug em all. ?

 


 

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7 minutes ago, Jay said:

Yep. Just drug em all. ?

 

Soma! Soma! Soma!


Because, Gentlemen, I don't trust you...  Gunning Bedford, U.S. Constitutional Convention
The worst form of inequality is to try to make unequal things equal. Aristotle
First God created idiots.  That was for practice. Then He created school boards. Mark Twain
Those who cannot remember the past are condemned to repeat it. George Santayana

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17 hours ago, Petee said:

My father was restrained in some sort of a chair that he actually rocked over.  He sustained a brain bleed from hitting his head but he was extremely violent and I would rather that happened than that he hurt any more nurses.  

The Geriatric Psychiatrist prescribed some sort of a medication that changed my father into the nicest man but then took him off of it because it was considered chemical restraint.  I was floored!


"The world will not be destroyed by those who do evil but by those who watch them without doing anything"

Albert Einstein

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Why would they give him a medication, then realize it was a restraint?  Seems to be incompetence or, what happens often, is that the nurse had no idea how to manage his behavior and resorted to the easy solution. The medication was ordered, doctor said 'ok' (trusting the nurse), then someone realized it was inappropriately prescribed.  They back-tracked.  They should not blame the medicine, which did not just jump into his mouth any more than a bullet jumps into a gun and kills someone.  Glad it made him nice, but, it could also have killed him.  There is a high mortality rate for certain meds used to make people nice, such as antipsychotic medications.  

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I used to play in a band and we would set up and play at many homes in the area. It was interesting to note that some did a better job and ran a better operation than others. Maybe it would be nice if the county could put together a crew to visit all these places and make note of the best practices and pass them around. There were some that made you want to hold your nose as soon as you walked in. Too bad.

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4 hours ago, TucsonSunset said:

Why would they give him a medication, then realize it was a restraint?  Seems to be incompetence or, what happens often, is that the nurse had no idea how to manage his behavior and resorted to the easy solution. The medication was ordered, doctor said 'ok' (trusting the nurse), then someone realized it was inappropriately prescribed.  They back-tracked.  They should not blame the medicine, which did not just jump into his mouth any more than a bullet jumps into a gun and kills someone.  Glad it made him nice, but, it could also have killed him.  There is a high mortality rate for certain meds used to make people nice, such as antipsychotic medications.  

He had mental problems all of his life and was always too afraid to deal with them.  When he had a mini-stroke on his 74th birthday it all went south and he severely injured more than one nurse to the point that they had to put a guard at his room.  He got suicidal in Intensive Care and no one could get near him so I went into his room and calmed him down till they could give him an injection.  Then they could reinsert his IVs and make preparations to control him better. It was terrifying for both him and me.  

He needed a medication that would allow him to remain peaceful and yet active.  I can't remember what it was but it was amazing and allowed him to go into a nursing home where he actually had fun.  Then the Psychiatrist decided it was Chemical Restraint and took him off of it which led to another battle till they tried many other medications, none of which really helped.  For too short a time I got to see what my Dad might have been like had he gotten proper treatment.  In the ensuing mess he had more mini-strokes and got more and more debilitated till he was finally bedridden and got a serious skin infection which killed him. 

Political experimentation with the elderly is simply cruel.  It was a terrible time for us, and more importantly, for him.


"The world will not be destroyed by those who do evil but by those who watch them without doing anything"

Albert Einstein

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3 hours ago, TD said:

I used to play in a band and we would set up and play at many homes in the area. It was interesting to note that some did a better job and ran a better operation than others. Maybe it would be nice if the county could put together a crew to visit all these places and make note of the best practices and pass them around. There were some that made you want to hold your nose as soon as you walked in. Too bad.

It would be wonderful if volunteers went into these facilities and kept an eye on things. Ombudsmen are assigned to facilities but they can't be there all the time. They are the only ones who can go in unannounced. State visits are announced. I think. without doubt, people who have relatives who come in regularly get better care. For those who have no visitors and aren't capable of advocating for themselves there are only  outsiders who are willing to get involved. Too bad there aren't more. 

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My mom was in a local nursing home 7 years ago. She fell out of bed and almost out of her chair.  I told them to put up bed rails and they said they were not allowed to. I told them to use seat belts in the chair and I was told they weren't allowed.  I said I would even sign a consent form for responsibility and they said no.  

 

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6 hours ago, Petee said:

He had mental problems all of his life and was always too afraid to deal with them.  When he had a mini-stroke on his 74th birthday it all went south and he severely injured more than one nurse to the point that they had to put a guard at his room.  He got suicidal in Intensive Care and no one could get near him so I went into his room and calmed him down till they could give him an injection.  Then they could reinsert his IVs and make preparations to control him better. It was terrifying for both him and me.  

He needed a medication that would allow him to remain peaceful and yet active.  I can't remember what it was but it was amazing and allowed him to go into a nursing home where he actually had fun.  Then the Psychiatrist decided it was Chemical Restraint and took him off of it which led to another battle till they tried many other medications, none of which really helped.  For too short a time I got to see what my Dad might have been like had he gotten proper treatment.  In the ensuing mess he had more mini-strokes and got more and more debilitated till he was finally bedridden and got a serious skin infection which killed him. 

Political experimentation with the elderly is simply cruel.  It was a terrible time for us, and more importantly, for him.

Sorry to hear about what happened to your dad.  Seems the facility put their needs ahead of your dad's quality of life.  Their "needs" are likely that they wanted to stay off the radar of the State/Feds, so to keep their number low of residents on certain drugs, they withheld it from your dad.  The medication itself is not a chemical restraint, but medication becomes a chemical restraint depending on how it is used. I find it hard to believe that any competent psychiatrist would not be able to understand this idea and advocate for your father.  Instead, it sounds like the easy path was taken and he caved to an institution pushing their rules.   Also, there was a time when nursing homes employed social workers who advocated for residents.  In the past several years, many of them have become burdened with administrative duties and have lost their focus as advocates.  

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38 minutes ago, Nita said:

My mom was in a local nursing home 7 years ago. She fell out of bed and almost out of her chair.  I told them to put up bed rails and they said they were not allowed to. I told them to use seat belts in the chair and I was told they weren't allowed.  I said I would even sign a consent form for responsibility and they said no.  

 

While it sounds plausible that a signed release would be acceptable, facilities are not going to take the risk because if family does not sue them, the government rake them over the coals.  As far as I know, every fall has to be reported to the State, which increases scrutiny that no facility wants.

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6 hours ago, lavender said:

It would be wonderful if volunteers went into these facilities and kept an eye on things. Ombudsmen are assigned to facilities but they can't be there all the time. They are the only ones who can go in unannounced. State visits are announced. I think. without doubt, people who have relatives who come in regularly get better care. For those who have no visitors and aren't capable of advocating for themselves there are only  outsiders who are willing to get involved. Too bad there aren't more. 

The variety of nurses and staff do not need to have more eyes on them, but the residents need more hands, ears, and smiles.  One of the bigger problems in nursing homes is that they need more paid staff to provide more care.  However, rural areas have a harder time finding enough people to fill these positions, even if they are funded.   I do believe that state inspections are unannounced, but they tend to occur in similar time frames each year.

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1 hour ago, TucsonSunset said:

The variety of nurses and staff do not need to have more eyes on them, but the residents need more hands, ears, and smiles.  One of the bigger problems in nursing homes is that they need more paid staff to provide more care.  However, rural areas have a harder time finding enough people to fill these positions, even if they are funded.   I do believe that state inspections are unannounced, but they tend to occur in similar time frames each year.

I spent at least 15 years working with the Area Agency on Aging. During that time we were advised that state visits were announced in advance. I certainly knew when they were to occur as I had to be there for the closing.  It was always emphasized that the advantage of ombudsman visits were that they were spontaneous. 

I agree that these facilities need more staff however they must be staffed to a certain level by state law so it is not as though they are being run with a less than safe level of staff. Employees must log enough hours , depending on their position, to spend a certain amount of time with each resident. If they don't have records of said staffing levels they are cited and must correct the problem. Failure to correct problems leads to withdrawal of accreditation, which leads to no more funding.   There is, of course, no way of ascertain that an RN, for example,  has spent the same amount of time with John Doe as he has spent with Richard Roe. And that includes the rest of the staff as well. Believe me that the miserable, combative resident or one that is totally passive isn't going to get the same attention as the sweet, cooperative, delight to be with resident. Visiting relatives or volunteers can sometimes bring problems to the attention of the staff that they have overlooked. 

It is not as though volunteers or relatives are watching the staff just to catch them in a dereliction of duty but  residents may share problems with these people that they won't share with the staff,  either because they don't want to complain or they can't get their attention. I once interviewed a perfectly rational man who was in a facility recovering from surgery. He wasn't eating and apparently no one noticed or if they did they put it down to lack of appetite.  It wasn't lack of appetite but the fact that he couldn't feed himself because of his position in the bed and the position of the tray. He didn't want to complain and he was going home eventually so he was just going to tough it out. Family and visitors are important as advocates for people who often cannot or won't  advocate for themselves. It isn't all just tourchy, feely, make the resident feel good.

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It's not just the elderly with these types of problems. The profoundly disabled are affected by these types of regulations. My son who is profoundly mentally and physically disabled has to have a mantoux TB test every two years to attend an adult training center during the day. He will fight a needle every time and it will usually take 2-3 people to keep him still. He last had the test in December of last year, at that time the doctor mentioned that they could not restrain him in any way due to regulations.

You are correct in the fact that these facilities get advanced notice of an impending inspection. In my 45 years of working retail grocery I never once heard of a city, county, state or federal health inspector giving advanced notice of an inspection!!!


"Any man who can safely drive a car while kissing a pretty girl, simply isn't giving the kiss the attention it deserves"... Albert Einstein

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