Dementia Patient Frequent Faller

[michael79]

I have a resident that is falling every time I turn around. He has a very mild amount of dementia, but is otherwise very sharp. HE JUST WON"T LISTEN!!!! We have asked him not to use his walker unless PT or a CNA is with him. He gets up and tries to walk around without it all the time. The family is mad and thinks we aren't taking care of him. We have him on hourly safety checks, keep him in the common areas, and toilet him q2h. We still find him in the floor. Any other ideas? I am beginning to think that he needs skilled care. We are an ALF and can't provide constant oversight.

[SuesquatchRN, BSN, RN]

You need to get an order for a Posey belt or a geri-chair. If your doc will write one.

[achot chavi]

I think you need to sit with an interdisciplinary team of nurses, docs, SW, PT and whoever else you got and invite the family for a frank discussion about this patients future. One serious fall and he could break a hip. Perhaps he DOES need more than an ALF can provide unless the family is willing to provide constant supervision- either themselves or a private aide. Does your facility require them to sign any waiver to exempt you from legal responsibility for his falling?

You might need other monitoring devices if he is to stay in your facility. A wrist call bell if he falls and no one is near by, a bed alarm, etc.

Good Luck

[michael79]

We can't have restraints in ALF...thanks though! Any other ideas?

[SuesquatchRN, BSN, RN]

We can't have restraints in ALF...thanks though! Any other ideas?

What achot chavi said.

Ask the family if they can pay for a sitter, one on one.

[jnrsmommy]

Other than suggesting to the family that they get someone to stay w/ him. I feel for you on this, I really do. We had a LOL that was like that too. Family was in denial, "she's always with it" "you guys aren't checking in on her." We had her on fall precautions, which were d/c'd b/c the family didn't want them, "the alarm makes too much noise for her at night". Umm, hello, that means she's getting up when she's not supposed to. After the alarm was d/c'd, I had her on q1 checks at night. Family became upset because she was not getting enough sleep. Sheesh. Only after she fell for the 4th time in 24hrs and looked like she went a few rounds w/ Mike Tyson and was in the hospital being evaluated, did the facility refuse to take her back unless she had 24hr sitter. She didn't come back, and I often wonder how she's doing.

Oh, and a state surveyer told me one time, "they have the right to fall." Uh huh, and I have the right to do everything in my power to make sure they are safe and protect my license.

[lpnflorida]

I am sure you realize it is not that your client is not listening, more to the point he may not be retaining information.

It is so sad when someone goes from being independent, to semi independent, then reaches the stage of needing more. I agree with the getting the team together. The assisted living setting is no longer meeting the needs of the client through no fault of the facility. The client simply needs more. Great if the family can afford round the care private duty, most can't. Skilled nursing home placement most likely is the only option.

[VivaLasViejas, ASN, RN]

This gentleman indeed does no longer appear to be appropriate for ALF. But before anyone jumps the gun, you need to have him evaluated by PT and OT and get some therapies done and the right equipment in place while he is still in your facility. His meds also need to be reviewed thoroughly (preferably by a pharmacist and/or MD as well as yourself) and his physical and mental status assessed by his primary care provider.

The reason for all this is, of course, to assure that the resident receives the appropriate level of care, AND to cover your keister (as well as the facility's) when the State comes in wanting to know what you did to prevent a move-out. I've been through this in several different ALFs, and you have to show that you have explored all avenues to keep him in place before even considering the issuance of a move-out notice. So get him to his PCP, do a medication review, ask for PT/OT orders, and of course, document, document, document!

[makes needs known]

Have you tried a seatbelt alarm? Maybe the loud alarm going off when he unhooks it would remind him not to get up without assist. Is he ambulated? Does the staff walk with him frequently enough to help him burn off some steam? Have you tried giving him something to do to keep him busy? Why is he getting up?

[VivaLasViejas, ASN, RN]

Unless the rules about restraints and alarms are very different in the OP's state than the one where I live and work, these "reminders" are not OK in assisted living. Even in LTC, a seatbelt alarm requires a thorough nursing assessment, a physician's order, and proper documentation, none of which are easily obtained in the ALF setting. Many ALF nurses are in the building only 2-3 days per week, and most caregivers are not certified as nursing assistants, so good documentation is almost always an issue in these facilities. Not to mention the fact that staffing is bare-bones minimum, so observation in the form of hourly safety checks is a great idea in theory---it just doesn't work in practice.

OTOH, it would be a good idea to find out what he likes to do and provide appropriate activities; this should have been part of his admission assessment anyway. So many residents who demonstrate "behaviors", or who seemingly "don't listen" to staff instructions to ask for assistance when they need it, are simply bored out of their skulls and need a project to work on!

I was the DNS in a community where lived a fairly demented fellow who kept banging on doors, all day and half the night, which drove the other residents crazy. Turned out he had been a door-to-door salesman in his younger days, hence the knocking, and once we figured out how to help him by allowing him to make periodic "sales presentations" to staff and volunteers, the disturbances occurred less often.

[achot chavi]

OTOH, it would be a good idea to find out what he likes to do and provide appropriate activities; this should have been part of his admission assessment anyway. So many residents who demonstrate "behaviors", or who seemingly "don't listen" to staff instructions to ask for assistance when they need it, are simply bored out of their skulls and need a project to work on!

I was the DNS in a community where lived a fairly demented fellow who kept banging on doors, all day and half the night, which drove the other residents crazy. Turned out he had been a door-to-door salesman in his younger days, hence the knocking, and once we figured out how to help him by allowing him to make periodic "sales presentations" to staff and volunteers, the disturbances occurred less often.

Thats Great- I had such a patient but it turns out she was a hooker(not making this up) - any ideas to help her? :chuckle:

[VivaLasViejas, ASN, RN]

I can think of a few.........but they wouldn't be appropriate for this forum, that's for sure!