Falls versus Culture Change

[ejpip1]

In trying to be supportive of residents rights and culture change I am having a problem with one of my residents. He is a bilateral amputee who has fallen out of his bed or chair numerous times. He is in a low bed, we have had OT evaluate him and have tried putting his commode lower. WE put a seatbelt on his W/C that he can remove himself. He has 1/2 side rails because he uses them to reposition himself in bed. He has a slide board he utilizes for transfers. Due to a decline his cognitive state has somewhat diminished but is still very able to tell us what he does and does not want. Our doctor ordered bed/chair pressure alarms. WE had tried these in the past but he would remove them. We are trying again but he has asked me to remove them. He states he does not fall but he is. We worked out a compromise that if he can go 30 days without a fall they would be removed and he was agreeable to that. Unfortunately, he continues to fall. Fortunately, despite the many falls he has only ended up with stitches to a nose one time. Does anyone have any suggestions on what I can do with a chronic faller yet keep within him wishes to remain independent?

[catlvr]

As Justus501 said, a schedule might help him; we've used it with some success in our facility. It does take take a lot of staff time and effort (something that just doesn't exist in LTC!) but it is worth it. Since it sounds as if this resident is going to get out of bed no matter what you do anyway, can you angle the chair and bed for the easiest transfer? Sometime we put the bed in the lowest position so that they have an easier fall, but the fall could be prevented by actually enabling them to transfer with without help if we can't get to them in time.

While none of us want someone to be hurt under our watch, it is the resident's right to do what they wish, even if they have dementia. We're guests in their home, and our job is to be supportive. One of our beloved ladies fell and broke her hip about six months ago; she died yesterday. And I can't help but feel glad for her since she was talking about wanting to die for six months before the fall (psych did talk with her; she didn't want to live in a facility but couldn't live alone, so she felt that she had enough of this life).

We're all gonna die, we as a society need to accept that. I view my job as keeping our residents as comfortable and safe as possible, while they do as they wish. And I careplan, to cover myself with the state.