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Discussion

Let's not try to make them invalids or keep them invalids

In one facility where I worked they talked about, "the right to fall," and one patient who refused to get help with walking kept on falling all the time. They did not force her to do anything she didn't want to do even though she kept falling and even when she had dementia. She would not listen to reason.

On the other side of things, there are old people who are as sharp as a tack and who can think for themselves who live alone who are at risk for falls. They have been given walkers, canes and other safety equipment they won't use. They understand the risks of not using their equipment just the same as we do.

The ideal plan is to get these people who fall to agree on some sort of compromise. Of course you don't want them to get hurt and go off to the hospital.

What bothers me is when people think they should push someone who can think for themselves to stay on a walker or a cane when they can walk well (and stand up strait) without them and when they have a keen understanding of the risks of not using them. When someone has dizzy spells, a walker has limited value and they can still fall. When patients are oriented they have the right to decide not to us their equipment.

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    This is an entirely new perspective for me. It seems odd because I am a huge patient advocate, but had never even considered this from a patient rights standpoint. Thanks so much for introducing it.

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    What we do is assess fall risk, teach our pts, and document refusals (bed alarms, equipment, and fall precautions). You can't force compliance but you can CYA. This also includes documenting teaching.

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    If living in a NH, these are pretty much Resident rights but we are still responsible for the falls, even after the Resident signs the negociated risk forms continually and the family is okay with it all, we are still responsible and have to come up with some sort of intervention after each and every fall. Quite honestly, coming up with a new intervention is getting to be impossible to do for some Residents because of the constant falls, monitoring closely, and the spouse/family are totally fine with whatever happens so as to retain this Residents dignity. In situations like this, it can be a real headache coming up with something for the careplan and sometimes wish there were some sort way we could just chart it and let the physician and family know about it without all the added documentation and follow up assessments unless an injury incurred. I know that's not a realistic requist though. Teaching the demented can be a loosing battle so we must be aware of everything at all times (as best we can, that is). Doncumenting is so important.

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    For patients who are at home with no supervision for some parts of the day, who have dizzy spells, I think there are times when canes and walkers would not really be enough to protect them. I think it might save their dignity if their surroundings are set up with safe places to sit down that would be at a close distance when they feel weak.

    This would be more dignified than just classifying them as old people who shouldn't walk without equipment.

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    That's an excellent point! We have those rails in the hall to assist ambulation, but on some units a chair placed every ten feet would be realistic and helpful for the patients. You could even have a fold down seat built right into the wall, and it wouldn't be all that expensive.

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