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Nationally I understand that guard rails are banned. She is very hard of hearing and suffers from dementia but has no other physical diseases.
I have looked up options on the internet like bolsters and other barriers but hope my fellow travelers on agingcare.com can share what has worked for their loved ones who are facility residents. While we as a family are struggling for answers, one elder care attorney told us that it is the facility’s responsibility to assure safety. What does this actually need?

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Oh my. What a headline. I thought at first you were saying she fell out of the building. I now see you mean the bed? silly me.
My aunt has a very thick floor mat beside her bed provided by hospice. She also has a wider than normal bed that she is in the center of BUT she is bed bound. Your sis may be active and she may be falling when getting up on her own. I have seen beds left very, very low to the floor and less distance to fall but not as convenient for medical staff If she is incontinent. As a rule you have to accept that elders fall. Especially once started to fall it seems they continue to fall. Bed alarms might be helpful for some but very annoying and staff isn’t always able to react quickly. Some spend the day in a wheelchair designed to make it difficult to get up. The bolsters I think would be good as long as it is an accidental fall but a determined elder can get around many barriers. Wishing you luck.
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Countrymouse Feb 2023
😂

God forbid, but what a picture.
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They do make foam matts you can put down at the side of the bed, quite cushions. Short of having someone in the same room 24/7 I have no real good ideas. I am so sorry. You have moved into the world of "not everything can be fixed." I wish you well.
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I have/had the same problem. My Mom is in Memory Care also. My Mom sleepwalks. Therefore. many times she goes to the bathroom and back to bed and has no recollection that she has gone (in addition to the dementia that forgets that she went to the bathroom). Nearly all her falls happen at night after she has gone to bed.

1. I've had to reiterate/train my Mom to pull the cord that is next to her bed before she gets off of her bed. Whenever I hear through the nurses otherwise, I talk to my Mom about it....well, lecture might be a better word.

2. The Floor nurse got a bed monitor. We always stated she was a fall risk since moving into MC. Now that she is more incontinent, it is in their best interests to get to her room ASAP when the bed monitor goes off.

3. Her walker is not close to her. In other words, her walker is further away than 3 or 4 steps. Therefore, she doesn't try to get to her walker to get to the bathroom, which is even further away.

4. I refuse to do xrays after the fall. Their protocol after a fall is to take the person to the emergency room for xray in case there is a concussion. One time, they called the ambulance to take my Mom to the emergency room and my Mom woke up and made a huge fuss (they can't take her without either her or my consent). They called me and I said NO. They told me she could die if she had a head fracture. I told her that at her present state, she would actually prefer that (this is true as she and I discussed it.) I called up my sister-in-law and she took my Mom to get xrays the next day. Because they want to monitor her after a fall, I told them to put her in a wheelchair and wheel her outside of the nurses station where she could be monitored. My Mom finds it easy to sleep in her wheelchair. 95% of the time, she doesn't even remember that she fell overnight and can't understand all the fuss.

5. I do daily exercises with my Mom that strengthens her abs and reminds her brain how to balance. The PT showed us these exercises to help her to gain her strength after a hip fracture, and I have found them extremely important so that she attempts to get up on her bed, instead of rolling off the bed at night. I tell her that she needs to do these so that she can get on and off the toilet. She seems to understand this. But she dislikes the exercises as they are getting harder and harder to do. At my Mom's age, I'm going for exercises that will train her body to behave in a certain way automatically.

6. We lowered her bed by removing the frame (she is under 4'10" now). When she gets out of bed, she can sit on her bed and touch the floor.

I hope this gives you some ideas. Best wishes!
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WearyJean Feb 2023
My husband in MC (with last stage dementia) was taken every week (or more) to the emergency room for every little fall. I asked them to call me first, but they refused to do that. I moved him to a different MC facility, asked his doctor to sign a DNR, and the new MC would always call me when he fell. I would go check him out. He rarely had even a bruise because he usually just slid to the floor.
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take her home and get guard rails
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Geaton777 Feb 2023
It didn't work for my Aunt. She wiggled past all the barriers and fell in her own home, in the middle of the night, and broke her hip on a carpeted floor.
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In rehab, they were able to lower my Dad's bed within 6 inches of the floor and place rubber mat cushions on each side of the bed. It was wonderful. If he climbed out, he couldn't really fall far.
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Sadly this will happen. We bought mom her own bed which we lowered a bit....mom still occasionally falls when getting up..she slids off the bed.. we bought corner bumpers for her side table. We are realistic that at 90 with LBD we realize this is a risk. Would be the same at home. We encourage her to keep her walker right near the bed. She can remember a lot of the time. Staff checks on her also. Like children we can not always protect them from everything. Good Luck..
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Sorry to hear what happened to your sister. If a fall starts, an aid must be right with the resident to stop the fall as it occurs in an instant. Read what others have said about safety mats to cushion falls.

My late mother suffered falls because she had lost her judgment with mental decline at age 92. Always forgot to use her rollater to get to the toilet, even after getting placed in a facility.
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"While we as a family are struggling for answers, one elder care attorney told us that it is the facility’s responsibility to assure safety."

True but impossible. Also, s/he's talking like a lawyer to a prospective client.

My 100-yr old Aunt fell 3 times in her own home, once when her caregiver/niece was standing right next to her. Three falls: 3 broken bones. She suffered from dementia and even though she had limited mobility, she kept forgetting about her limitations. We had an alarm on her when she was seated, we had barriers around her bed. The last time she escaped her bed and broke her hip, on a carpeted floor.

Like others have mentioned, lowering the bed and maybe using cushions. But this doesn't solve her getting up from a chair. Unless the facility has 1:1 staff/resident ratio I think you must have proper expectations of the care.

After my Aunt broke her hip and was in rehab, I was dreading moving her to a permanent facility because I knew her getting up/out was not an easily solved problem. As it happens, she passed in her sleep while at rehab, something I consider a blessing.
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XenaJada Feb 2023
That truly was a blessing!
100 year’s old.
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Remove the bed entirely and just put the mattress on the floor?

Works in Asia.
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Some falls in the elderly are actually caused by bone break from osteoporosis: bone gives way causing person to fall. In this tough situation I agree to get her bed as close to the floor as possible with an alarm on the patient to summon help as soon as possible. And maybe a bedside potty if she can understand how to use it, get herself onto it, etc. We are 'hardwired' to move, so maybe more daytime walking, gentle exercise, to tucker her out to sleep all night, in adult diapers. All the best.
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What everyone said here….plus maybe have a discussion with the facility about this issue?

My mom is a huge fall risk to the point of ideally having eyes on her every waking moment. Her MC has done everything they can , but still she will fall - she’s like a silent ninja that way. Her worst fall happened when the poor caretaker had to use the restroom. Mom probably seemed asleep and then alley-oop! Made a break for it.

Do the prevention with the understanding that falls will happen despite best efforts…sigh…it’s just one of those things .

Good luck!
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My mother (in a nursing facility) was recently put on Hospice care and they provided a bed with rails on both sides. Rules must be different when on hospice. She does not have dementia but has fallen twice in the last couple of weeks and is afraid of falling again. She has CHF (congestive heart failure) and kidney failure and doctor recommended hospice care. Her CT scan also showed a change in white matter in the brain. Her doctor recommended Hospice care and were fortunate to get her on it immediately. She is 92 and does not want to get out of bed for anything. The staff and my family agree she is giving up. She had a stroke in June of 2022 and has been in a nursing facility since.
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My mom has AD and is nearly deaf. She sleeps in her recliner rather than her bed. Not sure if that is option for your mom.
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Make her bed as low as possible, we removed the box spring from mom's bed. Then use a fall protection mat on the floor beside the bed. They are on Amazon. Even when mom fell, she didn't get hurt on that.
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It is impossible for anyone or any facility to "assure safety" which implies that all falls are 100-percent preventable. Falls happen.

It is the facility's responsibility to have staff and processes in place to *prevent* falls, which means they try things like lowering beds, pillows, wedges, and bed alarms, but nothing is foolproof. Again, falls happen.

At 91 and suffering with dementia severe enough to require memory care, talk to her doctor about do-not-treat orders so that she doesn't spend her remaining life in and out of the hospital. Hospitals are especially dangerous for people like your sister who require consistency. She is a high risk for hospital delirium. And studies show that too many patients end up getting an infection in the hospital. If you want to keep your sister safe, keep her out of the hospital.
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Interventions they are using to help prevent falls for my mother are 1) a bed that will lower to only a couple of feet from the floor, 2) cushioned mats on the floor on both sides of the bed, and 3) a matress cover with bolders primarily at the lower half of the bed. She is in a nursing home and so has the prohibition of complete side rails--frustrating for someone who is incapable of standing. If your sister can get up, the bolsters would make it extremely difficult. Best wishes
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My mother, 91 years old, in memory care with dementia, uses a bolster after falling out of bed twice and it works great for her. Not one single falling out of bed incidence in a year. I had to teach her a new way to get into bed from the bottom and staff is available to help. The bolster stays in place perfectly and she feels secure.
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The facility should be offering you options or call Adult Protective Services to visit her at the facility and have that person instruct the Memory Care Director about best practices and the laws in your city/county. If that's not productive, consult with a Elder Law Attorney who can give you the safety laws.

In the hospital, we just push a button and the nurse's aide shows up: it's a great safety feature when paying for health care.
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Hospice gave my mom a bolster pillow type thing that cupped her body in the bed, making falls less likely. There is nothing foolproof to prevent falls, unless your mom is lucid enough to press the button for HELP in going to the bathroom.

Its the MCs responsibility to provide a safe environment for the residents, and 24/7 caregivers to assist them. Not to guarantee falls will never happen which is ludicrous. That lawyer is reaching far w such a statement. And good luck getting APS out to a Memory Care Assisted Living facility bc an Elder fell!!!! My mother fell 95x while in AL and MC, and there was nobody to "blame" but her for refusing to ask for help when she needed it, and then forgetting she was unable to walk ( w dementia).

Falls happen with the elderly no matter what you do. #Truth

Best of luck
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If you really want a rail, there’s a way around the regulation. You can only get it for one side.

If she needs it to pull herself up or to help her turn over in bed, one rail is allowed. We had one returned for Papa because it was the only way he could turn.
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bkoropchak123: Perhaps you should address your sister's fall with the memory care facility. She could use a bolster pillow. Elders DO fall.
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If your facility will not allow the at least 1/2 rails on her bed. You are required to buy seizure crash pads on Amazon however if her room is on concrete like mine they need to be either doubled so when she lands she falls on a gym thick mat. it is the facility staff to allow both the half rails and the seizure matts it is on the staff to watch their steps or any staff falls.

you also can get a medical order for full length bed rails you might have to buy them they start at $79.00 on Amazon. your relative must be checked on every 30 min because of fall risk they accepted her in to their care

Sorry it on your facility to keep her and them safe

houseelf40 retired CNA CMA
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I know where my dad was they put the beds all the way to the floor and matts beside it. They actually do it for all the residence just in case one of the mc patients gets out of the area they are supposed to be in.
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