Mom is 96 and is a right side leaner she has fallen 5 times in 90 days out the bed that’s as low as it can go to the floor. She’s gone to the ER twice with a scare on her forehead but no broken bones (yet).
The Nursing Home says they can’t put up bed rails I’ve asked about cushions bedside on the floor to ease the fall but they said they can’t do that either because it’s against the law. Each time she falls there no way of knowing how long she’s been lying on the cold floor. She’s always be high tolerance for pain and she can’t tell them if she’s hurt.
My fear is that they don’t see any thing wrong external but there will be something internal if she keeps falling on that hard cold floor.
Any suggestions on what they can do?
I guess allowing them to leave the bed doesn't restrict their movements/freedom? But safety is ignored? Perhaps with bedrails up, a patient would climb over it, and that would be a greater fall...I never got a clear answer from the nurses.
However, at one place I was able to get the bed lowered to the floor and they provided a padded mat. His issue was getting up constantly (Parkinsons with dementia). I wonder why your hospital objects to a pad next to the bed?
During one hospitalization (for a week), he fell twice getting out of bed without calling for assistance (he wouldn't know how anyway). In one case he hit his head and needed an MRI (no damage fortunately); in the other case, he severely bruised his hip area, had excruciating pain, and it took months to resolve because of calcifications in the bruised muscle. The hospital had to have a sitter with him all night; and I sat with him during the day to keep him safe.
LTCs tend to err on the side of caution (as it were) because rails are considered a restraint, and restraints, whether physical or chemical, are taboo. It's up to us as family members to insist on them for our loved ones' safety.
PS - I'm in North Carolina. Things may be different where you are.
Anyway, I've posted some of the Medicare guidance in response to others, including a link. For more info, see those. Clearly they don't consider falling out of bed a valid reason for using a bed rail and NHs have to follow Medicare rules/guidance. Some studies have shown that rails and alarms don't see to reduce falls as much as anyone thinks they might. At least one case discussed a woman who DID attempt to climb over the rail and broke her left wrist AND tibia!
I would try some of the other suggested methods (what's wrong with nursing staff that they can't think of or try these suggestions?) If she tends to the right side, have that side against the wall. Wedge up the edges of the mattress or try one of those mattresses that keep you in the middle. I would think pillows or wedges just on the edge of the bed wouldn't help - those can be pushed off the bed easily.
I don't understand them saying the mats are not legal. I certainly WOULD ask for a copy of rules and protocols. Don't point to the mat refusal, just say you're exploring options, and will need to know if any ideas will have to be thrown out per the NH rules/protocols.
Also, many of the things that may seem like they should be allowed (bed rails, floor mats) are hazards themselves. Someone with dementia, or even without dementia, may attempt to get out of bed, be unable to lower the rail and attempt to climb over. The mat on the floor creates an unstable surface that can cause a fall.
Some have mentioned that a 'properly staffed' facility can check on residents often enough to prevent falls. That would require a 24 hour caregiver (with additional caregivers to support breaks) for each resident. The rent would be more than $25,000 per month. Plus, it's an illogical thought. People fall when no one is in the room because they get out of bed when no one is in the room. You could check in on a resident and two minutes later they could decide to get out of bed and fall trying.
Falls will happen. Bed lowered nearly to the floor is the best way to mitigate injury without restricting movement nor creating a hazard.
Climbing over the rail was one of the issues I found during lookup for information. Bad enough to fall, but to fall even farther, or get pitched head first over the rail? States may have laws or guidance, but CMS/Medicare has their own guidance, so in order to stay in good graces (and get paid), NHs do have to "toe the line."
FWIW, the shorter rails CAN be used, generally on one side, but only as an assistive method to allow the patient a way to help roll him/herself over or sit up. Half-rails or something like that. Those won't prevent falls. Other methods must be tried first, per Medicare OR have a iron-clad legit reason, by Medicare rules, for their medical use. Falls don't cut it.
They can put up bed rails. But it is a faff because it involves a great deal of paperwork and training, plus if they do this for your mother they'll have fifteen other families all asking for the same - including some families for whose elders bed rails will not be at all suitable, and then there'll be war.
So they just shrug and say sorry it's the law. And it is the law. But it's only PART of the law. There are other equally important parts that explain when bed rails can be used and how this must be authorised, monitored and documented.
If you Google something like "how to apply for use of bed rails in [your state]" you might get some useful information.
This gives some Medicare guidance on what NHs must do before resorting to rails, and reasoning behind Medicare's statement "CMS’s Interpretative Guidance adds that falls do not constitute a medical symptom that would necessitate bed rail use:"
There may be additional state laws or guidance, but in order to stay in good stead with Medicare (to be approved AND get paid), they have to follow CMS guidelines.
My dad used a low-rise bed with foam mats on the floor when he was in re-hab to prevent injuries if he tried to get out of bed. He was very disoriented when he first arrived there and I noticed he tried to put his finger in the electrical socket on the wall his bed was up against (outlet was mid-way up wall, not down near floor). Re-hab assistants immediately helped to re-position bed against a wall without a socket! Mentioning this because electrical shock or electrocution from outlet high on wall beside a senior or toddler bed can be a hazard!
The bed should be lowered all the way down so it is less apt to cause an injury if the person rolls out of bed.
Bed rails are not permitted as they are considered a restraint or confinement.
Some facilities will use bed alarms or alarms on the floor that will indicate when a person has gotten out of bed. But the bed alarms can be disruptive.
As far as I know mattress on the floor by the bed is not illegal. You might want to ask to see the facilities policy on that. They should have a book that outlines general practices. You could also contact your States Ombudsman and ask what the regulations are in your particular state. (you might even get that with a Google search)
Bed Rails are not illegal. You should speak with the main person of the Nursing Home and let them know that you will be furnishing a bed rail to kero your mom from rolling off the bed.
Tell them you will be happy to sign something to the effect if they need it.
Go Today and buy a bed rail, they have many types that are easy to install. You can even get one that goes under the mattress that is 1/2 the length of the bed and attach it to the side she usually rolls off of or put one on each side or scoot her bed against the wall.
If they don't allow it let them know you will be calling to report it to the news station and it won't make them look good,, allowing a 96 yr old woman continue to fall out of bed on to the floor.
Im sure they'll see it your way.
All else fails, let them know you will be looking for another Nursing Home to move your mom in to.
Prayers
I always wondered why my mother’s bed was on the floor. At home we have rails. But I wish I could lower it to the floor even with the rails she somehow tries to get up and holds the side of the bed yelling help help in the middle of the night because she is unable to stand or walk. But I guess in her mind she can.
If it's against the law due to "strangulation", then why can these places install a "rubber bumper pad" on the side of the beds? I'd check into that if I were you. My husband is in the special needs facility for Alzheimers, and doesn't need any railing yet, but if/when the time comes, I will request some kind of bumper padding instead of railing.