My 91 year old dad has Parkinson's and dementia and is in hospice. We are currently caring for him at home with a live-in caregiver. But things are getting more and more difficult and we are looking into transferring him to a nursing home. He has been bedridden since being released from the hospital in late August. Hospice has supplied a bed with full rails but he tries to get out of bed a few times a day. He can get his knees over the rail but then wears himself out. He does not remember that his legs can't hold him. We have applied to a nursing home with really good ratings and recommendations, but they do not use full bed rails or alarms because they are considered restraints. I have read that more and more nursing homes are moving away from restraints. The good news is that the nursing home will have the ability to get him out of bed and into a chair. Should we be worried about the lack of restraints?
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(210 ILCS 45/2-106) (from Ch. 111 1/2, par. 4152-106)
Sec. 2-106. (a) For purposes of this Act, (i) a physical restraint is any manual method or physical or mechanical device, material, or equipment attached or adjacent to a resident's body that the resident cannot remove easily and restricts freedom of movement or normal access to one's body. Devices used for positioning, including but not limited to bed rails, gait belts, and cushions, shall not be considered to be restraints for purposes of this Section; (ii) a chemical restraint is any drug used for discipline or convenience and not required to treat medical symptoms. The Department shall by rule, designate certain devices as restraints, including at least all those devices which have been determined to be restraints by the United States Department of Health and Human Services in interpretive guidelines issued for the purposes of administering Titles XVIII and XIX of the Social Security Act.
(b) Neither restraints nor confinements shall be employed for the purpose of punishment or for the convenience of any facility personnel. No restraints or confinements shall be employed except as ordered by a physician who documents the need for such restraints or confinements in the resident's clinical record.
(c) A restraint may be used only with the informed consent of the resident, the resident's guardian, or other authorized representative. A restraint may be used only for specific periods, if it is the least restrictive means necessary to attain and maintain the resident's highest practicable physical, mental or psychosocial well-being, including brief periods of time to provide necessary life-saving treatment. A restraint may be used only after consultation with appropriate health professionals, such as occupational or physical therapists, and a trial of less restrictive measures has led to the determination that the use of less restrictive measures would not attain or maintain the resident's highest practicable physical, mental or psychosocial well-being. However, if the resident needs emergency care, restraints may be used for brief periods to permit medical treatment to proceed unless the facility has notice that the resident has previously made a valid refusal of the treatment in question.
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What you'd need to find out next is how the NH goes about the correct procedure 😕
The whole bureaucratic can of worms will have a formal, legal label in your state/county. In the UK it is referred to as "Deprivation of Liberty Safeguards," or DoLS for short; but every jurisdiction has its equivalent. Try Googling "legal use of restraints in [name of state] Nursing Homes" and see what you can find out. Then it will be a question of working with the NH to make sure they have this all set up before your father is admitted.
It goes roughly like this:
1. Risk identified and assessed.
2. Solution devised, deprivation of liberty identified.
3. Formal application for "DoL" made to safeguarding authority.
4. Permission granted by authority, with conditions. Or refused, if they don't agree that the proposed solution meets requirements. The solution must be:
- in the person's best interests
- necessary
- proportionate
- kept under review
Or find a night stand or something and place it as close to bed as possible.
and go to home depot or lowes and find pipe insulators. or pool noodles and cut and place on bed rails. use duct tape to hold insulators in place (not dad)if you feel it is necessary.
pipe insulation is pretty cheap and so are pool noodles. pool noodles has colors, so it may be prettier to look at.
In some states a restraint is anything that could prevent a patient out of or off of whatever they are on/in ie chair, bed . If fact in some states or large cities
geri-chairs are considered a restraint if they are even used, in others only if it is reclined, and still others any use is o.k.
Also, the rooms have motion sensors so if the staff detects unusual movement in her room at night an aid is sent to check it out.
The staff tried to help her but, it wasn't to be. She didn't want anyone to bother and refused all help. In a way, I am glad she didn't have to hurt any more and definitely didn't have to go thru this Covid mess.
That is about the only legitimate way to get permission for them anymore.
She BEGGED me to buy her guardrails and I kind of fought her on them-they seemed more dangerous, but I hit Amazon and the next am there they were (am I the only person who feels slightly creeped out that you can order something and get it before you even have time to regret your purchase?)
ANYHOW-the rails came, I went right up and installed them. That night she slid down in between the rails and the bed and was stuck.
Rails came down less than 24 hours after they were installed.
We took her bedskirt off (not an issue in NH's) and lowered her bed as far as possible and had her PT work with her specifically on safely getting up. IF she 'fell' it was more of a gentle slide to the ground. We didn't use pads, there was no room.
If she were on a mattress on the floor---not one of us 'kids' could deal with her care...we're 57-66 yo and sore knees and backs won't allow that.
If he is already on Hospice Care, if at all possible, you should continue with the Live In until he dies.
No matter how great a Nursing Home seems to you, your Dad will probably be miserable, depressed, scared and sad.
My Grandmother lasted 1 month.
If it were my Dad, I would continue letting him stay where he is, where he will be the safest.
Also, determine if the facility is using chemical restraints as in heavy sedatives. Not a good solution ever.
I work in a nursing home in PT rehab and hope my post will be helpful.
About full length bedrails, they are not used in nursing homes due to evidence of increased deaths and entrapments associated with their use. This is a very real danger. About alarms, evidence has been that they do not effectively reduce falls. Hard to believe, but true.
Restraining nursing home residents is not allowed unless deemed medically necessary and then only with doctor's orders. Many facilities are going "restraint free" so what you are encountering is not unusual. That said, there are other ways to increase safety if someone were to attempt getting up (some of which may require doctor's orders):
-- low bed near floor
-- padded mats at bedside
-- scoop mattresses with built up sides
-- moving the resident's room closer to the nurse's station
-- out-of-bed schedule that gives the patient position changes and allows for social interaction
-- activities to address restlessness and boredom
-- medical management and nursing interventions that will address restless associated with pain and discomfort
You should have this conversation with any facility you are considering and do independent checking of their safety record. Every facility has a yearly survey and rating from the Centers for Medicare and Medicare Services (CMS) that is available online. Each facility is required to display and make available their yearly survey. You can ask to see it.
Unfortunately, there is never a completely fool-proof method of preventing falls, especially as one's physical and cognitive impairments decrease their safety.
It's not an easy decision to make, but many families find that caring for a loved one with an advanced degenerative medical condition is more than they are equipped to handle. Best of luck in your search for placement of your father!
I don't like restrints or full rails because going over them is 😥.
If there is an iv, feeding tube , catheter then weigh risk / benefits
if assisted most states won’t allow
if memory care they do
The biggest problem was
climbing OVER the rails & then falling.
Floor-lowered beds are used instead. Often placed against one wall with a 'crash mat' on other side.
I'd look at that. Hospice hopefully can provide this bed type.
I know that hearing about a fall after-the-fact doesnt ease worries about falls and injuries, but it does give you a way to monitor safety.
Ask about their falls and injury reports to get an idea of their safety record. You certainly don't want to see a high number of falls and injuries, but you also dont want to see absolute zero. If it's 0, most likely they are doctoring their stats, because unfortunately, falls arent 100% preventable without restraints.
My dad has fallen out of bed at most rehabs he's been in. Luckily, he never got hurt. He tends to fall more in placement than he does at home. THe plan to fix things for him is usually to put the bed down as low as it can go and put mats on the floor when in bed.