What to do when vascular dementia resident of MC facility doesn’t call for assistance to get up or get to walker and falls?

I doubt this is an issue of negligence. Yes elder care facilities are understaffed, overworked and underpaid , even the expensive ones, but to stop all the falls you’d have to have a one to one ratio of staff to residents.

I went through it with both parents. Even hired a private pay sitter for 4 hours a day. Made no difference. My mom seemed to have a death wish. The staff did everything to keep her from falling. Would wheel her out by the nurses station to keep an eye on her. Look away for two seconds, she would shove herself up and out of her chair and fall, face down. She had several broken bones when she died.

You have to try and mitigate the falls in every way but also accept the fact that for many elders with dementia and mobility issues it’s going to happen.

My mom went into the NH 2 years ago with a rollator. Since she kept trying to get up unassisted, it became part of the risk and was removed. They got her a wheelchair with sensors on it if she tried to get up, and they moved this sensor pad to her bed when she lay down. The bed was also lowered close to the floor, and pads (cushy like yoga mats) were put on both sides of the bed. Over a few months she lost all mobility, and now her falls are very few, just sliding out of bed onto the floor without injury. And even these slips have to be reported to me under the protocol for falls (These calls are not to force you to pay for extra care.). All these aids were available at the nursing home, and this place does take Medicaid. I'm amazed to hear a private-pay place says they can't supply them.

My mom was stubborn (with dementia) and refused physical therapy, so she lost the strength to walk or even stand fairly fast. Once I admitted to myself that she couldn't walk any more, I got her changed to a more comfy wheelchair for sitting all day: a broda chair. It can tilt back for resting or be upright for eating, and it has extra padding on the seat as well. All this was supplied to us.

Any facility that can't supply such common aids should be pushed, and if they resist, they should let you get such aids exclusively for your LO. No one can guarantee fall prevention, but I feel I need to do everything possible to minimize fall injury and pain. Better to not walk at all than to break a hip, believe me!

Mother's one stay in a low-quality NH resulted in her sliding out of her wheelchair several times--she refused to get into the bed! She finally did get in the bed and promptly slid out of that, repeatedly. Just slumped over and slid out of the bed.

It was partially her 'pitching a fit' in the only way she had possible and also a wake up call to us kids that this place was sub-par. They were seriously understaffed, but mother had CHOSEN it, against my knowledge that it was a bad place.

My OS swooped in and said "what's the cost difference between the 'concierge' type rehab and this place?" It was $25. Sis made a couple of calls and had mom moved in 4 hours. Sis paid the difference for the remaining 8 weeks of recovery. (Hip replacement).

Sadly, it's often money that makes the difference. Mom simply didn't have the $2K that it cost to break one contract and pay for the other one. Sis is awesome on solving problems when she can throw money at it.

It is often VERY HARD for elders with diminished capacity to remember to push the call button. It's hard for someone like me who has most of their marbles to remember to do so.

Having the same issues. Mom lost a lot of mobility after a 2 wk hospital stay and is still working with PT to get it back. We just cut back from 24/7 extra caregivers to night only. During the day they keep her in common room so there are eyes on her, because she's feeling stronger,, and is now getting up more,, but she is still unsteady and considered a fall risk if unattended.. But I know once we stop the evening one, I'm going to get a call. Its inevitable. One of the reasons I haven't asked to stop yet, is I refuse to spend Christmas in the hospital or ER. Multiple time there's be a fall she's managed to hit her head, which triggers she needs ER/Dr Xray to get checked out.
. But you are right its not sustainable long term. We are paying someone 28/hr on top of regular cost of MC, to stay from 7 pm to 7am, when she getting ready from bed or watching TV in her room in the evening. The MC checks on them several times a night and if awake will help them to bathroom, but doesn't wake if sleeping. The night staff has less people, not sure how many.

I asked about bed alarms or mat floor alarms and they don't do that; they said they only had ever done that with a matt outside a unit to alert for a wanderer who was going into the wrong room at night. My main worry was her getting up groggy from sleep and falling, she tends to get up and go, without getting her bearing first. I thought an alarm might check her and allow the staff to know she was up, but I guess they are worried that would wake others.

They offered a fall mat by the bed. Of course that would help if she rolled out of bed, but could be a tripping hazard if she got up.

Told them if she transfers to a regular chair to put the walker in front of her, but knowing her, she would probably just move it out of the way since she doesn't remember she needs help right now.

If she were truly going to be wheelchair bound going forward and not working on mobility, and further along in her dementia I'd consider a recliner wheelchair she couldn't get up from. But even now when she can't get up she is apparently moving the wheelchair around with her feet effectively so I don't want to take that away from her, either.

I don't know the answer, but my mom managed to fall even with the 24/7 caregivers.... caregiver went back to room to fetch something while mom was engaged with watching activity, and my mom got up and fell as soon as she left, she was ok, but really there is probably no foolproof way.

Unfortunately it is very hard to stop ALL falls. It becomes about minimising the likelihood of a fall & the severity. There will never be enough staff for 1:1 for each person but different strategies can be used using furniture, supervision & behaviour modification. Restraints are no longer used but floor lowered beds may be - against one wall. Supervision in bathrooms & sitting rooms. Behaviour charts.

Getting feedback from family & getting to know regular habits & routines is very iseful. Eg Bob was a farmer, wakes very early & wants to be active - so he is scheduled for early shower (& early to bed). Daisy gets very agitated looking for her children in late afternoon, but likes to walk in the garden with staff at this time. Tom needs to be engaged in an activity throughout the morning as he bores easily & otherwise will try to wander. June will try to get our of her wheelchair if she needs the toilet - but a regular toileting schedule helps reduce this.

I am sorry there is no easy solution to this problem.

The facilities I looked at had cords to pull by the toilet. I am not sure about buttons. I was looking at assisted living. I am not sure how different memory care was.

What does his facility have? Have you asked?

My friend’s mom who is in a NH still falls while in a wheelchair.

She thought that she would stop falling after being in a wheelchair. Nope, she tries to get out of bed and falls.

Her mom has ALZ and forgets that she can’t walk.

There comes a point when walking no longer works. Perhaps it's time for a wheelchair. One of these times he'll get hurt badly.

It's very much normal. If he needs to be in Memory Care you can't really expect him to remember to use a walker. Old people fall. There's nothing you can do to stop them. It's a part of life.