Care Home Fall

@comeagainx I was thinking one more like this.
If you pull someone up using this and their knees where not properly in the supports then you absolutely could break kneecaps. The knee supports are solid and if you're being forced into them as you stood up....

It's still negligent care as the carers role is to ensure that the client is positioned properly.

https://glebehealthcare.co.uk/products/oxford-journey-stand-aid-hoist?gclid=Cj0KCQiA2eKtBhDcARIsAEGTG43CjJdbB2rcehVluV0v3LaTFNTyJY1EWB8aCz-PB0ypvqWf0PDuasaAp1yEALww_wcB

you can't fall backwards out of a stand aid. I'm taking the mechanical hoist type stand aid

A hoist is normally referred to as a hoist not "a stand aid". I thought you meant an actual stand aid - like a Sara Stedy or similar - like this:

https://www.arjo.com/en-gb/products/patient-handling/standing-and-raising-aid/sara-stedy/

I still don't think you could break both knee caps together on a hoist. If the patient doesn't assist, normally what will happen is the sling/attachment will slide up under their armpits and give them injury there rather than a fall forward with such force to break knee caps - that's a lot of force.

@comeagainx you can't fall backwards out of a stand aid. I'm taking the mechanical hoist type stand aid and it absolutely would be possible to fall forwards and bash your knees hard against the supports if you were not supported correctly.
Although I would also expect other injuries to either face or arms if that occurred.
Mechanical stand aids have always been 1-1 operated. I've worked in care for more than 15 years and they have always been so.

Where I worked the nurses would dress and pack the wounds. Does she have a body chart documenting all bed sores? Also, are they providing pressure relief when she is on the chair and through the night?

Pressure mattress and cushions (probably the constant inflating/deflating type) and frequent repositioning, brisk all-over massage when doing the morning and evening wash to help the circulation so no more develop, and regular dressing of existing ones.

The bedsores should be assessed and graded by DNs who then will provide the correct dressings and packing ( if wound was deep)
She then should be repositioned regularly (2-4) hrs to help the sores heal.

Thankyou so much for your reply I am waiting for word from the manager who only works weekdays and this seems to be happening weekends overnight. Half the staff don't speak English very well so that's another worry and I believe bank staff are employed quite often so no continuity of care either. But I will be looking into a new place. Thanks again

@carerneedshelp
I'm now thinking there is potential for that injury with a stand aid if she failed to take any weight herself and fell forwards against the knee restraint.

I don't agree @carerneedshelp because a) the knee pads are more 'shin pads' and very padded b) you'd struggle to make bilateral full contact on the knee/shin pads even if you tried - if your legs totally gave way, you'd go down either totally vertical or down and slightly back - probably land on the edge of the chair/bed you were standing from. If you were mid stand and fell forwards your upper body which has more weight would mean you were 'caught' by the bar and again your knees wouldn't contact the pads beecause they'd move back.

AND no one should be using a stand aid alone which means if even one carer is there a bilateral break of both patellas on a stand aid is extremely unlikely.

@Fruitbat1954
Hi my mother in law is in a home and has had three falls in 5 weeks, thankfully nothing serious but very bruised also, the carer involved with the first fall has been sacked which is very worrying. Should I be taking further action with this home.

Yes ABSOLUTELY raise this. You want full accounts of what happened each time and why.

I would 100% because falls are highly dangerous in the elderly. Falls lead to breaks particularly hip fractures which lead to hospital admission and death. She's lucky she's not broken anything.

3 falls in 5 weeks is nearly one a week which is much too high. No one properly cared for should be falling like that so it is indicative of a serious problem.

either

the home is unsafe (loose carpets, trip hazards)

the staffing level is inadequate

the staff are not properly trained in moving and handling

your mother's mobility ability has been underestimated and she is treated as not needing moving support when she needs one carer, or she is being treated as suitable for one on one when she needs two on one.

or your mother does not have adequate supervision/equipment for someone with her physical ability and cognition (eg. bed with bed rails if required, seat with falls alarm seat pad so if she tries to stand alone when she cannot an alarm sounds immediately). Some people may need one on one care which is hard to achieve in residential care unless you have the funds to pay for an extra external carer to be with her all day.

To be blunt with that fall rate, she'll end up in hospital and dead very quickly so you need to address it quickly. Unless there is a very good explanation for the pattern AND they can show it has been addressed, I would be thinking of finding another home to be honest.

Hi my mother in law is in a home and has had three falls in 5 weeks, thankfully nothing serious but very bruised also, the carer involved with the first fall has been sacked which is very worrying. Should I be taking further action with this home.

your partner or sister could ask to read her care plan and the risk assessment (held by care home), the existing documents will state what staff ratio, equipment and moving techniques should be utilised for individuals. The hospital will be able advise on updates to document in relation to ratios, equipment and moving techniques. You could enquire about training undertaken by staff. Enquire about what happened during the incident and how they intend to prevent another fall. Ask to view incident log.

I'm now thinking there is potential for that injury with a stand aid if she failed to take any weight herself and fell forwards against the knee restraint. Or the knee restraint was used incorrectly....

With regard your original question about staffing numbers for transfer - if she was able to weight bare then she would most likely have been a 1-1 transfer.
If she needed hoisting then it would be usual to have 2-1 for transfers unless the hoists are ceiling tracked. Then they could potentially be a 1-1.
If she required use of a stand aid that could also be a 1-1 transfer.

I would agree with PP that it does sound an odd injury for a fall during a transfer. It sounds more like she has fallen forwards or against something...
I'd want a full explanation of how it happened and who was present. It may be simply she's tried to get up unassisted and has fallen forwards. Which sometimes is unavoidable with people who forget they can't do things and struggle to follow instructions.

But an odd injury and the presence of bed sores would make me concerned about her care. Both could be innocent but I'd want to be sure.

Does she have any known bone density issues? Osteoporosis for example?

I agree with Comeagainx. I have worked with elderly people for over 34 years and never seen anyone with bilateral fractured kneecaps. She would have had to fall awkwardly and heavily and have quite poor bone density. I would want to know how many carers there were at the time and if they were experienced in assisting her specific transfer.

I agree with a PP, very unusual injuries for a fall where she was being supported to transfer. The home should have raised a Safeguarding with the local authority. If they haven't, you can do this. Include your concerns about pressure sores too. A social worker will then start an enquiry into what happened and check to ensure everything was as it should be.

I'd be very surprised if she was being transfered by someone - even one person - who knew what they were doing that she'd break both knee caps.

Sounds like a very heavy fall forwards landing on both knees.

If you are being moved safely by one person who is holding you correctly, even if you fall, there is no real way you could land like that because a trained person would be able to control how you fell to a degree so you'd be looking at one sided injury. It's not impossible that it could happen but just unlikely. If there were two people it's very very unlikely to have an injury of that severity on both sides.

I'd guess it's more likely that she fell because she was unattended (Slid forwards off chair trying to get up).

I'd want an investigation and full report although it may not matter now.

In terms of how many people she needs to move her that depends on her mobility, stability and weight. Anyone who is unsteady is likley to need 2 people. Think of it this way - would you feel safe to assist her to move safely yourself alone - if not, likely needs 2 people.

I'm sorry she went through this.

Ex nurse here. Yes the pressure sores are big red flags of poor care.

If she was able to walk from bed to chair preciously then it's likely to have been 1 carer doing bedtime, but as PP have said you really need to ask the home because care plans are individual.

If she was largely immobile she should have had pressure relieving cushions - gel or air in the chairs and possibly an air mattress. But again you'd need to check the care plan.

I would ask for a copy of her falls risk assessment, mobility risk assessment and the related care plans.
You should find all the information on there.
i do hope she recovers as smoothly as possible.

Does MIL have district nurse intervention?
With bed sores she most definitely should.

I'd imagine if she is not mobile she would spend a lot of time on the bed? If so, she should be repositioned 2 hourly via slide sheet, if she can't move her self,
But if DNs are involved in her care, they should have instructed on pressure relief.
As stated above she should have 2-1 carers for transfers,
Is she using a stand aid for transfers or does she need fill hositing?
If you see any drag lifting ( hands under MILs arms) this should be reported.

I was a senior carer for 6 years before I got ill so feel free to ask any questions.

Do you know if she is able to transfer with 1 or 2 staff? None of us will know that. Some people can't walk far so will use a wheelchair, but will be able to transfer from chair to bed etc.
If she has pressure areas that could be indicative of poor care. Do you know what hrade they are and how many?