What should I ask the home after Mum's repeated falls?

[Purplepelican6]

Mum is in a nursing home with dementia,it is quite far advanced .she doesn't know me when I visit or remember me .
She is having a lot of falls
Recently she has had 3 falls in the last two months
Each time she has split the back of her head open .
This is because the home doesn't have carpet,it's a very hard floor .
The home say they can't use carpet for hygiene reasons
They also say she would not manage a walking frame and needs some one walking with her when she moves around .
I've already moved her twice ,from two different homes for different,but dreadful reasons
This home is far superior,and has plenty of staff.
Point of my thread
I'm wondering if I should move her to a home with carpet ,so if she goes fall she's at least not going to split her head open each time .
Or will she be attached to the staff and familiar with the home layout,and that is more important
or not because of dementia .
The home ring me every time she falls ,but they don't seem to have any suggestions how to stop her falling .
What should I be asking for to the home and her social worker

They have said they are finding her difficult to manage ,so I'm kind of expecting them at some point to say she needs more care than they can provide

Unfortunately the price of the home doesn’t always match the quality of care. Although you can’t stop falls, they should be evidencing everything they are doing to minimise the risk.

Unfortunately the price of the home doesn’t always match the quality of care. Although you can’t stop falls, they should be evidencing everything they are doing to minimise the risk.

Sorry thought of another thing- a door alarm to alert staff she is leaving her room? I’ve seen movement monitors put in people’s rooms for additional supervision and also to look for any patterns to try and reduce falls, so that might be worth mentioning.

Is it a registered nursing home? If so they should be able to keep her in there. What your mum is doing is not unusual for a mobile person with dementia. Certainly not the type of behaviour to need anything more specialised. If it is only a residential home she may need to move with CHC funding.

So I'm not even sure if I can move her ..
So she had a fall 6 years ended up in hospital and wasn't allowed home ,and I took over and sold her house and moved her to me and put her in a secure rest home ,as the hospital consultant said that was what she needed ..she was self funding for the next 5 years ,so I was able to move her to the nursing home she's in now ..while I was self funding (or she was ,I just manage the money),she didn't have a social worker... despite asking for one .then a year a go her money ran out ,and the council took over paying,and then we got a social worker
So I don't know if I can move her ,as the council are paying,and I'm thinking they would love to move her to a cheaper home ,and probably one where she would have to share a room and probably still no carpet

I am retired adult services social worker and thought the hard floors had gone out - they were certainly on their way out when I left.

Unfortunately I had to organise care for my late OH and only one of the homes I looked at did not have carpet - and the nursing home he finished up in was carpet all the way - bedrooms, corridors, everywhere. Hard floors are a huge risk with people with dementia who wander.

The staff cannot totally stop your mum wandering about but having hard floor in the bedroom increases the risks as she is not safe even in there.

Carpet does not guarantee no breaks if she fell, but it is better than hard floor.

This is part of the problem. Staff will not be allowed to restrain her from walking about, nor will they be able to provide 1:1 staff at all times. They are not allowed to restrain her in bed or use bed rails. Carpets on the floor won’t make much difference as she’s just as likely to bang her head on a wall or piece of furniture.
Without meaning to sound harsh here, sadly your DM is now very poorly and things will not improve. The priority is to keep her as safe as possible within the constraints permissible, if she’s settled in the home she’s in then that’s most likely the best place for her. Moving her won’t stop the falls, and will likely really unsettle her which in turn is likely to increase the risk of falls.
I have been through this with my grandmother, who only stopped falling once she became totally immobile, with my MIL who fell almost daily but had no awareness of having hurt herself, and my stepfather who couldn’t walk but would still attempt to get up out of his chair and fall over every time. All three of them eventually passed away peacefully in their sleep.

Homes are allowed to use necessary restraint under tight conditions and these need to documented in detail on the individual's risk assessment.

As I said above - we gave permission for the use of a tray fixed to my mother's chair which had 2 results - she did not keep getting up and risking her safety and she also was able to have interesting things accessible on the tray which reduced her desire to get up. We had to sign our permission for this - we had PofA. There are chairs to which trays can be fitted.

In the dementia unit my DF was in they had several residents on 1:1 care due to problems with them wandering and falling. Also one resident on 1:2 care due to violent behaviour. This was in a nursing home with LA funded residents. So it is possible to have the kind of care your DM needs to keep her safe. Insist that they do this.

Thankyou for your message
Yes agree
I'm thinking I will probably make things worse if I was able to move her

I'm not sure she would tolerate that
She's not an easy lady
She needs a padded room ,so when she falls she gets a soft landing..
Mind you she broke her wrist last year ,so maybe a padded landing won't help .
I don't know ,it's worrying

Would you consider/ would she tolerate a helmet?
With the best care in the world elderly wandersom people will fall, even with 1 to 1 care. It becomes more about reducing injury eventually.

Yes, strongly agree with all of this.

The best thing for falls is supervision, so if they current home has lots of staff, do not move her!
Some suggestions-

• If she is supposed to have staff assisting her walk, they need to do this. It won't be possible all the time of course, like when she gets up unnoticed in her room etc, but they should go to her whenever they see her up.
• Sensor mats next to her bed and chair in her room.
• Hip protectors.
• You can get soft helmets, but they are a little undignified, so we only really do that for the very frequent fallers, ie falling every other day. Dementia residents will often pull them off anyway!
• Move her room to closer to the nurse's station.
• Keep her in the common areas during the day for supervision.
• Medication review, some meds may be causing falls and could be rationalised.
• If she's a wanderer, can they try fiddle baskets or something to keep her occupied at the table for rests from the walking.
• How are her shoes? Are they well fitting and supportive?
• Is she rushing to the toilet? Does she need regular toileting?
• Do they do exercise class, maintaining some muscle strength is very important, especially legs.
• if she wears glasses, are they applied, and are they clean?

Hope that helps!

If they’ve tried and it’s proved dangerous that should be recorded. If they’ve done a risk assessment and decided it’s dangerous that should also be recorded.

they can’t just decide she won’t use it and not either do a proper assessment or give it a chance.

We had a row with my FIL’s home because they wanted him to not use a frame because of his falls risk, but he fell backwards. Having the frame actually steadied him. They ended up apologising to MIL because their assumption caused a lot of stress.

My DM, also with dementia, fell many times at her very good care home. I couldn’t blame the home. She was a persistent wanderer, even when very frail, so the only way they could have prevented all falls would have been by tying her to the bed or chair. She was provided with a Zimmer frame, but could never remember to use it.

Someone would have needed to be right beside her 24/7 to stop any falls, which obviously could never happen.

TBH I’ve seen another resident fall when 2 carers were present in the room and only a couple of paces away, each attending to someone else - but he just stood up from his chair and fell immediately.

My DM’s home (a specialist for dementia and purpose built) was carpeted, but that didn’t stop her looking as if she’d done 10 rounds with Mike Tyson after one fall - her face was black and blue almost all over. It looked horrendous! - but she didn’t seem to be in any pain afterwards and of course had no recollection of the incident.

This is excellent advice, unfortunately it's not always possible to stop someone with dementia wandering and can be very distressing for them to try, staff accompanying can work, however I've had backhanders from people who didn't want me there with them, and that of course puts a wobbly person at more risk when they start moving quickly and swinging limbs about. And that's assuming that the staff can be present in every moment with her, 1:1 funding for falls can be really hard to get, and as quickly as staff respond to an alarm, they don't teleport, so there's always a risk present.
And even when present, if a fall occurs, there's certain ways to break someone's fall safely, but grabbing arms or people by the armpits can actually cause injuries to the person and the carer.

The carpets/flooring is an odd one, because every home I've worked in has had hard wearing, easily washed carpets, but although they do help a bit, a carpet won't prevent injury to frail skin, tissue and bones unfortunately.

But checking all of the things in the post I have quoted, and ensuring there's an appropriate risk assessment in place that's being followed is a good starting point.

Unfortunately when people with dementia are mobile, and that mobility starts to decline, there's a period where falls are high risk because they don't remember that their mobility and balance are declining and carry on as normal, it's about the management of the risk of the fall itself, and the protection from injury caused by the falls.

This is all great advice. There’s no evidence that hip protectors work, though, and I haven’t seen them in years.
Im quite shocked at another poster who says her DP has a table fixed in front on their chair. That’s restraint and could only be done if a DoLs and super tight risk assessment has been completed. Again, it’s not something I would ever expect to see even with that done.
Regarding use of a frame, it would be helpful for you to see the assessment and documentation to show why it’s not considered safe, but ultimately i know from experience that introducing something like a frame to someone with advanced dementia is not going to help prevent the falls that happen when they try and walk unsupervised as they will forget to use it.
Are the carers encouraging your mum to walk either them, so closely supervised, regularly? If they do this, ideally with a purpose (let’s go and see your friend Maureen, let’s look out into the garden, whatever would be purposeful for your mum), along with regular toileting, that may help too.

It’s really tricky. My husband’s grandmother lost a lot of capacity after a stroke and is in a care home. She also falls regularly and is currently in hospital with a broken femur. She can’t walk by herself safely but doesn’t remember that she can’t or that she needs to wait for staff, so she gets up and then falls. We’ve discussed with the home some kind of light restraint similar to the tray mentioned previously but the home won’t do it. They won’t restrain their patients even if it means they fall. I’m a bit conflicted about it - on one hand I understand that they can’t restrain patients routinely, but then her constantly falling and injuring herself isn’t sustainable either.

Your mum should receive additional 1-1 care funded by the local authority. No nursing home can provide this from their normal staffing levels so often they then employ additional agency staff to do this. The social worker should be reviewing falls risk and requesting the additional hours as part of your mum's care needs.
Stair gates on every door is organisational abuse and needs to be reported to LA/CQC. The home may be well intentioned but this is a deprivation of liberty for those residents subject to this.
Speak to the social worker.
If nothing moves forward quickly complain to LA and to care home through their complaints procedures.
If home says they can no longer meet need LA should move your mum to a specialist care home which will have higher staffing ratios for their residents. 1-1 may still be needed.

A hat eg bobble hat with double thickness turned up bottom edge -can you buy a rug making sure it’s a neat fit -no corners to trip over.
I don’t see how staff can know when she wants to wander

I would ask that the care home puts a pressure mat on her seat or on the floor that activates when your mum gets up, it alerts the staff and they can get to her before she potentially falls. They dont prevent falls but they are are helpful. Unfortunately, there's no one to one in care homes as they dont have enough staff. Good luck.