Mother in law being confined to hospital bed

[Mrsgg1984]

I was just looking for some advice regarding my mother in law who has middle to end stage Alzheimer's.

She recently had a fall at her previous care home ( that's a different story ) and ended up with a severe hip fracture , two operations later and 6 weeks on she is still in hospital. With physio she is able to walk 10 metres with one person assisting and a Zimmer frame but she is extremely frail due to not eating and drinking much and suffering from dehydration.
When my husband went in to visit last night a younger lady in the same bay as my mil called him over for a quiet word. She told him she had put on a formal complaint with regards to my mil and treatment she was recieving during the night by the nurses. To prevent her from getting out of bed and potentially falling they moved her bed from the back wall and placed it so one side was flush against the ward radiator then placed chairs and tables around the end of bed and other side in an attempt to keep her in the bed. She was literally barricaded in by a wall and furniture. I should also mention both bed rails were up too. The lady said they did this whilst my mil was fast asleep and when she woke up she was upset and confused knocking herself on the radiator.
When The lady spoke to the nurses about this they simply stated it was for her own safety so that she didn't fall. The lady pushed for more answers as felt that it was plain wrong and they eventually moved all the furniture, put the bed back in the original place and had a staff member come in to keep and eye on her instead.
The lady also took photographs of this which we now have in our procession.
My question is for anyone who works in hospitals with dementia patients, is this deemed acceptable to do this for prevention of falls? Surely they could of had someone sit with her in the first place rather than using that as a last resort because a fellow patient complained. I know when I worked in care homes with dementia patients we used bed rails and sensor pads to alert us but even then there was strict guidelines when using these. It's been a long time since my care days and I also know that the wards on hospitals are always short staffed but after the lady complained they somehow managed to find a staff member to keep an eye out.
I feel so upset seeing the photographs of my mil scrunched up in the bed confused why she's pushed up against the radiator and not able to get out. Although I understand that another fall could be very detrimental to her, this isn't the way I feel like it's taking away her dignity like this and causing her distress.
I am so thankful to the patient who reported this and spoke up for her as we would of never known as it only would happen through the night when it was quiet. It makes me think they wouldn't surely get away with doing something like this to someone of sound mind but knew my mil wasn't able to speak up about it 😥
Please tell me I'm not over reacting here .

What if 4/5 of your 10 patients need 1:1 though? Which isn’t unusual in my setting sadly… and we can have funding for extra staff but these spaces are not always able to be filled- even when offering agency rates.
This is the reality of the NHS in many scenarios sadly. @Mrsgg1984 if she is pulling out cannulas and refusing medication, have you considered that she might be better off receiving minimal “comfort” care and not having further active treatment?

@America12 it's not optional. If 1:1 is mandated and the setting does not comply, they are putting the resident in danger and need to refer themselves immediately as a matter of urgency to LA safeguarding. Or, as is more usual, they can wait until there's an "incident" and hope for the best.

OP - MIL is vulnerable and needs you to advocate for her.

Staff do at least have a voice - difficulties with resources and staffing does not justify a breach of a persons rights or dignity.

I have been practicing 24 years and have never resorted to practice such as this .
It makes my blood boil .

@Mrsgg1984 do you have support from an Admiral Nurse? They exist to help and advocate for families of a loved one with dementia.

Snwannabe
Thankyou for your reply.
Yes we actually had a meeting with the doctor in charge of care and we all agreed for minimal care route and doctor agreed to only carry out medical procedures to keep her comfortable but when we went to visit one day shortly after the meeting both her hands were covered in bandages after they attempted cannulation 3 times due to her dehydration and antibiotics as she has leg ulcers on both legs. After we spoke to them again they then said it was time for her to be discharged which I understand as a hospital setting is no good if she isn't having medical treatment.

Ifonly. Thankyou for your reply, it is great to have feedback from people in the profession as I sometimes feel I am overreacting due to having an emotional attachment to it all

Marmaduke no we don't I haven't actually heard of that before

@Mrsgg1984 www.dementiauk.org/get-support/what-is-an-admiral-nurse/

Please ask for an OT assessment ASAP, whatever setting she's in (hospital/care home/at home/anywhere), and a social worker assessment of needs. Everyone is entitled to this by law per the Care Act. You shouldn't have to ask, all this should be offered and arranged automatically with your input but none of your effort. Makes me so, so angry!

Marmaduke she does have a social worker in place who is arranging care plan for discharge. Is that the same thing?

@Mrsgg1984 it is, in terms of what she needs for a safe discharge. Sad to say, they can be hit and miss and the emphasis is always on discharging people out of hospital ASAP (which is of course what everyone wants in an ideal world), and it can be a bamboozling time for families who may not realise what they are agreeing to (through no one's fault, just the pressure of the situation) especially if discharge is home rather than a care setting. What have they said about a discharge destination and care plan? They should be arranging 1:1 care in a setting that is familiar with helping patients in MIL's situation. It may (likely) mean a delay in discharge even though she's medically okay to leave. An Admiral Nurse would be able to liaise with the medical and social care teams to understand the whole picture. My hospital has an Admiral Nurse on site but I don't know about everywhere else. I wish I could help!

Marmaduke in terms of the discharge plan we have been told by doctors and social worker that she needs a general nursing placement but unable to go back to her current home. They give us a list of homes council run to work through and we were told to get back to them with our choice. However I found a private one ( mil is self funded anyways ) after alot of research with an outstanding rating so booked a visit. Had a look round last week and had a meeting with the manager of the home and I had a great feeling when I was there. He was on the ball straight away when it all went through and she was accepted. He came off his annual leave to go to the hospital to visit her, has already ordered crash mats, a high low bed and sensor pad etc. He was lovely and said we will do absolutely everything we can to prevent any further in falls. I know that there is always the risk of her falling but knowing they are putting measures in place to try reduce the makes me feel better as her previous care home never did a thing which resulted in 3 falls in 24 hours and her breaking her hip

Marmaduke and you are helping just by replying so thankyou very much x

I used to be a nurse and whilst this is pretty horrible to have been done to her, it's not uncommon, it may be that a staff member was allocated to her all shift but due to pressure they were required to work on the floor and assist. It's always about staff pressures. Nurses and HCA literally cannot manage to keep every patient with dementia in bed AND deal with the other patients, it's way too hard and not safe for anyone, staff and patients alike.

The technique of pushing her against a radiator is not good at all and I wouldn't have done that, people with dementia have poor pain receptors and don't know to move away from extremely hot/cold things and injure themselves badly simply by not realising the danger or feeling it happen. That's why people with dementia will routinely walk around with fractured limbs from a fall because they can't verbalise it hurts.

When I was a nurse we would take all the falls risk dementia patients beds and put them around the nurses station again it wasn't ideal (and absolutely shocking for patient dignity and privacy, it's shameful!!) but it was 100% done to prevent falls and injuries. A small fall for a frail 70+ person could mean catastrophic head injuries or injuries that would progress to a fatal outcome.

I'm so sorry your MIL was subjected to that it's horrible to think about, however the nurses would of been so happy to have handed over the next shift "no falls last night" and that's what matters to them.

@Mrsgg1984 I'm very reassured by your post about the new setting! I'm sorry, I've been a bit like a bull in a china shop on your thread...! Sorry to other posters too if I've been a bit fierce.

We can't stop every fall, but we can do our very best to reduce every risk.

You're an amazing DIL. I wish all of my patients had a Mrsgg1984 at home

Fromwetome thankyou for your take on things. Yes I do understand completely that nurses priority is to prevent falls whilst doing 101 other jobs at the same time and it must be so frustrating for them. I understand all of that completely and I know that it most likely came from a good place to prevent her from injuring herself but I still can't help feeling angry. It's because I have that emotional attachment. I just keep thinking what if she had burnt herself what if she had fallen on all the furniture surrounding her. She didn't and m greatful for that but if it wasn't for the other patient who spoke up for her, who knows what would of happened 😥

Marmaduke that message really means alot and I am so greatful to you.
I do try my best for her. It's funny really as she was such a difficult woman before this illness took hold. When I first met her she sat me down with a photo album of my hubby and his ex! She would say comments like I much prefer the other one to my husband meaning his ex to me but still she's the grandmother of my children, my husband mother despite all of that and I love her and will do everything I possibly can to ensure the remainder of her life is as comfortable as possible X and please don't appologise , your fierceness simple shows how much care and compassion you have as a person and I am truly greatful to you and to everyone else who has replied to me x

Sounds very familiar from own personal experience! You've got this, you're doing all you can. It's not your fault the health and social care system is the way it is. Keep going xx

From what you have said it seems
like she will need a 1:1 in every setting. I’m not sure how this funding is obtained though. It is v poor practice what the staff did. I would show the photo to the ward manager so she is aware of the poor practice and if staffing issues. You may have to accept without 1:1 care she will likely fall again.

Her being safe would be my main priority

whilst not ideal I’d sooner have them do that than have the call she’s had another fall

Mamaduke thankyou xx

Headstone, yes we have accepted that not all falls are preventable and it's very likely she will have another fall. But this new nursing home she is going to is putting all measures possible in place to at least try prevent her from falling which is reassuring.

Rwalker thanks for your input, her safety is most definately priority but from what others have said in this thread it appears what they did is actually causing more risk to her 😩

Having 4 or 5 confused patients who need 'specialed' has happened many times in my ward. In this situation we usually put them all in the same room. It may mean not specifically 1:1 but we have one staff member in the room with all 4 patients watching them at all times. If they need further assistance with more than one patient at a time, then they buzz to get assistance from another member of staff. Luckily our ward sister is very hands on, and jumps in to lend a hand with this very often.

I work on a care of the elderly ward. Absolutely not acceptable. They shouldn’t even be using bed rails if she’s such a high falls risk, let alone tables and chairs and whatever else. I’m genuinely appalled.

“Bedrails can be dangerous for some patients and it is not always appropriate to use them. Patients who are confused and can mobilise without help can climb over the rail and fall from a greater height. If it seems like a patient may attempt to climb over the bed rails then it is safer not to use them.” (NHS guidance)

On my ward the bay she is in would be ‘tagged’ so that someone is keeping an eye at all times to help prevent further falls if she does get up at night. No matter how short we are, this is a priority as falls can have such huge (sometimes fatal) consequences.

Raise a complaint with the Ward Sister or Matron. We are all short staffed but this not ok and it’s lucky she was not injured. So glad that other patient was looking out for your mum.

But it is not always possible to get the staff. There certainly is a huge shortage where I am.

This is restraint and a deprivation of liberty.

I work with people with LD and it is absolutely not sanctioned

My mother was in a&e last year waiting to be admitted. I went out to make a call after several hours and when I returned the foot end of her trolley was raised to stop her getting out of bed and I had to insist it was lowered

We all have to be vocal about this or it will be allowed to continue