Falls in Care Homes

[peachu]

My 87 year old Mum has been in a care home for just over a year. She has vascular dementia (although not confirmed by scan due to covid). She has language problems but is orientated and knows us.

When she went into the home she had been independent at home but was forgetting how to use money, applicances, phone etc. She was able to walk if a bit wobbly at times.

She has fallen many times in the home and last May fell and broke her leg. Since then she is not able to walk unaided and is generally in a wheelchair but can stand with help.

She falls quite regularly and the care home call us each time. Some times Mum forgets she cant walk and tries to stand on her own and slips to the floor apparently. At least the home thinks this is what happens as most falls are unwitnessed. Last night she rolled out of bed and was fine as she was wrapped in her duvet.

Are there things I should be asking the home when they call me to say Mum has fallen ? Or is falling something that just happens.

My father went into a nursing home two years ago, triggered by a succession of falls at home. He hasn't fallen since. So gut feeling is "that's not right". But my father hasn't got vascular dementia.

Has your mum been reassessed for mobility/had OT assessment/physio? Have the falls been reported to Safeguarding? If not then call your local council safeguarding team (number will be on their website) and tell them your mum is having repeated falls at her care home and you are concerned that she is at risk of harm. This is definitely not right, it’s the home’s responsibility to minimise falls. It is possible they are doing everything reasonable to prevent falls, but if she’s falling a lot I’d want to know what’s going on.

I work in a care home and when someone has repeated falls we start them on 30 minute safety checks. The in the case here where someone is forgetting they can't walk, they also get a pressure mat which sets off the call bell if they get up. After that it's 15 minute checks and if that is still not sufficient then funding would be sought for a 1:1 carer so they would never be alone. Some residents have crashmats next to the bed or wedge pillows. There's also the cot sides but you need a DoLS for that.

This is our process, it might help to know what options there are. The 1:1 funding takes a long time to sort out and there has to be a huge catalogue of falls to evidence the need. The system is terrible really.

This is incredibly difficult to manage in dementia patients. Often they forget the cant walk or that they aren't 20 and cant leap up from a chair or need a stick. Sometimes they arent falling but choosing to sit/lie down on the floor for reasons that make sense to them. A falls risk assessment should take place and measures put in place and reviewed after each fall so this is what to ask about when you are phoned.

Thank you all so much for your very informative posts. We are pretty new to this and I feel like I am running behind trying to catch up! Covid of course has not made things any easier.

I dont think the home is lacking in anyway and Mums life has been made as happy as pssible in the current situation. The love and care she has been given has been second to none and she has flourished in many ways whilst being in the home.

It is very useful to have all of your insights - thank you

I have a visit today and will ask for further info.

In the local authority where I work, falls that are unwitnessed are supposed to be reported as a potential safeguarding concern. Often this won’t make a material difference but it just means social services/the home should be open minded about what could have happened since no one actually saw. We would also check the falls risk assessment and that everything is in place to minimise risk as far as possible.

In some high risk cases I have known 1:1 care to be provided for people who can’t mobilise safely alone, but forget this and keep attempting it then falling.

Some questions to ask would be -
Is she left alone in communal areas? Can staff be present there at all times
If she wishes to stay in her room how frequently is she checked?
What’s in place in terms of sensor mats etc?
Have physio reviewed?

I know it sounds like a stupid question, but is your mum wearing a seatbelt in her wheelchair? Sometimes that resistance is the reminder a person needs that they can't just leap up and run across the room like they used to.

Seatbelts in wheelchairs are a form of restraint and are only used after very careful examination.

Back from visiting Mum. She was happy but very confused and could not really answer direct questions but was happily planning for Christmas and spending it with her dead sister and family on the coast

The home have been reporting all falls. Mum does now have a pressure mat by her bed and chair. She also has a lowered bed and protection if she does fall out of bed. It does sound like they are on top of things. If she is in her own room on her own she is checked every 15 mins and the door is open (if she is happy) with this so regulary checked. She does spend a lot of time doing activities etc so seems to be closely supervised most of the time.

However when I was with her she started to get out of her chair to go and make a "booking" but was persuaded to wait until help arrived.

Again thanks for all your wisdon and knowledge

Glad she is happy and has something to look forward to 😉 it's hard when they are in a different world.

This can be so difficult to manage. My mum, who died last Summer, spent her last 13 years in a care home. It wasn't in the UK so she was in a shared room of 4 but once she started to suffer from dementia she forgot she couldn't walk from the stroke which put her in the home in the first place some years before and was constantly launching herself out of the chair and falling. At one particularly difficult time the home employed a carer whose only job was to watch her and another resident in the home who also had a habit of trying to walk when they couldn't. So that's the level of supervision which is required and it just isn't financially or practically possible in most cases. The staff also took to wheeling her absolutely everywhere with them and still while she was travelling around on a medication round with the nurses they turned for a minute to administer drugs to another patient and she ended up on the floor. I'm not saying this is the case in your mother's home but it really can happen so quickly and be so difficult to prevent. Sometimes people who often haven't been able to do something (like stand up for instance) for months and whom the staff therefore aren't watching like hawks will suddenly stand and take two steps before falling over.

@helpfulperson that made me smile - yes she is looking forward to it

@unfortunateevents the care that our relatives get in the homes is fantastic. What a good idea to keep your Mum with them but also shows how difficult it is.

If she hasn't had a continuing healthcare assessment recently it might be worth asking for one.

A high falls risk requiring a high level of supervision is something that can alongside other factors tip the balance into NHS funded care.

Otherwise though it sounds like they are doing most of the things the should be doing, but it does sound like she possibly needs more supervision than her current funding allows.

Mum is totally self funded so has not had an official CHA.

The continuing healthcare assessment is separate from social services and is to see if someone should be NHS funded, self funders should have this too if appropriate although to be honest the threshold for NHS funding is very high and from what you’ve said it doesn’t sound likely she would meet the criteria, but something to look into and bear in mind for future. If it is awarded people often stay in the same care home but the NHS funds and it is not means tested.

Sounds like they’re doing their best
Probably the only thing remaining is 1:1 supervision, but this would be very expensive for her. Could work if there is a particular time of day she is more agitated and likely to get up.

Financially she might qualify for funded nursing care contribution if she is high risk, an assessment would help.

You could have a look at the Continuing Healthcare checklist (Gov.uk website), but I suspect she wouldn't qualify yet. Very glad to hear the home are managing so well.

I am pretty sure that the current care home does not have NHS funding we did look at one that did but decided on an alternative home. Hmm I will check though and may be something that is needed as the money runs out! My parents saved all their lives and went without all their lives - I guess this is her rainy day.

I will look into assessments.

Thank you again for all your advice it is so useful

In term of the money ‘running out’... when you get within about 3 months of her having £24 500 left that’s when you should contact social services at the council where the care home is located. Once her savings fall below that she is entitled to financial help towards her care. Again this is separate to the NHS continuing care assessment.

In the homes I've worked in we had sensor alarms to alert when a person stands or attempts to stand. Many times it reduced but did not prevent falls. There are the falls mats but they can be a trip hazard. We had a lot of amputees and they would often try to stand and forget they had lost a leg (as they can still 'feel the leg' .

Doesn't apply for your case or people who cannot walk but for those who can and are told to sit down all the time, this can actually increase falls risk and deconditioning loss of balance etc. Those who can't walk but can stand (even with assistance) should do it often as so important to retain the skill for transfers, balance, body mechanics etc.

Usually they are put near the nurse station or somewhere visible but it is not possible to prevent it entirely without 1 to 1 and even then it could still occurr as people get distracted etc.

Cot sides would not be used with someone with confusion or dementia who might attempt to get over the rail (someone above mentioned).

*Those who can't walk but can stand (even with assistance) should do it often as so important to retain the skill for transfers, balance, body mechanics etc (with a staff member or therapist)