What to do about falls

[AndStand]

DH and I are in a bit of a quandary. We live about a 40 minute drive away from his mother and partner.
His mother (86) and her partner (82) live together in a bungalow. Her partner who I'll call "Bob" is getting increasingly unsteady and falls quite regularly. DH's mum who I'll call "Doreen" is unable to help him to get up as she has her own health problems. Bob literally will just lie there and says that he can't move. He literally cannot even roll over apparently.
So Doreen is having to go to a neighbour to get assistance to get Bob lifted back up.
DH and I called round at the weekend and was told that Bob had fallen twice that morning. The first fall was at 4am when he got up to use the bathroom. Doreen rang 999 and was told that there was a 10 hour wait for an ambulance. So she ended up knocking on neighbour's doors at 4.30am to try to get some help. Two neighbours got him on his feet and back to bed. He got up around 9am and fell over again. Again the neighbours came around and helped.

Our problem is that obviously this can't carry on. The neighbours could end up hurting themselves because Bob is pretty heavy and like a dead weight. Doreen is only recently out of hospital from a broken back and pelvis so has her own problems.

Does anyone have any advice as to where to start? Doreen has tried to get the GP involved but she gives up too quickly if she can't get through on the phone immediately. She doesn't chase anything up, for instance there's meant to be a physiotherapist coming to see Bob but no-one has been in touch yet, and she'll just let that go if nothing happens.

Also, he's had a physio come before but frankly he won't help himself and doesn't do the exercises anyway. He just sits in a chair, and the only exercise he gets is to shuffle to the bathroom using a wheeled frame (which he often won't use).

Where do we start?
Sorry it's so long....I didn't mean to write an essay!!

I would call your local council or age concern and ask about how the carers work and getting an alarm system put in connected to the phone line. They can then wear a button on their wrist or round their neck to pull so any issues they can press it and it will automatically connect to the care line and someone can come out. I had to do it for my dad and it was put in for him for free. I then got him moved into sheltered housing which has more support and helplines so i know hes safe and can call someone out as i cant always come straight away. Put my mind at rest.
I hope you can get some support for them.

Yes local social services for a community alarm. They often have emergency Social services linked to the alarm so they can send people round to get him up.
GP should be able to refer to the Falls service (usually a physio) to look at why he's falling, need for walking aid etc.

Good luck

I used to work in care, and helped an elderly neighbour in a similar position.

Phone their GP or email the surgery on their behalf, and insist on occupational therapy going in. If he can't get to the toilet then he needs a commode urgently, and possibly grab rails for getting in/out of bed, up and down from chairs etc. They were really good sorting stuff out for my Dad recently and it was all done/installed within 3 weeks.

Thanks very much for your replies.

Sorry to dripfeed but I know that they've already been in contact with the Falls Team at the GP's who stated that it was all down to "old age" and recommended a Zimmer (which I'd already bought him) and a toilet frame to aid getting up and down from the loo.
They've already got a commode (due to Doreen's broken pelvis/back episode) so that's covered. They've got grab rails here there and everywhere, but he just won't use them all the time.

I have suggested the community alarm option but Doreen is insisting that it'll be me and DH who'll be the first port of call on that kind of system which isn't really do-able due to the distance we're away from them, and also we can't lift him anyway.
Or are they linked to the emergency services (ie ambulance) because that service is on its knees with its 10 hour response time? Or does someone/other service come to the rescue?

I have suggested the community alarm option but Doreen is insisting that it'll be me and DH who'll be the first port of call on that kind of system which isn't really do-able due to the distance we're away from them, and also we can't lift him anyway.
She's right. My mother had an alarm and DSis and I were regularly called out at 3am when she fell in the night. The alarm system is to get a responsible adult there, not an ambulance. In fact I was furious when mum had a stroke and they insisted on getting hold of me rather than calling 999.
I wish I could tell you some other service would come to the rescue but they don't.

No harm in getting the falls team back out. Especially if he is falling more. I would also be asking the gp for a medication review, falls can often be a side effect of meds, or combination of the meds. Have any been changed at all recently?
I guess you can think about why he is falling. Is it in the dark? In which case can he have automatic light sensors fitted? Is it when he rushes to the toilet? In which case would he consider an urinal? Is he tripping on a rug? In which case can you remove that or any other objects getting in his way?
You say you brought the frame yourselves. Are you sure it is suitable? Set at the correct height, consider the benefits of 2 wheels at the front v's no wheels. Is there enough space to turn using the frame? If he prefers the rails would using them plus a stick be better?
Personally I would be chasing up the physio and falls service.
I think falls sensors work differently in different areas. But here they will contact the nominated number, this could be the neighbours, or indeed yourself. They work well when someone lives alone and they are unable to reach the phone etc.

@YourLittleSecret ah, thanks for that.

It's looking more and more like the sheltered housing option then. Or a care home for Bob. It'd be a shame because the house is fine for him really, but the falling is getting to be far too much for Doreen to cope with.
Thanks everyone, it's very much appreciated.

Definitely not the ambulance service. In my area the community alarm can be linked to SS out of hours carers service if an elderly person has no nearby relatives.
The carers have a portable hoist they can take out to get a person up. The response time is very quick.

If Bob has capacity the decision over sheltered housing / care homes will be up to him. By all means you can try and persuade, but presuming he owns part of the bungalow, that is all you can do unfortunately.

@HarvestFly Definitely not the ambulance service. In my area the community alarm can be linked to SS out of hours carers service if an elderly person has no nearby relatives.
The carers have a portable hoist they can take out to get a person up. The response time is very quick.

This is what I was wondering. I mean what if an elderly person actually has NO relatives, friends or neighbours to call on? There must be some other option for help? A link to a carer's service sounds feasible. I'll have to check that one out....thanks!

We had this conundrum with my brother. He got to the stage where he was falling literally every day. Sometimes he managed to get up himself, sometimes he got up with help, sometimes he injured himself and needed to be taken to hospital to be patched up and sometimes he couldn't get up and we had to wait for an ambulance to get him up. He was referred to the falls clinic and was supposed to do exercises but he didn't really do them. He had a stick and a frame but when he falls he goes over sideways like a skittle so these didn't help.

Eventually he had a bad fall and was admitted to hospital. He's in a care home now and hasn't fallen at all since being there. I think he just needed the extra care.

MIL had a local authority falls alarm, they did have their staff who would come, if they were available. She's been on the floor up to seven hours waiting for someone to come out. The alarm people are very quick if they aren't sitting with someone with a broken hip waiting for an ambulance.

MIL ended up with a care home placement because of falling, it was deemed to be in her best interests because she wasn't safe at home. By then she'd had three years of various investigations to see why she was falling. She had fallen dozens of times by then, fallen an hour after a hospital discharge, fallen in hospital after being admitted for a fall. It was a grim time for the distant family but she wanted to go home so each time she went home and everyone waited for the next phone call. As long as she had the capacity to make that decision her decision was respected, once her undiagnosed dementia was clear to see then someone else could make a better decision on her behalf.

Start with the GP, it could be anything from an ear infection to low blood pressue causing a black out on rising (especially if the falls are after getting out of bed or a chair). It might be something that is a quick and simple fix with a medication review. It would help if your husband had health and welfare PoA or (quicker) your father's permission for him to talk to the doctor because then he can do the pushing and know that it's being done. In the meantime Bob needs a talk about using the walker, when he's run out of goodwill it will be a straight up choice between using it and a ten hour wait on the floor.

Community care alarms are linked back to a call centre, who will call an ambulance if necessary. Some areas (and some ambulance services) have rapid response falls teams but unfortunately most don’t so with the way things are now in the NHS Bob is just going to have to wait.

FIL is a faller - it’s a vicious circle. He’s scared of falling so he just sits in his chair, so has no strength in his feet/ankles/calves, so his balance is crap, so he falls, so he’s scared of falling…. We’ve managed to persuade MIL not to try to lift him and have taught as many techniques as we can for him to help himself get up but in all honesty we’re just waiting for the call that says he’s broken his hip.

If he won’t help himself or your mother I’m afraid this is the way it’s going to be for a while. It’s grim and scary.

Even if the alarm people do call you can tell them you are unavailable in this instance. DH only drinks weekend evenings so a Sunday evening call response was "sorry, I've had wine with my dinner" and they had to call an ambulance. They still tried to convince him to drive for an hour after half a bottle of wine (!) and told him the ambulance would be 9-10 hours. It was actually about an hour.

Dp's dm has a pendant and they send someone to pick her up, she pays for this service.

I should add the pendant service people have carers on call, it's not an ambulance

If he hasn't applied already it sounds as though he would be entitled to Attendance Allowance. That could help to pay for an alarm service.

Has he got those bottles by his bed that men can pee into whilst in bed? Bit grim but we've got 2 elderly relatives who've ended up using them recently as they are preferable to rushing to the loo and falling. You can buy them with lids from Amazon.

It depends where you are in the country a to who it will be linked to OP. Very few link directly to the ambulance service unless they are commissioned to provide the falls pick up service and this varies from one CCG/ICS area to another. The majority will go through to a third party arranged by the local Adult Social Care, although these also vary in terms of quality - some are brilliant and have a team of carers covering the area in a vehicle while others basically just speak on the phone and if the person can't get up they call ambulance anyway, defeating the object.
As others have said, if he has capacity he won't be forced into care/sheltered. I would start with an adult social care referral and a GP referral to ensure he's had a recent OT and physio assessment and a care needs assessment. If your Mum won't do it then you will have to ask his permission and take it up for her.
I appreciate her neighbours are trying to be helpful but unfortunately the system is on its knees and so wherever someone is managing - however badly! - they are generally left to it. Squeaky wheel syndrome is needed here.

My Dad has a button which we got him through the council it activates if he falls and they can speak to the him through the unit which plugs into the phone line to see what has happened.

They will also ring whoever is on their list, but you do not have to attend if you are not near, they will call an ambulance out.

They do call you anytime day or night.

He now has a neighbour who has volunteered to be on the list and is able to pick him up on his own so that has removed a lot of the worry.
And we also have the number of one of the carers who attends and they will go round to see if he is okay but they are not allowed to pick anyone up.

I would get hold of their local council and see about the red button first my Dad pays about £120 a year for his and they come round regularly to check it and they also put in smoke alarms and carbon monoxide alarms and they check them too he also does a check every few weeks by pressing his button and they check everything is good and he likes to chat to the person who answers!

Thanks everyone for your input, I'm very grateful. There's certainly some things that you've suggested that I can follow up with. Thank you.