Prevention of Falling Out of Bed

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My 89 year old Mum has been in a care home for 2 years. She has deteriorated a lot in this time. She has dementia, can no longer walk or stand, is incontinent is very confused and hard to understand.

She has fallen out of a bed a few times and the care home now lowers her bed and put a mattress on the side that she falls out.

However she has now fallen out of the other side of her bed. She has a massive wound on her head and also her knee burst open.

She has been in hospital since yesterday morning waiting for a GA so they can wash out and stich up her knee as the wound is down to the bone.

She spent 36 hours in A&E no food or drink and was then moved to EAU where she now waits hopefully for surgery today. She is now on fluids but totally confused and is trying to get out of bed most of the time the last few days for her have been norrendous.

So hopefully she will get over this situation and will go back to the care home what should I be asking for in to prevent this situation from happening again or is it just inevitable that this will happen again.

Are there ways the care home can make her safer. I doubt there is blame but should this have happened to Mum when she is in care home.

Ask for an OT assessment while she's still in hospital. There may not be much they can do unfortunately as sometimes putting guards etc on the bed can be more dangerous than a fall. I'm so sorry, I know how it feels to be the relative in this situation, it's so hard. Wishing you and your mum lots of love.

I assume they will put crash mat on both sides now? They can put falls sensors on the bed and mats but that won't stop a fall, just alert them to go and help.

Can they put a mattress on both sides, or put the bed up against a wall ?

The care home may be able to apply for 1 to 1 funding to have someone in the room with her 24/7. Ask to speak to the hospital social worker as well as the OT.

I would ask for her to be moved to a room which has a wall suitable for the bed to be pushed up against so that there is only one side to fall out of. With the bed lowered and a crash mat that should hopefully help.

If she is trying to climb out because she is agitated could you ask for some medication to make her less agitated maybe?

Thank you all for your ideas.

Some are so obvious now you have suggested them but right now I cant seem to see any logic at the moment!

So thank you again I really appreciate your ideas.

I am not sure why she is falling out and had not considered that it may be due agitation. She is definitely trying to get out of her hospital bed due to this so I will ask about this.

She also forgets that she cant walk so this could be playing a part.

Unfortunately they have to remove the rail as there is a higher risk that she will become entangled in the rail, is falling from a greater hight etc and the fall impact would cause more damage.
I would look to see if they can use alarmed weight pads on the bed and motion detectors if she is sitting up before getting out of bed.
See if she can be given a room nearer the staff area.
And if a change of meds would help her sleep through the night.

It's catch 22, can't leave the sides up because if she falls over them it's a worse injury, can't leave them down because she rolls out. Can't give sedating meds at night because if she does get up she will be dowsy and fall but if you do give sedating meds she might sleep through and not fall. I'd be having a chat with management about what they can do, in hospital she would be 1:1 nursed but even that doesn't completely eliminate the risk of falls

I think the best option would be low profiling bed(only a small amount off the floor and then the otherside up against the wall

Having a bed pushed up againgst the wall one side does make it difficult for the staff to help her with changing position, continence etc.

I've seen horrific injuries caused by demented patients climbing over the (supposedly safe for dementia patients) guard rails.

At some point, the guard rails have to go, the bed lowered to its lowest point and mattresses placed either side of the bed.

It makes life extremely awkward for staff, but it's the best way, besides having a thick mattress on the floor.

The only thing they may try is to rearrange her room and push one side up against the wall, lowering the bed to it's lowest level and putting a crash mat there is one of the best safeguarding measures at staff disposal. I am assuming it is already a low profiling bed which means it can be lowered to almost floor level.
And a sensor alert mat to alert staff when she is no longer in the bed.

Medication can create issues in itself, drowsy causing meds can increase the risk of falls, not just overnight but during the day as well.

Night waking can be due to anything from agitation to continence to confusion (thinking it's day time) so the staff will likely be trying to find a pattern to the episodes of getting up at night.

I was a night head of care in a care home and it's bloody awful, one of my ladies honestly spent more time laying on her crash mat than she did in her bed because we simply could not get her to stay there. I really feel for you OP, it can be incredibly worrying and difficult when your loved one gets hurt.

Also, I would assume she is already on 15 minute observation/welfare checks, if not you could suggest this as a course of action. Tho once she returns from hospital this should be implemented as standard.

And depending on the bed (thinking of the low profiling beds I worked with) maybe some creative thinking around cushions and padding the area around her, ensuring the bed wheels are inaccessible to the patient (albeit making staff life more difficult for continence care)
And looking at rearranging the room furniture to ensure nothing is close by the bed that she could harm herself on - such as bedside tables.

Thank you all for your time and wisdom.

Yes her bed is low profiling. She is on 15 mins ops. Initially she just seemed to roll out of bed and was usually found wrapped up in her duvet on the crash mat still asleep. This last time however does seem to be different as it was the other side and also so much more damage was done and maybe she was trying to walk so fell from a greater height.

Bedside table is moved away from the side she usually falls out of but there is a wardrobe on the other side which we think she hit her head on. So need move that further away.

There was nothing to knock her knee on but hopefully a crash mat on both sides of the bed would lessen the impact. As she is so frail it seems just the impact smashed open her knee.

Presumably it’s a bed on wheels that can be moved.

Yes they has wheels but I have seen beds pushed up against a wall and there is no space where it can be pulled out for the staff to get to the other side without rearranging the whole room so the staff have to lean over to do all care, including any emergency treatment..

That’s a nasty fall!

Sounds like she needs 1:1 if falls sensor is not enough to alert staff to reach her before she’s on the move. We would use 1:1 but I do know getting funding in social care is difficult.

I’m NHS older peoples mental health, we don’t use bed rails because of the risk of injury. We would use 1:1.

Profiling ultra low beds are better than mattresses on the floor which can be trip hazards if patients are able to get up. Ultra low positioning can reduce risk of injury from a fall out of bed and May also make it harder to stand from sitting up so enabling staff time to respond.

Due to your mum sustaining a serious injury, safeguarding concern should be raised. Do check the care home have done this.

Not directly related to the falls issue, but this level of day and night time needs may mean your mum is eligible for NHS funded continuing healthcare. If she's not already receiving it, or being assessed,

.... I'd suggest asking for a checklist assessment. (Sorry posted too soon.) Good luck

Handhold OP, dementia is such a cruel disease, what a worrying time for you trying to keep your mum safe

I am speaking from experience here. I loved my mum dearly, however with dementia worsening she totally changed. Anyway she was in care in the end and had a low bed with crash mats. Constantly falling out of it. NH said they could not use guard rails or any form of restraint ( I was thinking handcuffs after a particularly horrible week for her with falling lol!).

Anyway, she fell for the sixth time and was taken to hospital. They put up guardrails immediately. I could never understand the difference in approach between the NH and the hospital.

I have no solution for you, but I'm holding your hand.

That won't happen. I work in ASC and the only time a 1:1 24/7 is agreed is if the behaviour is so challenging that other residents are endangered by it. And even then, 1:1 is very rare

I've seen blow up bumpers instead of rails to stop patients falling out of bed, can they not have these?

I've never heard of an issue with rails before, she'd have them in hospital, but she certainly needs something. You could also look at mesh bed guards that do the same.

Hospitals and carehomes have to carry out a bedrail and falls risk for all their patients now. The danger is agitated people climbing over the top of them so bumpers only help people not getting their limbs stuck in the rails. . Most hospital beds have solid sides and a lo bed that can be lowered to the ground is the safest option. Bedrails are also,a form of restraint so that also needs assessing and consent.

I would ask the doctor if they can give your mam something to settle her at night. I used to care for dementia patients and one of the biggest dangers was them getting up through the night and harming themselves in some way.
If she's in a home she's more protected but the falls need to be prevented. Good luck!

Thank you all for your time and ideas.

Eventually this evening she has gone to surgery to have her knee repaired. Fingers crossed it goes ok. Last GA left her with delirium for a while.

We think she tried to stand up and walk rather than just roll out of the bed. She has not been able to stand for a while so we think she must have fallen onto her knee hence the damage and then fell forward and hit her head on the wall or wardrobe.

In hospital she has been in a bed with a big padded bed rail.

I have spoken to the home and we will have a meeting in the next few days. Thanks to all you comments I feel better armed with suggestions and things to consider thank you all.

Hospital (no ones fault) has been horrific and we cant wait to get her back to the home where she at least will be fed and be encouraged to drink.