Care Home Fall

[Windmill34]

mil had a fall in her bedroom on Friday night being taken from chair(next to bed) and being put to bed for the night.

she was taken to a&e and has broken both
knee caps. consultant said had it of been one they could of operated but because of her
age 90 they are just putting them in leg brace.
She has dementia and can’t remember and doesn’t really know where she is.

So to anyone that works or has parent in care home

When being put to bed for the night
is it 1-1 carer & patient or 2-1 2 carers & patient
As it’s not my mum and dp is not good at thinking why/what etc, I’m just relaying to him my thoughts.
His sister is POA and also a bit dippy sometimes

so thought I’d ask on here

I would think it depends on the mobility of the patient. How able was she able to get about before she fell?

Your poor mum.

Can she usually weight bear while transferring?

Entirely depends on the residents needs at the time. However as distressing as it is, sometimes accidents still happen. Might be worth asking for more information regarding what happened. Eg a hole in the carpet causing a trip could be prevented, but just losing balance and falling is more an unfortunate, unforeseen accident.
I can remember all to well sitting at a table playing snap with some residents - all fine and independently mobile. One minute we were all sitting and laughing, a split second later one resident was on the floor. No reason for it to have happened - but it did.

Yes it depends on the individual and their mobility. All falls whether witnessed or not need to be documented by the Home so I’m sure they can provide further info. It’s important to remember things can change very quickly too with mobility and such. I hope your MIL recovers well.

I'd imagine it should be 1-1 care for the moment but definitely 2-1 patient transfer - reposition if on bed rest due to broken knee caps.
Also reposition every 2-4 hours if unable to reposition herself

They may assess her for a hoist for moving from bed to chair or toilet etc.

There is no hard and fast rule it depends on the person. But for someone who can walk 1:1 is more common. Its possible she should have been assessed for equipment. But unfortunately these things just happen. You could visit and ask about how she is being moved now and what the advice was from the hospital when she was sent home.

The level of staffing will be directed by a care plan, you could ask to see that. Of course it will need.to be updated now, as will her falls assessment.
I'm sorry for your Mum, poor love.

Mil is not mobile , when taken to dining room she is in a wheelchair.
The only moving she does is
chair to bed and vice versa. She’s also developed bed sores , has had an air bed since being in there since 18mths ago.
She does Do anything

Yes we know a hoist will be used once she comes out of hospital back to the home

Do you know if she is able to transfer with 1 or 2 staff? None of us will know that. Some people can't walk far so will use a wheelchair, but will be able to transfer from chair to bed etc.
If she has pressure areas that could be indicative of poor care. Do you know what hrade they are and how many?

Does MIL have district nurse intervention?
With bed sores she most definitely should.

I'd imagine if she is not mobile she would spend a lot of time on the bed? If so, she should be repositioned 2 hourly via slide sheet, if she can't move her self,
But if DNs are involved in her care, they should have instructed on pressure relief.
As stated above she should have 2-1 carers for transfers,
Is she using a stand aid for transfers or does she need fill hositing?
If you see any drag lifting ( hands under MILs arms) this should be reported.

I was a senior carer for 6 years before I got ill so feel free to ask any questions.

Don’t know grade or how many as I’ve only been told today as she’s only been in hospital 2 days with broken knees .
she can’t walk far at all, so really bed to chair
she has bed washes.
The bed sore thing git me as fil had off the scale bedsores 😱 the sister in the hospital told me when I had had enough of partner not asking (he’s very don’t cause a fuss )
but as not my parent I could only say so much . If it had been mine I’d off kicked off

Im nit sure what goes on in the nursing home
only thing I know is
shes in her own room, sits watching her own tv, ears mostly in her room and out of bed transfers to chair and vice versa at bed time
She doesn’t get hoist lifted from bed to chair it’s carer

I just think immediate family don’t say enough
they think because it’s a nursing home they get cared for ! They infuriate me sometimes

thank you Jamiej93 for your offer

I would ask for a copy of her falls risk assessment, mobility risk assessment and the related care plans.
You should find all the information on there.
i do hope she recovers as smoothly as possible.

If she was able to walk from bed to chair preciously then it's likely to have been 1 carer doing bedtime, but as PP have said you really need to ask the home because care plans are individual.

If she was largely immobile she should have had pressure relieving cushions - gel or air in the chairs and possibly an air mattress. But again you'd need to check the care plan.

She’s had an air mattress since she went in there over 18 mths ago .
Dont think she’s walked for over 2.5 yrs she just sits in chair then bed at night. She wears pads for the toilet

I’ll get dp to ask sister to check on bed sores grade
She was in a lot of pain last night in hospital as lady in next bed said she was crying and shouting out .
but dp saw no morphine drip today unless you get morphine by tablet
one of her knees is very swollen and badly bruised

Ex nurse here. Yes the pressure sores are big red flags of poor care.

I'd be very surprised if she was being transfered by someone - even one person - who knew what they were doing that she'd break both knee caps.

Sounds like a very heavy fall forwards landing on both knees.

If you are being moved safely by one person who is holding you correctly, even if you fall, there is no real way you could land like that because a trained person would be able to control how you fell to a degree so you'd be looking at one sided injury. It's not impossible that it could happen but just unlikely. If there were two people it's very very unlikely to have an injury of that severity on both sides.

I'd guess it's more likely that she fell because she was unattended (Slid forwards off chair trying to get up).

I'd want an investigation and full report although it may not matter now.

In terms of how many people she needs to move her that depends on her mobility, stability and weight. Anyone who is unsteady is likley to need 2 people. Think of it this way - would you feel safe to assist her to move safely yourself alone - if not, likely needs 2 people.

I'm sorry she went through this.

I agree with a PP, very unusual injuries for a fall where she was being supported to transfer. The home should have raised a Safeguarding with the local authority. If they haven't, you can do this. Include your concerns about pressure sores too. A social worker will then start an enquiry into what happened and check to ensure everything was as it should be.

I agree with Comeagainx. I have worked with elderly people for over 34 years and never seen anyone with bilateral fractured kneecaps. She would have had to fall awkwardly and heavily and have quite poor bone density. I would want to know how many carers there were at the time and if they were experienced in assisting her specific transfer.

I would agree with PP that it does sound an odd injury for a fall during a transfer. It sounds more like she has fallen forwards or against something...
I'd want a full explanation of how it happened and who was present. It may be simply she's tried to get up unassisted and has fallen forwards. Which sometimes is unavoidable with people who forget they can't do things and struggle to follow instructions.

But an odd injury and the presence of bed sores would make me concerned about her care. Both could be innocent but I'd want to be sure.

Does she have any known bone density issues? Osteoporosis for example?

With regard your original question about staffing numbers for transfer - if she was able to weight bare then she would most likely have been a 1-1 transfer.
If she needed hoisting then it would be usual to have 2-1 for transfers unless the hoists are ceiling tracked. Then they could potentially be a 1-1.
If she required use of a stand aid that could also be a 1-1 transfer.

I'm now thinking there is potential for that injury with a stand aid if she failed to take any weight herself and fell forwards against the knee restraint. Or the knee restraint was used incorrectly....

your partner or sister could ask to read her care plan and the risk assessment (held by care home), the existing documents will state what staff ratio, equipment and moving techniques should be utilised for individuals. The hospital will be able advise on updates to document in relation to ratios, equipment and moving techniques. You could enquire about training undertaken by staff. Enquire about what happened during the incident and how they intend to prevent another fall. Ask to view incident log.

Hi my mother in law is in a home and has had three falls in 5 weeks, thankfully nothing serious but very bruised also, the carer involved with the first fall has been sacked which is very worrying. Should I be taking further action with this home.

@carerneedshelp
I'm now thinking there is potential for that injury with a stand aid if she failed to take any weight herself and fell forwards against the knee restraint.

I don't agree @carerneedshelp because a) the knee pads are more 'shin pads' and very padded b) you'd struggle to make bilateral full contact on the knee/shin pads even if you tried - if your legs totally gave way, you'd go down either totally vertical or down and slightly back - probably land on the edge of the chair/bed you were standing from. If you were mid stand and fell forwards your upper body which has more weight would mean you were 'caught' by the bar and again your knees wouldn't contact the pads beecause they'd move back.

AND no one should be using a stand aid alone which means if even one carer is there a bilateral break of both patellas on a stand aid is extremely unlikely.

@Fruitbat1954
Hi my mother in law is in a home and has had three falls in 5 weeks, thankfully nothing serious but very bruised also, the carer involved with the first fall has been sacked which is very worrying. Should I be taking further action with this home.

Yes ABSOLUTELY raise this. You want full accounts of what happened each time and why.

I would 100% because falls are highly dangerous in the elderly. Falls lead to breaks particularly hip fractures which lead to hospital admission and death. She's lucky she's not broken anything.

3 falls in 5 weeks is nearly one a week which is much too high. No one properly cared for should be falling like that so it is indicative of a serious problem.

either

the home is unsafe (loose carpets, trip hazards)

the staffing level is inadequate

the staff are not properly trained in moving and handling

your mother's mobility ability has been underestimated and she is treated as not needing moving support when she needs one carer, or she is being treated as suitable for one on one when she needs two on one.

or your mother does not have adequate supervision/equipment for someone with her physical ability and cognition (eg. bed with bed rails if required, seat with falls alarm seat pad so if she tries to stand alone when she cannot an alarm sounds immediately). Some people may need one on one care which is hard to achieve in residential care unless you have the funds to pay for an extra external carer to be with her all day.

To be blunt with that fall rate, she'll end up in hospital and dead very quickly so you need to address it quickly. Unless there is a very good explanation for the pattern AND they can show it has been addressed, I would be thinking of finding another home to be honest.