Falling from wheelchair

maifleur01

As my husband's dementia is progressing he has started moving his body front to back in his chair. Each time he moves a little forward. He has increased the movement and always leans forward with his hands clasped in front of him but arms on his legs. He keeps falling out. The pad hospice thought would help sent him to the floor quicker. The nursing home is now trying a sticky pad, sticky on both sides. However his movements are breaking the bonds between it an the chair. In older days he would be strapped into the chair. Would only cause more injury as he would loose his balance and bring the chair over on top of him. Has anyone seen something that might help. I thought of one of those chair beds that tilt backward but both I and the staff think he would try to climb over the sides. I had never heard of the continual rocking in dementia patients before him and see none of the other patients doing it. However I have a friend who still has here father at home and he is doing the same thing.

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sunnyca_gw

Rocking is very common in some patients, I visited a place for retarded & folks with severe seizures & they had a new director a number of years before that thought some of the young people should be able to sweep the floor & dust, their mental capacity was very low & they became extremely agitated & rocked & 2 girls(in late 20's by then) spent every waking minute licking their skin until it was raw. They had many bandages but had to let them lick or they became violent. The brain can only take so much & hard lesson as I think they had 6 people they had tried to get to work ,the other 4 stared off into space ,1 lady gripped a rag doll. If they could Velcro some kind of pad in wheelchair, but how to keep him in place, could they Velcro a walker to the wheelchair so he couldn't fall out?! end of long Velcro piece would be on walker on each side to goon each side of wheelchair right below the arms, some have a tray, that might be good, wonder if he would play with something soft that is attached to tray, soft balls or soft stuffed dog or kitty, something he used to like, might get his mind off trying to get up all the time.

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maifleur01

Thank you for the suggestions but none of them would work for him. A walker could not be close enough to the chair to keep him falling and he would probably hit his neck on it. Nursing homes here refuse to use the trays attached to the wheelchairs except for activities as it is considered the same as strapping patients into their chairs. His dementia has progressed to the state that he cannot grasp things so the toys are out. Today he was in a new high back chair and although he was still moving his knees back and forward he was not trying to scoot his chair. The problem is not so much him trying to stand as his sliding out of the chair with movements of his legs and hips. The sticky pad did work for a couple of days until part stuck to his pants and part remained on the chair.

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CA Kate z9

I'm missing something... just why can't your husband be belted-in to his wheelchair?

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sunnyca_gw

Kate, she said when he was strapped in he flipped chair over on top of himself. Some get very upset with the strap I noticed & they put them back in bed. The rocking or constant movement is mental in the brain, we had young woman at church that constantly moved her head & shoulders, she did well in college but if you talked to her very long you could tell something was wrong with her brain(got very upset when several of us put our purses on a cabinet to get food organized on table for potluck (her mom probably told her to keep purse with you at all times) then someone had chicken pox & she was angry that the family missed church. I tried to tell her rest of people would be exposed to disease. No reasoning & the strange body movements would get much worse. Brain problems can present all sorts of problems. Sure maifleur's hubby rather be up & easier for staff if they aren't bedridden so hope this works. Lately I've seen 3 new type wheelchairs, 1 was high back & could be a bed & several adjustments, lady was frail & body pretty twisted so don't know her problem but before her head was almost on her chest so this looked much more comfortable. Do have to go along with most nursing homes as they aren't going to change unless they make the changes.

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cooper8828

CA Kate, the use of restraints in a chair can cause the nursing home no end of grief if the inspectors come.

Have they tried a merry walker?

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maifleur01

It is against the law now to restrain a patient either in a hospital or nursing home at least in this state. Too many people were being forcibly kept in their beds or chairs by straps for the ease of staff. Even in hospitals only two rails of a four rail bed can be raised. It is now considered to be inhuman to cage people except for rare cases where people will do bodily harm to themselves. He can stand and still walk a few steps for some of the staff. Refuses for most of the staff. Which makes it harder. Most use a lift and two people to use it as he fights them. I had wondered if the rocking was from Haldol but he was doing it before they started giving the stuff to him because he was yelling at the top of his lungs. His dementia is advancing now where it was slow for a long time. We first noticed he had a problem 2002/2003 when he started having problems with the simplest paperwork at his job. Luckily he was offered a buyout along with anyone that had more than 20 years of service and he took it. We were dealing with it with little progression until Oct/Nov 2016 when he developed a kidney infection. Something shutdown in his brain. He lost the use of his legs for about 6 months. His mind went from slow functioning to full blown dementia. He was a big guy and the doctors refused to allow me to care for him at home as I had been doing. He has been in the nursing home since then. In January his doctor thought he was ready for Hospice although I did not think he was ready because he had some type of infection. Trying to decide to continue Hospice for another 6 months or forget it until later. Hospice is great in a home setting but at a nursing home for patients without pain what they do is normally handled by the staff.

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maifleur01

mdln that would be nice but most nursing home rooms at least here are too small for that, a bed, and a small chest to hold things that can not go into the closet. Here there are two people of the same sex in a room with a bathroom between another room. Think hospital room sized but used by two people. His problem is he rocks himself out of his wheelchair.

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CA Kate z9

I was going to recommend the type of wheelchair we had for my husband, but I imagine that someone could wriggle out of that too. He didn't have dementia until the end, but he could still manage to move his butt down and out of the more upright chair, but we would always catch him before he actually landed on the floor. The big one laid back as far as wanted and that seemed to help, maybe because he was more comfortable.

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Anglophilia

I remember when KY passed the law of no restraints in beds and wheelchairs, and no mood-altering meds. I pictured homes with heartless, lazy attendants doing this and thought it was a wonderful law...until I had a friend with dementia.

My friend would hurl herself out of her wheelchair and would attempt to get out of bed at night and would fall and injure herself. They finally had to put her mattress directly on the floor - no side rails were even allowed. When things got really bad, the nursing home said she could not stay there unless she had a private 24/7 attendant to watch her. The cost of such is prohibitive. Did I mention that my friend is my age -- 73? She could live for years and years.

So, her guardian, had to move her from KY to OH where there are no such laws. She is in an all-demential facility. She spends much of the day in a wheelchair that has a tray attached - think high chair tray. She seems to like it and cannot harm herself when in it. Her bed has very high rails and a net over the top, so no more falling and trying to get out of bed. She is also on a mood altering drug that has stopped her aggression - she had drawn blood on attendants in her previous facility. I've visited this facility multiple times and they have lots of activities for the patients (who participate to varying degrees due to their dementia), and they get her up and walking with two aids multiple times daily. The place is clean and the staff appears to truly care. I don"t know how they do it - 15 minutes there and I'm looking at my watch!

Much of such legislation was passed with the best of intentions, but with a LOT of ignorance about dementia patients and what is best for them. I hate to think what will happen to my friend when some do-gooder legislator in OH decides that they need similar legislation.

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maifleur01

His new chair looks similar to those that lay back but it did not look like it tilted as the mechanism to do that was missing. Several of the more advanced patients do have that. One day I was there and in less than a minute his lower back moved from the back of the chair to almost the front when I called for help. Which is why they are trying the sticky stuff placed on the chair. The sprayed on stuff did not work. Less than an hour later he had rubbed it off.

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maifleur01

When he goes to bed they lower the bed to the lowest position. Only once have they found him on the floor. For those people who do roll out of bed they place foam gym type mattress's next to the bed. Most only have one but one woman has two. I remember shortly after rules changed the daughter of one patient insisted she be strapped to the bed. Apparently she never found another home that would do that because the mother was not moved. From their experience the gym pads are thicker and can be cleaned easier than the medical ones that are available. My husband is 74. Depending on the studies many people with dementia if they live past five years of their diagnoses will live for 20 more years.

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maifleur01

If/when I develop dementia I hope I am bad enough to go to a regular nursing unit unless I am far gone. Most of the units here are segregated by sex. I was looking before I knew the rules about patient handling. He lost the use of his legs which requires the skilled level. Here if a patient requires two aides to safely move them from place to place skilled is required. Each state may have their own rules. Something to look into before needed if you have a loved one that may need help in a few years. Many did have activities but everyone except for the bedridden were kept in common areas. I mentally thought what it would be like for a person who was just developing the problem to be placed with people who were unable to control anything. Sitting there day by day waiting to turn into one of the more advance patients. One of the things mentioned in my Alzheimer's group sessions was that many spouses for whatever reason will also develop dementia. Five years was most common for the symptoms to start appearing.

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raee_gw zone 5b-6a Ohio

Each facility interprets the rules about restraint a little differently but it is true that the gov't agencies cracked down because people complained about their family member being "tied in a chair all day". And, yes, some places were abusing that in order to minimize staff -- to control folks who wander. But for other patients, it is a matter of safety, to prevent falls. Unfortunately even for a permitted reason, (to prevent falls) the use of any kind of safety device in the hospital (don't know if any rules are different for nursing homes or in other states) that can act as a restraint requires paperwork to be filled out by the staff every 2 hours, and a new order from an MD daily. However, it is not against the law and doesn't require the paperwork to have 4 siderails up if it is for safety -- and in many circumstances 4 up is the standard of care.

All that said, maybe this would work, if the facility would be able/willing to use it:

http://www.posey.com/products/patient-safety-and-protection/belts-and-pelvic-holders/4125c-4125c-posey-pelvic-soft-belt

I did use hospice for my mother at the nursing home: they supplemented the attention paid by the staff and really were more attentive and responsive to her changing needs than the staff. I did not use the hospice that was owned by the nursing home company BTW.


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maifleur01

I do not think it would work for him as sometimes he falls headfirst rather than slides out as he has been doing recently. I would also wonder if it would increase the amount of heat retained in the pelvic area. Yeast infections are common when people wear diapers and this could increase the heat in that area. I was given a list of six hospice organizations by the home all but two connected to local hospitals were national companies. Not certain who owns the nursing home currently because last September it was sold from Golden Living to a Missouri company. It has 100 beds between dementia women only, skilled, and rehab. Currently not many in rehab and no mention of number in dementia unit.

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maifleur01

I would like to thank all of you for coming up with some good suggestions. Although none of them works for him I hope someone looking for suggestions will read this and find something to help them.

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raee_gw zone 5b-6a Ohio

I am afraid that no measure will be perfect, you need to choose which one will work for the most frequent problem most of the time -- what is the highest risk for him?

Yeast comes from not changing the diaper often enough, not using barrier cream, and worsened by antibiotic use. These devices are typically breathable materials (although I haven't seen this particular one in person)

If he is restrained with the pelvic belt so that his hips are kept well back in the chair, and is in a heavier chair, the chance of his tipping over (or falling out) even if he leans far over will be much less, because the hips are held back and down.

Keeping someone like this in a standard wheelchair is a poor idea however, it needs to be a more stable, heavier chair.

Good luck to you. Both my parents had dementia at the end; I don't wish that on anyone.


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