HogDoctor or anyone else in medicine

Megan had to go out of town to tend to a family member and try to get her lined up for long term medical care. The family member is in her 90s with dementia and has fallen several times recently and is currently in the hospital.

The nurses had her in a wheelchair near the nurses station last night because she had fallen twice yesterday. They called Megan and she went up to the hospital and saw she crying and wanting to go to bed. Megan insisted they put her in bed.

Megan stayed in her room last night because she kept trying to get out of bed. If not for Megan she most likely would gotten out and fallen again.

Here’s the dilemma, they won’t put her in a bed with railings because that’s restraining her according to the state. Evidently that’s pretty standard nationwide. I was told it’s the same in Arkansas.

How is she not a prime candidate to have a bed with railings? What are the options?

She could have a bed alarm installed so that the nurses will be notified immediately if she tries to get up. There is supposed to be a fall prevention protocol that covers this kind of thing and includes alarms, restraints, etc.

I’m not aware of railings being considered restraints. Anyway, I had to put people in actual restraints frequently because they were pulling out IVs, taking swings at the staff, etc. The need for restraints had to be reassessed/renewed frequently but I had that option. The nurses couldn’t do that on their own but they’d let me know that 2610 was pulling out her IV or hitting the CNA and I’d order restraints.

Also, I’ve never seen a hospital that any inpatient beds lacked rails; unrailed was not an option.

I’m not a doctor but I had a similar situation with my 92 year old mother. When she was put in rehab nursing home they said they couldn’t use rails because people were getting hurt more often with them than without–I guess by people determined to climb out, rails or no. I think the prohibition against rails was coming from the state.

But this only came up in the nursing home, not when she was in the hospital. Also, her dementia was relatively mild so she wasn’t as determined to get out of bed as much as some in that condition. Our solution was to keep her walker, that she knows she needs to get around, out of reach.

This is a tough situation, so I feel for you all and will be praying.

From a nursing home position in Ft Smith and the State here is what is going on…

The Patient has the right to fall. Therefore rails and bed alarms are Not allowed.

What can be used is fall matts and lowering the bed.

Just the facts. Stupid ones I might add. I’m pretty use the State might state something else but this is just form some people who work in one right now as I asked for a ruling today…

That is completely bizarre and nonsensical. And frankly asking for a lawsuit if someone does fall and breaks a hip, which will happen and often leads to death. The one-year survival rate after hip fractures in the elderly is not good at all; all-cause mortality approximately triples in the first year.

I can see nursing homes having somewhat different rules than hospitals, but Richard was describing a hospital scenario.

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Had a nurse here say this is the case here in Arkansas. Poor Megan is running on fumes. She’s seeing lawyers and trying to sort through all kind of things in order to get her placed where she’ll be taken of long term. Another family member is trying to come to help but when you’re dealing with someone who’s not capable of helping it’s a nightmare.

Like I said I’m stating the FACTS!

And I said it was stupid. It is what it is. Call a nursing home and see…

I also saw the hospital case but a nursing home might be in the future unless you keep both parents like WE did…

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I’m not disputing you, Mike. I’m saying that policy is insane.

There’s has to be some sort of common sense and allow doctors or nurses make a call and use railings for someone that’s not in the condition to decide for themselves.

That’s what I was told, too. Best they could do was lower the bed so a fall is not as severe.

I think it is one of those, when lawyers get involved, it’s a damned if you do, damned if you don’t kind of things.

Apparently, “Giving residents ‘the right to fall’ is a core element of every good senior living community,” has been a thing since 2015 at least, in senior care. Could be now bleeding over into hospitals.

With a recent court case they might be rethinking this, tho.

This.

Richard, having been a dementia caregiver my heart goes out to Megan. Prayers!

Thanks. She went through this with her mother. Megan has a heart of gold and no one is more caring than she.

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Rails are not restraints at Vandy, to be restrained does require a lot to enforce. I’m not sure about medical law variability by state, but level of care needed for a restrained patient is much higher obligation at Vandy and we have trouble with enough staffing every day of the year. I cannot help with the original question, but some of the ensuing thread is bizarre.

Sorry Richard and crew, just seeing this after my day was busy…Joy (wife) had her screening colonoscopy this morning (all good) and I’ve been behind all day.

As to your question about rails & constraints, I just completed a board review course for my boards this upcoming spring, and one of the surprises I learned was that demented patients had a higher FRACTURE rate if getting out of a bed with rails vs no rails. The conclusion was that our poor confused dementia still got out of bed if rails were up, and the trauma more severe if climbing over rails vs simply getting out of bed with rails down. Obviously also higher fracture rates if patients took certain meds(BEERS criteria is list of high risk meds for bad falls in elderly).

Restraints have been frowned upon by CMS auditors/review agencies for several years and fallen out of favor bc hospitals are getting dinged by surveyors. Restraints are helpful in certain situations and understandable if the family/friends can be educated about their use.

RD, I’m sorry Megan’s having to deal with this. Hopefully they’ll find her relative a better living situation soon that can better handle the relative. Dementia caregivers and workers are SAINTS in my eyes bc that is one tough job day in and day out.

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I have actually never in my career heard of rails being considered restraints

Admittedly I have not had a hospital practice in 9 years and things have changed

I didn’t expect a reply for awhile because I know you’re busy. I appreciate the info and kind words.

Hmm. I was on a geri unit in 2019 and nobody ever dinged me for ordering restraints when the patient was jeopardizing her care or a danger to staff. I can see how the poor demented ones could try to get out of bed over the rails and increase their risks, though. Sometimes I would order sitters if there was available staff to do what Megan was doing, but that was rare.

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You can still use restraints, but the process and documentation for using them is more cumbersome over the last few years, to appease CMS. If you don’t have a really good algorithm in place like Ray suggested, with ongoing justification for using restraints, CMS will bust the hospital with a hefty fine. It’s made our jobs more difficult and seems unnecessary to those of us with years under our belts.

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The caregivers wind up sick from exhaustion and the effects of the care they render to their peeps. Tell her to hang in there and try to see some joy in her relative and the memories of them in better days.

Example, we all laughed at my grandmother(who would totally laugh along with us given her personality if she were aware) because she would call me Frank (my dads name) every time she saw me when her dementia was advanced…bc I look exactly like my dad did 25 years ago! Id play along and mess with her about it & make her smile, usually at the expense of my uncles and aunts.

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