Falls in Long Term Care
I've been sitting here on the side of my bed for ten minutes now. I really got to go. It must have taken me five minutes just to sit up. I've been so weak since my hip surgery and catching pneumonia. I really have to go, bad. I wonder what's taking the help so long to answer the light. Well, the portable commode is right here, I bet I could make it........
I've been sitting here in my room for three hours now. I am bored. There's nothing decent to watch on TV. Is it lunch time soon? Or is it almost dinner time? Maybe I should get up and go look down the hallway and see if anyone is there, or will that darn noise start again when I do.......
Lack of help, boredom, confusion. No, these aren't the only way falls happen. In any long term care facility you can probably find a thousand reasons why the residents fall. The sad part is when a fall results in injury or death. According to the Centers for Disease Control and Prevention (CDC) statistics, nationwide about 1,800 deaths occur yearly from a fall or injuries related to the fall. A typical nursing home with 100 beds reports 100 to 200 falls per year, but then some falls are go unreported. Serious injuries occur in 10-20% of these falls, with 2-6% of the falls causing fractures.
Preventing falls seems like an impossible task. With the current restraint reduction guidelines, reduced staffing, and tight budgets, most homes are limited in what they can do. As much as restraints, when used appropriately, can benefit a specific population I never see the day when all homes are restraint free. In one facility (MR/DD) I worked, following the yearly survey twenty five residents were identified as possible restraint reduction candidates. Beginning with the best eight residents the restraints were removed and within the month all but one had fallen. Two of the falls involved serious injury, with one occurring because the resident got up to help the aide who was catching another of the residents that was falling. The aides ended up having to sit these eight together and constantly run from one person to the next to keep them safe. This job needed two or three aides alone, but was delegated to one aide, in addition to care of the remaining seven or eight other residents on the hall. The one who didn't fall, by the way, was sick all month.
Making environmental changes can help reduce falls, however since major changes can be a big financial investment most homes must schedule these into a future budget. That won't help the resident now, as I found out during an assessment once. The resident was reported with a decreased ability to brush their teeth, now requiring set up daily. I found out that this resident had been recently "alarmed" (pressure sensitive seat alarm placed) due to numerous falls. Their only mode of transportation was a power scooter that barely fit in the bathroom door, and would not fit next to the sink due to the design of the counter. The only answer was a total remodel of the bathroom.
As much as I joke about tying fifty helium balloons onto a person's belt to keep them from falling, falls are not a laughing matter. The only constant factor here is the population. We will always have the confused residents that can't remember they are unsafe to stand up and walk. Keeping these people safe will probably remain an unsolved problem for many years.
Until next time, hope all your "Thoughts" are Good-
Tim