What can I do for my father who keeps falling, even while under 24-hour care?

Ummm ... yes, paid caregiving by the shift and family caregiving 24/7 are very different situations. No argument there.

I still don't think that Ruth's comments were insensitive and self serving. When I have to hire someone, I hope it will be a Ruth.

I'm sure Ruth is a wonderful caregiver. You must understand, however, that most of us family caregivers are utterly exhausted mentally and physically and hearing words like that is like rubbing salt in our wounds because we try so hard and still have our elderly ones fall and get injuries. From our standpoint it was insensitive to point out that she "NEVER has a fall on her watch, thank you very much." You don't think that sounds a little insensitive? Really?? And self serving in that it makes her sound so great whereas the rest of us are somehow failing to measure up. She may not have meant to imply that, but when you are dealing with a group of people who are suffering as much as we are, you should really try to use a little tact.

Ditto annt.
I have had two wonderful PC's with Mom when my grandson was born and when my daughter was seriously ill. They were A+++ and provided exemplary care for the week they were with Mom. Had Mom fallen in their care I would still rate them this highly. No caregiver is so good that they can - or should - guarantee infallibility. It is both unrealistic and unachievable.

Mom has PD, arthritis, and osteop. She uses a walker and is generally not so steady on her feet. To date, she has not had a fall. I chalk this up to an army of guardian angels watching over her when I and others cannot. Could it happen one day? Yes, even if I was with her 24/7 it could happen. So I would not fault a facility, caregiver, or family member if she should fall in their care. Having said that, if a family member is falling, on a regular basis, in a care facility I would be climbing someone's frame. They would have to put in in writing how they were going to keep the falls from happening again or I would report them and even take legal action. Really.....businesses that deal with the elderly and infirm should have the most sophisticated processes to keep this from happening. I am a rookie and even I found, online, a very soft, padded criss-cross harness that can be used in a wheel chair or regular chair. It is a simple item that can save so much pain and time in the hospital and rehab.

As for our fellow forum member, Ruth...let's all give her a big 'ol break. She made her comment with a wink and a nudge and doubt she was lauding her skills over family caregivers. Her job is to work with clients who are at the end of their lives. Yes, she gets to go home at the end of the day. But, when our loved one passes, we go back to our lives, such as they are, but she soldiers on to the next person in need. I have hired paid caregivers in the past who were wonderful. And even though we could only afford having them for a few hours a week, those were precious hours that I could have to myself or use to do errands for Mom. I felt completely confident leaving Mom in their care.
Caregiving, paid or not, is an incredibly stressful and draining job. This is forum is the one place we can come to vent and speak our mind in complete openess. I hope we can keep the atmosphere here congenial for all our sakes.
Lilli

Well said Lilli.

Linda and ksobhie, you are so right. Falls come with the territory. They just happen. People who think that falls are going to completely stop when the loved one goes into a care facility are surprised and disappointed to find out falling happens there, too. Falls happen with paid caregivers.

I remember comforting our daughter who was with her dad early in his illness when he fell in the bathroom, landed in the bathtub, hit his head, and she had a heck of a time extracting him from the tub. I had to assure her that he didn't fall because of her carelessness, that it could have happened no matter who was trying to watch him.

Hubby fell several times a day in those first few months, in spite of using a walker. Going to a wheelchair was a great relief to both of us. Having a doctor come up with the right drug for him was even a greater relief.

After not falling for several years, he is once again having problems. Of the five times he has fallen this summer, I was with him during four of them. The other happened at his day program. If I were to claim, "No husband of mine is going to fall while I'm with him," I would have to say, as Ruth did, ha-ha-ha. 'Cause no-falls is a great goal, and the goal we are sharing tips about, but that is all it is -- a goal.

Since my husband's symptoms are becoming more severe now, his doctor has ordered two changes to his meds. The second change may help with the falls, but we can only make one change at a time, so I'm expecting more falls. I'll try to prevent them, of course, but I know that my power is limited. We may resort to the wheelchair if the problem worsens.

I'm sure that our loved ones are much better off with us than they would be on their own. But the fact is, falls happen.

Falls do happen and life after care giving of a loved one is not a bed of roses. That attachment and sense of responsibility goes on for a very long time. My mom fell and I felt terrible every time it happened. The fact that she was my mom only added to how bad I felt.

miz

I know what you mean Miz. The first few times my mom fell I burst into tears. I felt so badly that I had "let" her fall and that now she was injured. Especially when she broke her shoulder. I was standing right there. I saw her falling and just could not catch her in time. And seeing her hit the kitchen floor so hard....well I came unglued. This was on a Sunday and I called hospice immediately. They said to call her ortho Dr which I did. I was told that because it was Sunday they couldn't come to the office and do an xray and that she'd be ok til Tues when they could see her. What????? I called the office on Monday and said I wanted to come in and let them work me in but the nurse got a little huffy and again said she would be fine til Tues. I politely told her they wouldn't see her Tues or any other day and hung up. I found another Dr who saw her right away. This Dr has a smaller practice. The first one is a big sports medicine franchise who just turn and burn hundreds of patients a day. The facility was nicer, but the attitude was sucky. I value service over amenities so I'm happy with her new Dr. But I digress, the point I was making is that I cried and cried over all her falls and now for my own sanity I just can't cry any more. It's not that I'm detached, I could never really detach from mama, it's just that I've come to view it as an occupational hazzard for both the patient and the caregiver. They are going to fall. That's just what they do. Most with dementia or Alz like to wander. They don't know where they are going, but they're making good time gettin there. She's fairly restless and will sit or lie on the sofa for a few minutes then go lie on her bed. Then get up and go to the bathroom, no pee just sitting there with me waiting for something to happen so I can wipe her. Nothing happens so back to the sunroom and the sofa for another 10 mins before she decides she needs to find her purse and go thru it for the hundredth time. I keep a little cash in there so she has something to count and let her buy me a burger once in a while when we are out. Then I replace the money when she's not looking. She never wonders how the money never runs out. ha! Anyway she keeps me busy jumping up and down walking with her or dropping whatever else I'm doing to walk with her. Or I use the sofa seat belt so I can get the dishes done and laundry and floors etc. always doing one thing then stopping and sitting with her awile then going off to do another chore for a few mins then back to sit with her and on and on it goes. She always needs fresh ice water cause her's is stale. or needs a snack between meals. You all know the drill.

Here it is 1:30am and I'm still up mainly because I've had a migraine and the fioricet has caffeine in it. Might as well shoot me up with Red Bull and expect me to go to sleep.Not happening. It's so nice to have someone to write to even if none of you are awake and tuning in. I don't feel so alone.

I'm probably getting y'all down so I'll shut up. I'll go thru my joke bank and see what I can find to post.

TTYL

I want to get a job as a call center at home, but I can't because she won't sit still long enough for me to work. And the night shift is out of the question. I'm trying to see if I can afford to put her in day care a few hours several times a week so I can work. Not sure if it would be worth it. The day care is $50 a day. The call center would have to pay more than $10 per hr to make it even pay for the day care not to mention that the closest one to me is 40 mins away so gas would be costly. If I work the night shift and pay someone to come in and take care of her during the day while I sleep, that would cost 10 to 12 and hr. Sooooooo my only sensible option is to get my depressed husband to agree to a regular job. I don't know if any of you have ever dealt with a self employed construction worker, especially one with major depression and panic disorder, but talking him into trying something new is tantamount to asking him to try a sex change. He won't even consider doing this. I've told him it's him or me. One must work and the other take care of Mom. I don't care which. But then I worry about him watching her because of his meds he is apt to go to sleep any moment and she'd be up walking right past him lying on the sofa. At least a few feet before she fell. Also he would not do any of the things I do like dishes and laundry and dusting etc. So I'm between a rock and a hard place. I've talked to his Pdoc and we've tried to cut out some of the meds, but so far nothing is working. And now my heating and air conditioning unit is on the blink. The compressor I think. So far it hasn't been bad cause the weather has cooled off, but soon we will need the heat. So it has to be fixed. or replaced.

My Dils are PO'd at me cause I can't babysit any more. My sons love their Nanny, but listening to their wives whine is getting hard on them too. No problem keeping the bigger boys, but the toddler is just too much for me. She and her brother both have ADHD I think. They are just off the chain. And my energy level is so low, I just don't think I can keep up with them. Speaking of whining...just listen to me whine. Ok done with that.....moving on...

I don't know if I mentioned it before, but my best friend whom I love like a sister has a prescription drug problem. I'm beginning to avoid her calls because she's always asking me for pain meds. She's always just one day away from getting her prescription filled and can I give her one of mom's percocets or my fioricets. I can't in good conscience give her any more. I'm afraid she will od or something. She's having black outs now. She's my best friend and I don't want to lose her either to the drugs or from getting angry with me and never speaking to me again. She makes me avoid her and now I'm lying to her about not having any. What do you do? Any ideas? My pdoc said I should just tell her it's illegal, but that won't fly cause we've helped each other out in a pinch too many times before to just suddenly say it's illegal. Another dilema as if I needed another one.

annt- omg
Do you know knotting hill the movie? we remind me of the scene where they see who has the saddest story to win the last slice of pie - and each story sadder than the other? yours breaks my heart. i wish i could help in some way

Oh wow. I thought I lost that post. I didn't see it and I figured I forgot to hit submit. ha! The migraine med is making me dopey.
Hey, I'm really not looking for sympathy. I hate being a whiner and yet it seems I've turned into one. Y'all overlook me and just skip all my moanin and groanin. I appreciate the sweet words tho.

OMG, Ann. Your husband is depressed and unemployed. Your demented mom lives with you and totally depends on you. Your sons married selfish women. And your best friend is addicted and expects you to supply her. You suffer from migrains.

Whew!

No wonder you are exhausted and grumpy!

You need to get some of these problems addressed! (No kidding, right?)

Your sons should be trying to figure out how they can help you with Nanny. Do they ever come over so you can have some time to yourself? Do they offer to take her to any of her appointments? That they expect, or allow their wives to expect, you to babysit their kids is outrageous. If they can't figure that out for themselves, I think it is time for you to set some boundaries. Yes, I know that is adding something else, and something distasteful, to your overflowing to-do list, and I'm sorry. But you did ask for advice. No more babysitting of the grandkids! How about you take them on an outing some evening or weekend while their parents stay with Nanny? Certainly you want a relationship with your grandchildren. But under the circumstances that desire is being exploited unfairly.

The girlfriend on drugs? Please, please don't give her any more. My brother is also addicted to pain pills. His doctors are quite careful but he has "friends" who feel obligated the way you do. It is not doing him any favors, and you are not really helping your friend -- which you know, which is why this is a problem for you. I think you might have to go with the truth on this one. "Friend, I'm really afraid you have become addicted to these drugs, and I am worried where that will lead. I can't in good conscience contribute to that. I love you and I want to keep you as a best friend. I'm sorry I can't give you pills any more." Whew, another not pleasant or easy task.

Now, for your husband. Depression is a serious illness. Is he taking his meds as directed, and following medical advice? Where is he while you are following your mother from couch to bed to bathroom? What does he do all day while he is unemployed? Is he unable to work because of his depression? Have you considered applying for disability? Do you suppose he feels like, "I'm hurting and I'm ill, but all my wife's attention goes to her mother. What's the use?" Just asking. Some people, especially depressed people, in his situation might be feeling that way.

And then there is Mother. Sigh. Have you been in touch with social services to see what might be available for her? Is there anything that could relieve your burden just a wee bit? Could they provide transportation to the day center? Cleaning help? Respite care? You don't know what is available until you ask. (Maybe you have already done this.) You are obviously working very hard at being an excellent caregiver for her. I'm glad you've accepted that the disease makes her fall -- you don't.

Whew! You have so very much going on in your life right now. One by one I hope you can address your stress points, if not by the ways I suggest by SOME way that will lighten your psychological load.

Best wishes to you.

Jeanne, Most of the questions you asked have already been addressed. Mom is in Hospice care, Husband has a wonderful psychiatrist and we are constantly trying to find the right coctail that will work for him. He is able to work a few hrs a day some days then crashes. He sleeps mostly. He tries to help with mom and is very loving to her. He has no jealousy there. He also has elderly parents in another state and has to go take care of them when he can. His dad has cancer and mom has heart disease. I understand his depression and have taken classes to learn to deal with it, but it's still very frustrating. I'm trying to get him to find a part time job for now til he feels he can work full time again. It's only gotten this bad in the last 18mos. I had to quit my job to care for mom. He's beginning to understand that I'm stressed out(depression often makes one self centered) and has stayed with mom a few times so I can get out. I'm not real comfortable with that tho cause he goes to sleep and is not really on the watch. Her fall last week was while he was with her. He's so used to me doing it all that he's not as diligent as he should be. I usually wait til I put mom to bed for the night to leave her with him. My mother also has some bowel issues that preclude asking him or my sons to stay with her during the day unless absolutely necessary. They would not know how to deal with the explosive diahrrea episodes that sometimes happen. Pancreatic cancer with dementia can be nasty business.
My sons try to help when they can. They all have small children, jobs and are going to school too. Their wives were spoiled by an overly indulgent mother. My sons look to me to put them in their places. Unfortunately, I have put up with their bad behavior and now I have trained them to act badly toward me. I have a hard time setting boundaries. And won't fight back unless I'm really pushed into a corner. I am the youngest of four children. Three brothers ahead of me, and an adult child of an alcoholic. Never felt like I had a voice. I've been working on that too. I have the same pdoc(psych doc) as my husband. And I'm also on meds for depression. My depression is event related. Having to deal with all this.

I have already made the decision not to feed my friends habit. Now I have to decide if I should approach her enabling husband. Her daughter in law would probably back me up, but I'm not sure. She also knows theres a problem.But mom in law has been so generous to her and her hubby that it's hard to speak up in a critical way. Some people control their atmosphere by obligating those around them. I think she is unconciously doing this. She's very sweet and hugely generous.

Anyway, thanks for listening. Sorry if I seemed to jump on Ruth. My nerves are pretty raw and it felt like salt in the wounds that someone else is able to control the falling but I can't.

TTYL
Ann

Is his medicine making him dizzy or unstable? Sounds like I would check on that. does he have a walker or cane close by? Is there a rail near his bed to hold onto? Are there rails on the bed of some sort? Can he ring a bell so someone will come and help him? Just brainstorming here.

As I said before Ann, Whew!

And you are doing a fantastic job. I probably would know some of these things from reading other posts, but I'm afraid I'm not very good at keeping people who post straight until I've interacted with them a few times. Sorry.

Hugs to your husband. He certainly deserves to be well. I hope the treatment plan is a success.

It sounds like you are doing a good job of learning to set boundaries. (Not easy for many of us.) I understand that the sons have to have peace in their homes, but it is too bad that turns you into the bad guy. Hang in there!

Some very fine people have fallen into the prescription drug trap. I sincerely hope your friend can get some help, without damage to her relationships in the process. Given your situation, it may be enough for you to refuse to enable her -- taking on a more direct intervention may be more than you should try to handle right now. When other aspects of your situation improve/conclude/change, then perhaps you can direct some of your energy toward her situation.

Don't let anybody tell you that any of this is your fault, or that you somehow should be doing a better job. I don't think that is what Ruth was doing, but I understand your defensiveness. Some people really do imply that, and you are right to reject such implications.

Well there are some answers here that are well meaning but outside my experience with seniors. I have a small ALF in SE Florida; these small group homes have more attention than large ALFs or skilled nursing facilities. We are not allowed to restrain them in any way, and that's what makes it tough with someone like this. For example the bedrails (built onto hospital beds) are not allowed. Yes there are Some cases where they're physically Able and very determined but Quiet about it, where they Might climb Over the full bedrail and more chance of injury. But we also had a woman who could NOT climb over Anything, but could move around in bed to get below the tiny 2-ft long rail we are allowed to have in Assisted living and fell out of bed that way a couple of times. At which point, I referred her out to a bigger ALF with hoyer lift tracks in the ceiling, and they have a way around the regs like an LPN on staff or something. We are all CNAs and/or HHA's in most ALFs.
In fact right now, we have a man who also jumps up out of bed and just fell twice in a week. The first time no biggie but the 2nd time the nightstand cut his head... Then if we move it away, we are out of compliance for what each room must have - nightstand by bed with at least one drawer, can have shelves, doors...
You would think whatever someone can do in their Home, we can do More here, but actually Not - for example insulin injections etc... I've found a lot of times it's about the money for Drs, nurses, insurance companies. And the Big places, of Every kind, have far Fewer staff to Resident ratio and that's Allowed by Law, so it Favors the big places and Punishes small ones that already do a better job in many ways for those not needing skilled nursing care.
Nursing facilities simply medicate them so they stay in bed at night. I give a couple of melatonin/Valerian/Chamomile tabs at bedtime, and if they like tea, I give chamomile tea to relax after dinner. Also, keeping them well hydrated through the day and not giving liquids after dinner can help (unless they specifically ask)

You may want to consider a Urologist consult b/c if he's doing the typical elderly man thing, that's a few drops each time, maybe a tablespoon and not worth getting out of bed for but they Feel it as if it's a full 'event' they need to rush to the bathroom for. So maybe the Dr can give him something (increase flomax if there are not contraindications) to help him go More and Empty the bladder, that then coupled with mild herbal sleep aids & Technology*, he can sleep sounder for a few hours instead of tryng to get up every half hour to hour like our guy does.
The Technology is Amazing - one of those radios by the bed that plays Sounds, like surf, rain, crickets & other soothing natural sounds. I find I sleep much sounder and wake more refreshed when I use mine, and it's given great results with a few clients.
If I find out anything else as we go through this with our resident, I will let you know.
Doreen,

Great posting, Angelhouse...... You are right on target! The smaller facilities where people get better care are punished and it's all about the $$$$$. The rules are all so crazy, I really do wonder if the people that make the rules have ever had a loved one in a facility, large or small. So much of it just doesn't make any common sense.

If I ever bring my mother to SE Florida, I'll be looking you up for sure! Sounds like you're doing a great job for your people!! God Bless!!

Gait therapy. Sounds goofy but it has helped both my parents. Their doctor prescribed it for them to see a physical therapist for this. There is one available in hte home that they are in.

Sorry you are in such a terrible situation but it sounds like you are going to have to have the care givers put some extra effort into their job and insist they do what they must even if your father doesn't like it. This is for his own safety since falls are at the top of the list for people his age going to the hospital and not coming out. Hopefully you can visit him as much as possible and give him support and love in his advanced age. You have been fortunate to have a father for a lot longer than many of us.

No restraints are allowed in an ALF. My mom kept getting up at night too, for years. And fell multiple times, even with help, railings and a walker. Now she is in a lower bed but it's too late as she had a stroke and can't get up anymore. I wish I had known about the bed earlier. Also, check the MEDS....my mom was taking something that made her restless and agitated at night and made it worse.

Does your dad's bed have bars around it? If it does, it might be able to prevent him from gettng up by himself or from falling off the bed. Since he is on high level of care already, is it possible to communicate with the nurses to maybe wake him up at night to go to the washroom so at least when he does so he is under supervision? (Just as when potty-training a child you would wake the child up at night to go to the washroom.) What do you think?

My 86 year old father flails his arms while sleeping. He has begun oxygen treatment. Are they related?

Bedside urinals are great. The bed and chair exit pads with remote alarm isn't quite quick enough for my needs. That 10 second delay can be the difference between home or ER visit. He's on coumadin which makes it that much more dangerous. He forgets to ring the bell he's had for years (dementia). A physical therapist told me about an alarm that alerts immediately as the feet go over the side of the bed and break a laser. His dog would set that off throughout the night. I purchased a belt that goes around his waist for me to hold onto, but find that his sturdy robe belt serves the same purpose. The bathroom scares me the most. We have sturdy grab bars and a sit down tub. I bought a slightly used Hoyer lift that's too difficult to use by myself. I would love a low bed except my dad could never get up unless the bed electronically lifts up. For some reason I can't bring myself to use any type of restraint. I know they're not harmful. It's my issue. Other than falling, I worry that he'll be scared or upset without letting me know (because of dementia & not knowing where he is, etc) 
I recently purchased a seat cushion with a slight slant towards the back of his chair. It's helped to reduce sliding out of his lounge chair. He has the television on too loud at night to effectively listen to him using a baby monitor. I walk behind him when he's up so he doesn't fall backwards (Parkinsons). I've decided to take a break from purchasing items in the hopes of avoiding a fall. I take care of two elderly parents with multiple medical issues as a 24/7 live in caregiver. I always hear that I must take care of myself in order to properly take care of them. It's not always that simple. When I saw the post above advising three full-time caretakers for 8 hour shifts it makes me think about my need for respite care. My parents insist they can stay by themselves because they don't want to spend the money.