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Mom is 97, dementia, been in MC at ALF for 1 year 4 months. She was mobile at placement but has had 9 falls in since placement. All falls have been face forward resulting with goose eggs on forehead and bruising masks around eyes and nose. Never is observed when falls but is transported to ED for CT Scans. Luckily has not broken any bones. Has anyone ever requested to view tapes from cameras to confirm that no events are occurring that would create a fall. Mom is oldest resident on the unit and is still mobile where many residents are wheelchair bound. Really concerned she cannot recover from many more forehead injuries.

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The sad fact is that falls happen in the extreme aged population.

So many reasons;
physical & cognitive
- Reduced eyesight / changes to vision
- Reduced muscle strength
- Reduced balance
- Dementia - memory but also dementia brings damage to the areas in proprioception areas of the brain (sense of body position)
- Confusion, delusions
- Arthritis, stiffness
- Fatigue
- Legs giving way
- Stroke, TIAs
- Heart attacks
- Blood pressure changes

Then there is impulsivity & lack of insight into walking ability.

Preventing all falls is sadly not always possible. Not even with someone right there, as it is near impossible to safely 'catch' someone. Both can get injured.

But trying to prevent as many as possible is always a good goal. Looking for a common theme could help. Eg most falls are on waking at 6am, or during staff handover, or middle of night in bathroom.

I'd try to phrase it that way with staff - that you are looking to investigate the falls in order to help identify a common cause. (Better to have staff on side & helpful, rather than defensive).

The usual strategies are ruling out medical issues & adding MORE supervision.

Supervision can include being sat in a day room in view of staff, bed & chair alarms to alert staff quickly, adding in regular supervised walks & bathroom trips.

My Grandmother had many falls. Loss of conscious (suspected TIAs). Supervision & company couldn't prevent them.

I hope you can find some solutions & improvements.
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Have you seen the facility fall reports? I would assume the falls are reportable to the state as in NYS when I worked there. States have a procedure to safeguard against falls. Careplan needs to be set up by the facility. Ask to see that. I also might consider doing a call to the state surveyors to review her case. My mom at 89 has falls but she is off balance and using a walker. Her Lewy Body Dementia raises her risk. She fell showering alone so the care plan now states when they shower her {her time not theirs} and every effort is made to avoid her trying to shower alone. Good Luck
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Beatty gave a very thorough answer.

I would want to know if the falls are occurring at night. If so, one solution is to put her mattress on the floor. Or there's such a thing as a concave mattress. If it is happening during the day as well, then that's a different challenge.

My 100-yr old Aunt has advanced dementia and still believes she can get up and walk -- and often attempts it. We have to watch her all the time! When she's in her recliner watching a dvd we have an alarm on her in case she attempts to get up. If she does, she just falls -- she cannot walk unassisted. She broke 2 bones on 2 separate occasions even with family caregivers right there with her. All the more a challenge in a facility unless you hire a private aid to stay with her all day.

My Aunt's dilemma is that no one can legally be restrained in a facility or in their home. Until she qualifies for LTC and can no longer get out of bed or a chair on her own, falling will continue to be a risk for your Mom. I would discuss strategies with the admins, as she is not their first case regarding this situation.
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I’d be surprised if there are tapes. Camera in her room ?

when my mother started falling more, the MC put an alarm on her chair / bed if she got up. They had talked of moving her room closer to the center of things. But things progressed rather quickly for my mom.

maybe time for hospice to be involved? She may qualify and receive the benefits. As things progressed for my mom, a wheelchair arrived, a bed table, a hospital bed.. better yet more eyes on, a CNA twice a week , a nurse visit weekly, clergy visit weekly, social worker monthly, depends, pads , lotions etc… you may not see your mom as needing hospice, I didn’t… but as I said , things progressed quickly for her.
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My mother had a hospital bed that lowered from regular height all the way to the floor. It also had rails around it. On both sides of the bed there were vinyl (or similar) foam mats much like those used in a gym for gymnastics. All of this made falls less likely because even if she managed to get over the rails (unlikely), she couldn’t raise herself to standing and the mats cushioned the floor if she fell from the lowered bed while trying to get out. This equipment might help your mom, but she’ll almost certainly still fall at times. They can go limp when being supported even by two or three people. They can tip over at the slightest opportunity. It’s quite common and the attendants do the best they can.
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My mother lived in AL and then Memory Care AL (same facility) for 7 years and had 95 falls during her time there. I never asked to see 'tapes' of anything, either. My mother was old, had neuropathy in her legs and feet, refused to use her walker, and had her own way of doing things that did not include following directions. When her dementia set in, things started REALLY going downhill with the falls. The staff bent over backwards to prevent her from falling, and installed bed alarms, chair alarms, all sorts of things which did not work. Mom kept falling, through nobody's fault but old age, infirmity, neuropathy and a hard head.

Once she moved into Memory Care and became wheelchair bound, that's when she took the majority of those 95 falls; off the toilet, out of bed, off of her wheelchair, etc. For me to ask to see 'tapes' would show a distrust of the Memory Care and to insinuate blame on their part for her falls. That was not the case at all; falls happen ALL the time to very old people, especially those with dementia going on. So to answer your question, no, I didn't ask to see tapes b/c I knew why mom was falling and didn't need to analyze anything. She thought she could walk which she couldn't, and so, she kept trying to get UP from a sitting position or from bed and WHAM, down she went.

Any managed care facility can only do what they can do to keep a resident safe, but they cannot monitor them 24/7. Even if they could, the resident would STILL fall b/c that's the nature of the beast with advanced old age and disease.

My mother never went to the ER for any scans when she fell b/c she never hit her head, so it was not required. The fact that your mother is still mobile at 97 tells me she WILL fall no matter WHAT the MC does to help prevent it. Nature of the beast and all that. At 97, she WILL die from something, one way or another, so it's impossible to prevent it, unfortunately. That was my take on all my mother's falls and all the phone calls and all the hand wringing for all that time. Ultimately, she passed away in February from advanced dementia and a very tired and worn out heart that gave out. Not from any of those falls, believe it or not.

I know how difficult it is to deal with all of these falls, trust me. But it's impossible to prevent them. Unless this MC is blatantly leaving trip hazards out for mom to fall over, they're not at fault. Old age is the culprit. Accidents happen continuously at 97 years old b/c their balance is dreadful. Plus, they don't pay attention to what they're doing or where they're walking. Before mom went into a wheelchair, she'd look all over BUT where she was walking, and walk into walls all the time. It about gave me a heart attack to watch her stumbling around. It was truly a miracle she didn't break her neck long before nature took it's course and she died at 95.

Wishing you the best of luck with a difficult situation.
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Mymomsthebest Sep 2022
Well ..falling off toilet is def negligent since they should have known not to let her there unattended. This happened with my mother -in-law who was luckily not badly hurt , just very very bruised . We arrived just afterwards and the staff said they “told her to pull string for help back to bed”. She was a documented fall risk and had dementia. I said , as I had told them many times prior.. she might sweetly nod her head and say “oh I understand” but the minute you leave the room she has all ready completely forgot what you told her, that there is a call string and even that she has any difficulty walking !
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I installed a very inexpensive ($20?) camera in mom's memory care apartment. Not so much for falls, but to track her "stolen" items and show her the "thief" is actually her. If/when mom starts to fall, it will be very helpful to show how the falls happen. The facility cannot prevent you from installing a camera, but it is on you to make sure there is a wireless connection in her room. This was already part of the installation of mom's TV/phone, so I was covered there. I will warn you - it can be very depressing watching your loved one's "life".... my mom mostly refuses to participate in the multitude of activities and just sits around all day.
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Residents fall in memory care because there are usually 2-4 staff on to manage 10-15 residents. I had an approved camera in my moms room at a very upscale memory care facility and can tell you that she was left alone for hours on end to get into all kinds of situations. Sometimes she had fallen and spend hours on the floor before someone came in to check on her. Everyone with a loved one in a memory care facility should have a camera. You are their only advocate and trusting complete strangers to be his/her voice makes no sense. The reason elderly have so many falls in any of these facilities is because they are not receiving appropriate care which for most dementia residents is continuously checking and monitoring their activities and bathroom schedule.
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help2day Sep 2022
"The reason elderly have so many falls in any of these facilities is because they are not receiving appropriate care..." Actually, that's not true. The main reason elderly people fall is they are elderly. Their muscles are getting weak and they will lose their balance. Why do you think many have walkers? My own mother had THREE walkers and would never use them! She tottered around grabbing onto furniture, tables, walls, etc, to get from room to room. She hated using them.

Gravity is a real problem when you get old and sit all the time. Muscles weaken and many elderly people have arthritis and/or osteoporosis that weaken their bones. No MC or NH is going to have eyes on your loved one 24/7. Just isn't possible.
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Many facilities do not allow cameras...surprise!!!How ineffectual with all the pluses that you would have identifing problems...I was told at my Dads NH that the state of Virginia does not allow them....probably a little detail conserning liability issues but what a boon these would make and people are naked..which really is an invasion ....I too wondered is the attendant giving my Dad any water,is he being diapered.....so as things went along I had planned to put a camera in myself in a little stuffed toy by his side but sadly Dad died....actually cameras would identify
a number of problems...really...can u imagine monitering all that activity....and the large square rubber mats that are used in a health club are really cheap...they are the black puzzle type that fit together and sold at Lowes....to surround the bed...
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My mom falls often, too. I placed a Wyze camera in my mom's room. It connects to her wifi and I have an app on my phone so I can check on her anytime. I did not ask for permission and they have not said anything. The Colorado Ombudsman for Long Term Care actually recommended one, after I had placed the camera, so I'm assuming that they may be permissible in one's private room in Colorado. You should call you state's Ombuds office if you want clarification. What I learned from witnessing her falls is that sometimes she just falls over. I've seen her just sit and fall too. The worst was when it appeared she fell asleep in her chair and fell out of her chair directly onto her face. I'm not sure there is anything that could be done to prevent my mom's falls. I've also seen a lot of tenderness from the care staff. They cover her with blankets when she is sleeping and always are very kind to her. The camera gives me peace of mind.
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Perhaps she needs to be in a wheelchair now. My mother fell three days after moving to her memory care and hit her head on her bedside table. That resulted in 28 stitches, and a wheelchair. She never fell again.
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My 96-year-old dad kept falling. It was happening almost three times a week. He’s been pretty lucky. He has not broken anything and he has had one trip to the emergency room for stitches, but mostly he just really injures and opens up his arms because of his creepy skin and he needs wound care. We were finding that he was falling when he gets up from a sitting position and tries to walk. Before, he was refusing to use his walker because he felt it made him look like an invalid and he wanted to look like a strong man. He finally learned that he needs to use his walker. Now that he uses his walker, he has had no falls. He wears a button on his wrist at assisted-living and he has been very good with pushing that button when he falls. That brings emergency care to him from the facility and the facility also contacts his doctor and Wound Care is set up if needed. Of course, in Colorado, you need authorization from a family member for wound care. My dad is currently undergoing wound care and he has an LPN come in twice a week to take care of his wound and they will come by contract for 60 days. I doubt he needs 60 days of Wound Care but it is nice to know that he is getting focused attention twice a week.
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Talk to her doctor, ask for a PT gait eval. She might just need a walker
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Have you considered putting a camera in her room? I have Wyze cams all over my mothers house, and they are extremely helpful. Cost about $30. They can see in the dark as well as during the day. With memory cards, which cost about $6, it’s possible to look back and see what happened.
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A physical therapist can offer information, a heart specialist may have a test to determine why she is falling, getting a walker with a seat will be very helpful, a helmet may save her from severe injuries. Perhaps a body cam is affordable? Hope you find the answers you need.
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My mother was a good walker until her dementia advanced. She also was then falling often in her MC facility. Then she "forgot" how to walk and eventually was not assisting with transfers from bed to wheel chair. Talk about your mother's falls with her case manager and nurse at her facility. They may have some ideas about when it is happening. Ask them for advice on how to prevent the falls. Are the falls happening when she is trying to get out of bed? Should she be getting occupational therapy to learn how to use a walker? Maybe she needs to have an aide with her now when she is walking. Can she get a hospital bed with bars so that she cannot get out of bed on her own? Medicare pays for durable medical equipment like hospital beds and wheel chairs or walkers, when needed. The nurse could probably order it for her. Should you mother be using a walker or wheel chair now? My mother never could learn to use a walker, she had to transition to a wheel chair. Then she started reaching for things that nobody else could see and would fall out of the wheel chair face forward. At that point she was in hospice-type care with a no-hospitalization directive. Hospice recommended a geri chair, which is a very supportive comfortable chair that can recline and is impossible for people to fall or get out of without assistance. This is going to be a difficult time for your both as her health declines. Take it day by day, and make the necessary adjustments for her condition as it changes. Try to keep her functional as long as you can. All the best to you both!
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Tenie2: Imho, quite honestly IF you were to ask to view videotapes (if they even EXIST), it may be a moot point because it's a known fact that elders do fall. While certainly scary, it's generally common knowledge. My late mother took many a tumble, many times without letting me know. One time in particular that she did advise me, she said "I slipped out of a chair." I thought to myself 'How can that even occur?' Falls in the elderly population occur with age, weakness, drops in blood pressure, failure to use walkers and other mobility devices for fear of 'looking old' (yes, that is sometimes a mindset, believe it or not) and other things. My mother said that she didn't tell me about all the falls with a childish response "I don't need to tell you everything." I said that that was true and I didn't need to know when she broke a nail per se, but I definitely needed to know when she took a tumble.
Best of luck during this difficult time.
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Beatty avatar
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Beatty Sep 2022
They slip off chairs when they slouch too far.

If they have lost much core strength, they cannot correct themselves. Can't sit themself upright then wiggle each hip back.

Instead (sadly) the slouching means the bottom slides too far forward on the chair. Too far then Oops! Bottom over the edge of chair, gravity to the floor.

I have seen this many times.
(aka the bumslide)

My LO should have a medal in bumsliding - multi event: chair, commode, bed & toilet!
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I feel that they don't give enough physical therapy to help people to be strong and to help their balance. We need a total overhual of how we care for people in nursing homes. Most nursing homes will not allow cameras but it is a good idea! My brother just fractured his clavicle from a fall and I blame the fact that anyone's muscles would atrophy from not having any exercise.
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If mom is the only one mobile y do u leave her there. Those caretakers are lazy. If everyone is in wheelchairs no one has to do anything. Ur mom is falling bc there not assisting her. Sounds like she’s in the wrong place. I would sue them. U don’t have to ask for camera contact a company place ur own tiny camera(s) in her room. If u have to do that and so worried I would remove her. Sounds like u didn’t do ur homework and just placed her wherever. She should be around like minded ppl. All those falls trust it has did her damage u just can’t see it. Do u talk / listening is the key to help mom
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Elderly do fall..but not ALL elderly ..or not just because they are weak or unstable. They do sometimes trip over linen , because a potted plant is out of place , because someone know is into them , wet floor , etc…but will be blamed on their age. In point of fact recently I fell in one store and almost fell in another ..why? Because in one there was a shoebox on floor right where I was going around a pole and I didn’t see it as I was looking ahead, in second I was looking at the shelves of toys and there were boxes on the floor below..right in the walking path and I had to step sideways to get through but I didn’t go down. For my mom, when she had her second and most devastating stroke ..we told the ER personnel that we strongly suspected a stroke ..but as she likely experienced it , as she was sitting on her bed after an independent shower , perhaps feeling faint due to impending stroke, she did go to her side and possibly hit her head ..no marks though we looked. She was in her 80s so despite our saying she was speaking exactly how she did after her first stroke, her left of face and mouth was drooping slightly , and when they were examining her I pointed out that she had lagging on the left arm — they kept asking whether she used a wheelchair or a walker (neither!) and would have sent her home but she was too weak to make it to the lav to give a specimen. They decided to keep her for observation ( not even admitted) , what they didn’t tell us was they were only checking for signs of hitting her head (though they didn’t do an mri but ordered a cat scan for following day) and her diagnosis was “weakness”. They didn’t even put her on the stroke protocol! And all because she was elderly and medical providers hear 80 and assume person is decrepit. That night she experienced a full stroke , losing use of her left side ..and interestingly ..or shockingly ..the staff didn’t even NOTICE ! When her daughter arrived to find her slumped to her side breakfast tray in front of her and drooling her food m unable to swallow and confused that she couldn’t use her left side ..the nurse scolded my sister that “ you can’t expect a miracle recovery from her stroke. They somehow thought this was residual from her first stroke years prior , despite our telling them she was fully functional. So don’t assume people jsut fall because they are elderly or,even infirm ..sometimes it is negligence and we need to hold people accountable . Oh and as a note ..when we called lawyer and got copy of her records .
the ER reports contained NO mention of any kind about our insistence that this was stroke related..NONE .
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Luta65 avatar
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Luta65 Sep 2022
I'm so sorry to hear that your mom received such poor care and that no one listened to you and your other family members. I'd imagine that it's very hard, the wondering whether her being placed on the appropriate stroke protocol may have spared her the second stroke in a 24 hour period.
I would personally have to try to Let Go and Let God and try to accept that this may have gone according to a plan much bigger than I and that I lack understanding for.
Unfortunately, the state of medical care is no longer what we grew to expect in years past and I fear it will decline ever further. The demand for Elder Care will only increase and as our population ages, there will be fewer of the able-bodied available to care for us.
My dear Mom is in a SNF and early on, I spoke with an Elder Law attorney who was very forthright with me. Our US culture places little value on the lives of our elders and even the most heinous acts of neglect, whether medical or care related, can be brought to suit because juries do not award much at all for the early loss of an aged person.
Having records is important, but don't expect to find a basis for legal action; charting is not reflective of the neglectful care provided and it's impossible to force accountability for poor medical or other care provided.
I'm a retired RN, have worked in most every kind of care setting, ended my nursing career in Hospice and Home Care and I loved it.
What I encounter now, when on the receiving end of care is a lack of caring and compassion that years back, would have been career -ending for nurses; it's now the norm. I encounter RNs with whom I would've been unable to work, so poor is their personal standard of care.
We're in for it; we Boomers are on the cusp of the shortage and I thank God for the many wonderful immigrants who are holding themselves to a higher standard of care because of their cultural norms of honoring elders. The best care I've received has been from people of color, including MDs and nurses, and this is without exception.
Despite those precious few who provide good care, we have to be at bedside with our loved ones if in hospital and closely monitor cares in any SNF. We have to advocate for our loved ones while under the care of others and all we can do is our best.
I hope that you mother can regain some of her losses from the recent strokes and that she's spared from suffering.
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Just because your mom falls, it doesn't mean the facility is doing something wrong. Assisted living is for folks that are still relatively independent. This could be something as simple as your moms shoes catching on the carpet. It could be that she has deteriorated some. She is 97 and at that age folks typically decline, not improve. I am guessing the facility is assessing her to make sure she doesn't need more care....???

I do know of people who have installed cameras in their family members assisted living apartment. You could try that or change her shoes, make sure that furniture is not in the way or maybe move it out up against the walls...nothing in the middle of the room, etc. Make sure she is not wearing long nightgowns or housecoats. My first thought is that she may need more care than assisted living.
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