Another Aging Parent Question

[PinkTulip]

Hi all, you were so helpful with my last post on nanny cam suggestions, that I thought I would ask her for help again:

is there a product that detects falls and will notify me instead of a central operator? My mom has fallen 3 times now in the last 5 days and adamantly refuses to go to assisted living. We have an aide lined up, and people to come into her home daily, but they won’t be there all day every day. She cannot use her cell phone. I’m hoping there is a product where she can push a button that will call me, or detects a fall and notifies me (in case she can’t push a button). 
 

I know, we should insist on assisted living or move her in with my sister or me, but she is hard and we’re trying to balance all the things. 

[Katy]

Gently, no reputable assisted living will take an elderly person who’s fallen repeatedly in the last few days. She needs to be in a licensed nursing home in a wheelchair with alarms on her so if she gets up an aide will come running. 
 

ETA: alarms are being phased out. I’ll post more below later. 

Edited May 21 by Katy

[prairiewindmomma]

For a time, we used an apple watch.  All she had to say was, "Hey, Siri, call __________."  

That said, 3 falls in 5 days is not good, as you know.  The fact that she can't use a cell phone is not good. I suspect she is scared at losing her independence and of dying. When you are dealing with big and scary emotions in the elderly, rationality rarely factors in.  It's rational that she should go to a nursing home. She's not dealing in rational. She's living in fear. 

FWIW, they have balance oriented physical therapy. I would try to get her in with her doctor to rule out other serious things, and then try to get her in to physical therapy.  The lever we used on this was, "You know, one broken hip and you're stuck in a nursing home. I know neither of us want that for you."  I'd also make sure she's had a recent DEXA done so that if she needs osteoporosis treatment, she's got a better shot at not breaking bones. I still think you're going to have incidents happen, but it isn't necessarily a quick run to the nursing home if she can turn around. We went from three sets of broken bones in one year....to her going to PT and OT and still managing at home 6 years later.

Edited May 21 by prairiewindmomma

[kbutton]

16 minutes ago, Katy said:

Gently, no reputable assisted living will take an elderly person who’s fallen repeatedly in the last few days. She needs to be in a licensed nursing home in a wheelchair with alarms on her so if she gets up an aide will come running. 

None of the nursing homes here use alarms anymore. They are considered restraints even though the person is not actually prevented from falling.

 

[Carol in Cal.]

2 minutes ago, kbutton said:

None of the nursing homes here use alarms anymore. They are considered restraints even though the person is not actually prevented from falling.

 

Here, too.  And although there are monitoring cameras in the rooms, no one watches them.  My dad was in the best SNF we could find for him and got up on his own and fell repeatedly.  They took absolutely no responsibility for that.  If I had thought of it sooner we would have hired a personal aide to just always be with him.

[mlktwins]

21 minutes ago, Katy said:

Gently, no reputable assisted living will take an elderly person who’s fallen repeatedly in the last few days. She needs to be in a licensed nursing home in a wheelchair with alarms on her so if she gets up an aide will come running. 

They won’t use bed rails or anything either. This is why I have 24/7 caregiving in my dad’s apartment. 

[lauraw4321]

13 minutes ago, mlktwins said:

They won’t use bed rails or anything either. This is why I have 24/7 caregiving in my dad’s apartment. 

Yup. This is what led to my grandmother's death. She fell from her wheelchair. I could tell she couldn't really be upright in it anymore, and they had a tilted one for her, but she was put in the regular one. She fell face forward and passed about 2 weeks later. I had asked about a seat belt - not allowed.

[Indigo Blue]

This is awful. What is one to do, especially if you can’t afford to hire an aide for an elderly parent? 

[PinkTulip]

Thank you everyone. I genuinely appreciate the help and the perspective. My sister and I are in the thick of big decisions and trying to figure out what to do and how to balance my mom’s wishes for her future with what is realistic. I appreciate your help! 

[Kalmia]

The multiple assisted living and nursing homes my MIL was in (NY) did nothing to prevent falls. She fell so often, so many contusions, a broken rib. They don't care at all. My SIL paid a private nurse to sit with her in one of the nursing homes all day to prevent falls. This was  ON TOP OF THE $10,000/mo for the nursing home. I was actually so relieved when she deteriorated enough that she could no longer walk. And when she would get hurt and went to the hospital, one refused to have her back! The elder care system is insane. If we don't buckle our kids in it is abuse, but if we do buckle in our elders it is abuse?!?!? In both cases living, feeling people can be injured, sometimes fatally from impact. And if alarms are restraint, I'm an orangutan. Yes, I have strong, ANGRY feelings about assisted living and nursing homes.

Edited May 21 by Kalmia

[gardenmom5]

re: the falls - has she had a GOOD eye exam lately?  it is one seldom diagnosed cause of falls with vision changes with age.

eta: the other thing to check is shoes.  you want a wider secure base.  

My mom had a number of falls, getting her rx stabilized (she'd double dose or skip a dose) made a big difference.

Edited May 21 by gardenmom5

[Katy]

Wow, that’s crazy. I knew a nurse who lost her license for not attaching an alarm to a nursing home resident who fell, broke a hip, then got hospital acquired pneumonia and died. I wonder if that’s everywhere in the US or only in certain states. 

[Pawz4me]

Just now, Katy said:

Wow, that’s crazy. I knew a nurse who lost her license for not attaching an alarm to a nursing home resident who fell, broke a hip, then got hospital acquired pneumonia and died. I wonder if that’s everywhere in the US or only in certain states. 

I don't know about nursing homes, but I have recent experience with an elder in a hospital setting here, and they absolutely did use a chair alarm while she was deemed a fall risk.

[Katy]

I just googled. There are NO laws declaring alarms to be restraints in the US as of December 23rd, 2023. But there was a nationwide movement starting last June to get rid of them because there should be more staff available to stop the person from standing in the first place. 
 

Personally I think this is ridiculous. I have not worked in a nursing home that was ever even ideally staffed. No nursing home will EVER have enough staff to prevent all people in the early stages of dementia from standing up when they are a fall risk. This seems like they want people to fall and subsequently die. 

[Katy]

4 minutes ago, Pawz4me said:

I don't know about nursing homes, but I have recent experience with an elder in a hospital setting here, and they absolutely did use a chair alarm while she was deemed a fall risk.

It was a legal requirement in the hospital I worked in the longest. 

[Pawz4me]

8 minutes ago, Katy said:

I just googled. There are NO laws declaring alarms to be restraints in the US as of December 23rd, 2023. But there was a nationwide movement starting last June to get rid of them because there should be more staff available to stop the person from standing in the first place. 
 

Personally I think this is ridiculous. I have not worked in a nursing home that was ever even ideally staffed. No nursing home will EVER have enough staff to prevent all people in the early stages of dementia from standing up when they are a fall risk. This seems like they want people to fall and subsequently die. 

Staffing rules were recently put into place for nursing homes. How or if things will change -- I don't know. I doubt it will change much. I know most nursing homes around here are constantly advertising for CNAs and nurses, but the salaries they offer can't compete with the local health care systems.

[Katy]

5 minutes ago, Pawz4me said:

Staffing rules were recently put into place for nursing homes. How or if things will change -- I don't know. I doubt it will change much. I know most nursing homes around here are constantly advertising for CNAs and nurses, but the salaries they offer can't compete with the local health care systems.

Unless we open up to a lot of immigrants, we don't have enough people to staff one CNA to every 2 nursing home residents. We just don't.  There are too many baby boomers and not enough younger people.

[Carol in Cal.]

5 minutes ago, Katy said:

Unless we open up to a lot of immigrants, we don't have enough people to staff one CNA to every 2 nursing home residents. We just don't.  There are too many baby boomers and not enough younger people.

Almost all of the assisted living and outside aides at my parents assisted living facility were from the Philippines, many not very long before.  Tagalog was spoken far more than English there.

[Ailaena]

To specifically give a recommendation for this situation: Alexa. If you put an echo in strategic places, she can call out emergency and it will call the number you tell it to.

I’m sorry you’re dealing with this.

 

[Tenaj]

My Aunt has a device through Lively (she also has a Lively jitterbug phone).    It cost $35 a month and has a fall detector built in that we activated.  It is monitored so she can push the button to get help and they can talk to her but it also has fall detection.  They actually call me first.  They did call EMTs one time because they couldn't get me on the phone.  

One time I was with her when she fell and it was nice to hear them contact her right away through the speaker and ask questions until they were sure she was ok 

We've been happy with it.

 

[kbutton]

1 hour ago, Katy said:

Wow, that’s crazy. I knew a nurse who lost her license for not attaching an alarm to a nursing home resident who fell, broke a hip, then got hospital acquired pneumonia and died. I wonder if that’s everywhere in the US or only in certain states. 

I suspect it’s to avoid lawsuits like this. Because they can’t realistically avoid all falls, having a monitor makes them more negligible because “they should’ve gotten there in time.” So, calling them restraints is how to un-liable themselves. That’s my guess.

DH worked in a nursing home and for a good fifteen years afterward had nightmares about not getting to call lights fast enough, and he was an excellent aide. (In the case of call lights though, it was to be changed, and many old people finger paint with diaper contents just like toddlers will.)

I didn’t offer up the idea of hearing aids with fall alerts because I don’t know who gets called. I do know you can get fall detection aids, and you can also get ones that will do reminders for things too. They add new features all the time.

[Carol in Cal.]

To the OP:  ADT has a fall detector option, and it's monitored.  Their first call is to the owner.  Then they go down the chain as established by the owner, calling 911 only if that prior work fails.  The issue is that the pendant has to be worn all the time.  Not always easy to arrange remotely.

It's really sounding like your relative can't be alone.  That's not addressable just by putting them into a home.  You have to arrange continuous care or at a minimum, continuous monitoring, and the institutional settings are not set up for that--not even hospitals.

[DawnM]

3 hours ago, Carol in Cal. said:

Here, too.  And although there are monitoring cameras in the rooms, no one watches them.  My dad was in the best SNF we could find for him and got up on his own and fell repeatedly.  They took absolutely no responsibility for that.  If I had thought of it sooner we would have hired a personal aide to just always be with him.

when my dad fell repeatedly, they told me I would need an aide with him all the time.   So, in addition to the $283 per day charge, they wanted me to pay $720/day for 24 hour bedside nursing care.   I don't have $30k per month!  $30/hour times 24 hours.

[Carol in Cal.]

2 hours ago, DawnM said:

when my dad fell repeatedly, they told me I would need an aide with him all the time.   So, in addition to the $283 per day charge, they wanted me to pay $720/day for 24 hour bedside nursing care.   I don't have $30k per month!  $30/hour times 24 hours.

I only wish they had told me.  When we moved my dad into assisted living, they started him with a fulltime aide, and I saw clearly how much difference it made and how essential it was.  I sold my brothers and sister on continuing, and I'm thankful that I did.  But if I had seen this sooner he would have been a lot better off.  His last fall in the SNF was what led to his terminal problems as well as a lot of discomfort.

[Faith-manor]

My mother in law fell today. She went down four steps on the side of her porch. She was beyond lucky Mark was actually heading to his car to leave when she decided to try to go out to her flower bed. She refuses to keep her cell phone or call alert button with her so she would have laid on the grass and likely died. She isn't badly hurt. But I was not slated to see her tomorrow, and Mark had meetings in the city all day. No one would have checked until evening - her choice. 24 hours without water, laying in the elements, not getting her five different BP meds on time. I doubt she would have survived.

She refused to go to the hospital, and told Mark after he helped her into the house and got her a sandwich and a big glass of water that he had to leave because she was fine. Ordered him out the door. This is her whole schtick. She would rather die miserable, in pain, and alone than accept that she needs more help and supervision. She refuses to have a wheelchair ramp. She refuses to use the walker.

Even IF she agreed to an aide, she has $15,000 in the bank, and $2000 a month in pension/social security. She can't afford it. It would fall on us. Mark figured out if she lives five more years at the current price of a CNA for just 12 hours a day/7 days a week and we do the rest, after we pay the taxes to withdraw the money from his 401K to pay for it, 1/3 of our retirement savings would be gone before he ever retires. She absolutely refuses to sell her house and get the less expensive but very nice condo in the senior center which is fully handicap accessible, made to reduce fall risks, and has someone who checks on each senior twice per day. Her home is worth a lot so she could do that, and use the remains to fund a housekeeper and an aide to help us out with all of this.

Sigh. He has given up. It is just mentally too much. He is reconciling himself to the fact that she is going to die horribly and alone in that house, and we can't stop it.

OP, I have no advice just a lot of hugs from me to you. Take care of yourself.

[J-rap]

This is a tricky and difficult stage.  I'm sorry.  Constant falls are usually the beginning of a big decline.  My dad started falling often, and I researched fall buttons and there were a couple that looked good and had good reviews.  You can google them.  Your mother would need to wear the button all the time.  My dad, unfortunately, was stubbornly against that idea.  Fortunately, he always had his phone on him and was able to call us when he fell.  But we also checked on him everyday and he had neighbors across the hall who did too.  (He lived in a nice senior apartment complex.)

His last and most serious fall sent him to the hospital, and then to a rehab facility.  They were great about helping him with his falling.  They wanted him to get stronger so he wouldn't keep falling and could live independently again.  They put a mattress on his bed that had the sides built up, and passed his room about every 30 minutes or so to check on him.  He wasn't even allowed to be in a wheelchair unless he was in a public place, since he was a fall risk.   (When he was in the hospital, there was an actual bed alarm, but not at the rehab facility.)   While in rehab, they really pushed him to get stronger -- which is what he really wanted.  He did a lot of physical therapy!

His path didn't go so well after that though... He was 96!   But he had lived in the independent senior apartment for four years and that was great!  

If he had lived longer and was still sharp and wanting to be semi-independent, our state has a version of Medicaid that takes over long term care  payments but I think can sometimes help with home care or assisted living.  There's also help for veterans (through the VA) who need help while living independently.  My dad would've qualified for that as well, if he had lived longer.  

This is a hard stage and I wish you the best!

[Laura Corin]

34 minutes ago, Faith-manor said:

My mother in law fell today. She went down four steps on the side of her porch. She was beyond lucky Mark was actually heading to his car to leave when she decided to try to go out to her flower bed. She refuses to keep her cell phone or call alert button with her so she would have laid on the grass and likely died. She isn't badly hurt. But I was not slated to see her tomorrow, and Mark had meetings in the city all day. No one would have checked until evening - her choice. 24 hours without water, laying in the elements, not getting her five different BP meds on time. I doubt she would have survived.

She refused to go to the hospital, and told Mark after he helped her into the house and got her a sandwich and a big glass of water that he had to leave because she was fine. Ordered him out the door. This is her whole schtick. She would rather die miserable, in pain, and alone than accept that she needs more help and supervision. She refuses to have a wheelchair ramp. She refuses to use the walker.

Even IF she agreed to an aide, she has $15,000 in the bank, and $2000 a month in pension/social security. She can't afford it. It would fall on us. Mark figured out if she lives five more years at the current price of a CNA for just 12 hours a day/7 days a week and we do the rest, after we pay the taxes to withdraw the money from his 401K to pay for it, 1/3 of our retirement savings would be gone before he ever retires. She absolutely refuses to sell her house and get the less expensive but very nice condo in the senior center which is fully handicap accessible, made to reduce fall risks, and has someone who checks on each senior twice per day. Her home is worth a lot so she could do that, and use the remains to fund a housekeeper and an aide to help us out with all of this.

Sigh. He has given up. It is just mentally too much. He is reconciling himself to the fact that she is going to die horribly and alone in that house, and we can't stop it.

OP, I have no advice just a lot of hugs from me to you. Take care of yourself.

I'm sorry. I had to respect my mother's wishes then wait until she ended up in hospital.  At that point her future was shaped in collaboration with doctors and a social worker.

[gardenmom5]

8 hours ago, Katy said:

I just googled. There are NO laws declaring alarms to be restraints in the US as of December 23rd, 2023. But there was a nationwide movement starting last June to get rid of them because there should be more staff available to stop the person from standing in the first place. 
 

Personally I think this is ridiculous. I have not worked in a nursing home that was ever even ideally staffed. No nursing home will EVER have enough staff to prevent all people in the early stages of dementia from standing up when they are a fall risk. This seems like they want people to fall and subsequently die. 

yeah - that's never going to happen.  Even if they had one person for every single patient deemed a fall risk - as soon as they leave the room for five minutes (pick up a rx, go to the restroom themself, etc.) that fall-risk patient can be climbing out of bed. . . 

bed rails, alarms, and whatever else sure didnt' keep my fallrisk mother in bed. . . 

[DawnM]

10 hours ago, Carol in Cal. said:

I only wish they had told me.  When we moved my dad into assisted living, they started him with a fulltime aide, and I saw clearly how much difference it made and how essential it was.  I sold my brothers and sister on continuing, and I'm thankful that I did.  But if I had seen this sooner he would have been a lot better off.  His last fall in the SNF was what led to his terminal problems as well as a lot of discomfort.

I'm sorry, that is rough.

At the time they told me that, we also got the diagnosis of bone cancer so I spent several days fighting the insurance and hospital to get dad to the hospice house, which is typically free, but I told them I didn't care, I would PAY if I had to in order to get him the care he needed.

He finally did get approved and we didn't have to pay.   He was only there 10 days before he passed, but at least his last 10 days were as comfortable as they could be.

[Eos]

Like a previous poster, my mom wears this https://www.livelydirect.com/mobile2/ but it didn't detect a fall she had last week. She has to charge it overnight and making her way to the bathroom when sleepy and in the dark makes me guess that one night she will fall without it.

[Tenaj]

1 hour ago, Eos said:

Like a previous poster, my mom wears this https://www.livelydirect.com/mobile2/ but it didn't detect a fall she had last week. She has to charge it overnight and making her way to the bathroom when sleepy and in the dark makes me guess that one night she will fall without it.

The charge time is a problem because I want my Aunt to wear it especially at night.  In our situation, we charge it when her aides are there during the day and then they make sure it's on her when they leave.  Her most recent fall occured when she for some reason had taken it off and I am often finding it off when I arrive.  Not much I can do about that though 

 

So sorry it missed your mom's fall.  I am surprised because my aunt's has gone off twice at my house when she has "dropped"(sat down ) on the couch 

[Eos]

2 hours ago, Tenaj said:

So sorry it missed your mom's fall.  I am surprised because my aunt's has gone off twice at my house when she has "dropped"(sat down ) on the couch 

Yes, hers also sometimes alerts when she's done something other than fall like sit down or pick something up off the floor.

[Alicia64]

One device that can really stop most of the falls is a rollator. They're way prettier today than ones of old.

Let me know if you want info, I did a ton of research before I bought.

[Ottakee]

Also might want to check with the doctor on a UTI and have a pharmacist review the meds.

[goldberry]

My dad got an emergency call button he could wear from the VA.  It was free, and when he lost one, they replaced it for free.  It could be programmed to call caregivers first.

[dsmith]

I would have her medications looked over by a geriatric specialist to be safe. When mil had a serious fall a few years ago, they reviewed her meds when she was in ICU, and were amazed at what her doctors had her on. They cut a lot of things out, reduced pain meds and tranquilizer doses, etc. The blood pressure medications especially needed to be cut down. I feel guilty about it, because she was slurring a bit a few days before the fall and we just put it down to fatigue. But her falls were increasing during the few months leading up to that. When we cleared out all her meds while she was in the hospital we couldn't believe the extra medications she had laying around, especially pain meds that weren't hers. I don't know how she figured out what she needed to take when. I'm pretty sure she went through withdrawal while she was in ICU. We got a lot of pushback when she came home, from her and my fil about her reduced prescriptions, not just pain meds. But we wouldn't budge on the changes and the new doctors. No way was she going back to the one that put her on most of that crap. We fill her medications into the daily plastic pill holders every Sunday and give her one every morning. 

Even living in the same house as mil, we still have a Philips LifeAlert pendant for her. We also had one for fil before he died. We can't always tell when she falls, although if it's a big one we can usually hear it. She won't keep her pendant on when she goes out, and it only works in the house, but she forgets to put it back on. My son usually will make sure she has it on. I'm not sure if it can be set up to call someone before first responders. We usually respond to the person on the speaker right away that everything is ok or that we need help. I'd call a few different companies and ask. Hasn't happened while she was alone in the house yet - that's very rare.

Edited to add: If it hasn't been mentioned yet, maybe she should be checked for TIAs. That happened to an aunt - she was having TIAs every few days, and she would fall every time.

Edited May 22 by dsmith