Today's ingredient leaves a very sour taste in my mouth. Today we are adding falls to our Caregiver Salad.
Unfortunately dealing with resident falls will be a part of your job when working in a Nursing Home or Assisted Living Facility.
Falls can also become something you have to deal with as the caregiver of a loved one in your home.
As someone ages they become much more prone to falling.
There are many different reasons for this.
Some of those reasons are:
Pain or weakness in their legs that can cause issues with getting around.
A struggle with balance control causing them to tip and fall much quicker than a younger adult.
Problems with vision that can cause them to be less likely to notice obstacles in their path leading to a trip and fall.
Memory issues that cause them to forget they have limited abilities, making them prone to try and move around without the walker or wheelchair that they need.
Memory issues and/or slower reaction times can also cause them to forget how to protect themselves during a fall, making that fall much more detrimental than the same fall would be for you or I.
As caregivers we can do everything by the book and a resident or loved one can still experience a fall.
As always, a caregiver in a facility will have access to more resources than a family member or friend trying to do this on their own.
I am reminded of the time my dad had knee replacement surgery. During his recovery he had a very minor fall. Luckily he fell right into a bean bag chair that was sitting in the room. He wasn't hurt but he was on the ground or near to it anyway. My stepmother and my daughter were his caregivers and they had no way to get him up. Dad had to sit on the ground until they were able to get another family member over to help.
In a facility all the help and the tools would have been on hand.
If you are a familial caregiver and you find that your loved one is falling more often, I would strongly suggest getting a gait belt for your home.
A gait belt is a good way to keep your loved one steady and on their feet while they are moving about with your assistance.
A gait belt can also be used to assist your loved one up out of a low chair, bed or off the toilet.
It's important to remember that a gait belt is a mobility assistive device, and it should not be used to lift or move patients outright. If the patient is not able to partially move themselves, a powered portable or mounted lift device should be used to safely transfer them.
As with any assistive medical device. Please have a professional show you how to use it correctly BEFORE you attempt to use it on your own
Here in the state of Minnesota another wonderful asset that you may not know about is your local non-emergency first responders number.
This number can be called if your loved one has fallen and you are unable to get them off the floor on your own.
If your loved one is hurt and needs emergency assistance call 911.
If you are unsure if they are hurt always call 911 to be safe.
As a caregiver who works in a facility, I do have the luxury of having a lot more resources at my disposal but that doesn't change the fact that falls will happen.
The very first fall I witnessed tore me up inside. I kept trying to figure out what I could have done differently. How could I have prevented this?
After I took care of the resident and made sure he was ok, I headed out the door planning to never return. I didn't think this would be something I could handle. I was gonna' need to find a new profession.
A caregiver who had been doing this for a very long time stopped me. She grabbed me by the shoulders and she talked me into going back. I am very glad she did. I would not have wanted to miss this part of my journey.
No matter how much you practice these scenarios or how much you try to retrain your brain, a fall at your facility can be very traumatic. However, I have worked really hard to contain my panic during a fall since that first incident.
Because I am an older CNA and I have been at the same facility for many years, people tend to count on me to take the lead in an emergency.
Not always, of course. There are people who have been there longer or know more than I. I am happy to hand things over to them if given the choice but if I need to be in charge then I need to be ready to be in charge.
I can not be sloppy or scared. If I am, I let people down. People that mean the world to me; my residents.
If you are there when a fall happens you have a better idea of what you are going to be dealing with but so many falls are unwitnessed events; you are going in blind.
In the larger units the residents wear a pendant that they can push if they need you.
Sometimes they just need something simple like a bathroom assist or a Tylenol but sometimes this pendant call means "Emergency" they have fallen or gotten hurt in some way.
When that pendant call comes across, this is when I start working through those calming exercises.
In the dementia units, there are no pendants. They would not know how or when to use them.
With dementia comes wandering therefore in these units you may witness a fall or just happen upon it.
Meaning you will have zero time to calm yourself. You just need to jump in and do what needs to be done. If you panic, they panic. So you must have yourself together. You can fall apart AFTER they are taken care of.
One of the worst falls I ever witnessed was a resident who was actually walking right next to an aide; arm and arm.
The aide had her arm looped through the resident's arm. They were walking through the dining room headed for a bath. I was just on the other side of the room helping another resident finish her dinner.
Step by step they walked together on a hard flat surface. There were no obstacles in her path and she was wearing her tennis shoes. This resident was not labeled a fall risk resident.
For a fall risk resident you would always walk them with a gait belt
I say all of this to say that there was absolutely no reason this resident should have fallen.
All of a sudden she started to stutter step. The toes of her shoes were scuffing against the floor and we all watched in horror as she started to drop face first into the hardwood floor. The aide who was walking with her tried desperately to grab her but to no avail.
Our resident landed directly on her face. You could hear the crack as her face hit the ground and then she skidded across the floor on her nose.
Her nose immediately started to bleed and a bump began to form on her forehead.
Although the aide was ready to burst into tears, she held it together long enough to take care of her resident and then left the unit to collect herself.
It was later determined that this resident had a seizure while she was walking and that is what caused her to trip and fall.
When you truly care about these residents they become like family. It's devastating when they get hurt.
Another fall that still haunts me was in the family room at an old facility. It was afternoon snack time so everyone was gathering in the family room. I had my back to the door, I was pouring coffee for residents that were already seated.
Suddenly from behind I hear a collective gasp and I felt a hand grabbing at the back of my scrub jacket.
I turned around just in time to see my resident land hard on the ground. He did not hit his head but he had opened up a giant skin tear on his arm.
He had been grabbing at me on the way down to try to regain his balance.
"What if" I had turned around just a few seconds earlier. Maybe I could have helped him. Those "what ifs" can drive ya crazy.
We made sure he had no other injuries by following our facility's fall protocol and then we got him up off the floor. We tended to his wounds and took him back to his room.
When I walked back into the family room, a female resident pulled me aside.
"Are you ok? You look like you could use a hug."
I am forever grateful to her. Her hug got me through a horribly hard moment.
These were two of the really bad falls that I was there to witness but as I mentioned earlier, many many falls will be unwitnessed.
I have two of these that stand out in my mind as well. Both of these occurred in a Memory Care unit.
The first was at a facility that did not use bed alarms. Although a bed alarm will not always prevent a fall, I am a strong advocate for their use. The facility I am at now has always used bed alarms once a resident is no longer capable of using a pendant.
I feel that a facility that does not use some sort of bed alarm/motion sensor has a much higher likelihood of a resident being on the ground for an extended period of time. A bed alarm may not prevent a fall but it will let you know the moment they are out of bed.
With this particular fall, I am unsure of how long my little lady laid there waiting for us to come help her. We did hourly safety checks but we never knew if the fall happened the minute after we checked on her, the minute before we walked back in or somewhere in between.
When I came in for her safety check I found her on the floor. Her bottom dresser drawer was open and her head was lying on top of that open dresser drawer.
Nursing was called and all of the fall protocol procedures were performed. This includes but is not limited to vitals, range of motion, injury checks and a discussion with nursing. It was determined she was ok to get up off the floor. She had only a slight bruise underneath one eye, no open wounds and nothing broken. The bruise was presumably from hitting her face on the drawer.
What happened in the days following was the spooky part for me. That little bruise under her eye turned into a bigger bruise. Then her entire eye blackened. Then the bruising spread down her cheek and even onto her neck and chest. It was scary to watch. As always, the facility continued to monitor her and even though the bruising was crazy, there were no further injuries found.
The second incident was at a facility that does use the bed alarms for safety. Since I typically work overnights, some of the things I rely on are bed alarms and safety checks along with my scheduled tasks to let me know if a resident is up.
The resident's bed alarm went off letting me know she was up and headed to the bathroom. She was not a fall risk but in MC you head straight to any room that a bed alarm sounds in.
When I got there my resident was on the floor on her back. I went to her and immediately realized that she had hit her head. Not only had she smacked it hard, the back of her head had hit the metal frame of her bed. The bump on the back of her head was already swelling and getting bigger by the moment. I was able to cup it in my hand.
Nursing was called and my resident was immediately sent out to the hospital. The hospital did all the necessary scans and thank goodness she was ok. An extremely scary fall but it all turned out ok in the end.
Unfortunately, our elderly population is much more prone to falling. As caregivers we all do our best to keep them safe and secure.
If they do experience a fall it is our responsibility to know the next best steps.
If you are a caregiver for your loved one at home and find yourself dealing with falls or a family member who is a fall risk, please educate yourself on all aspects of preventing and dealing with a fall.
You can reach out to the Alzheimer’s Association for help.
If you are in the US, you can always call the Alzheimer’s Association 24/7 Helpline (1-800-272-3900) to vent, get advice, & resources.
If your loved one does not suffer from dementia the Alzheimer’s Association can still lead you in the right direction.
If you are a paid caregiver in a facility, you will be trained by your facility on how you are expected to handle these situations.
You will always be expected to follow that protocol and you will always have your training to fall back on.
Squashing your panic response and being able to do what needs to be done in the moment may be a work in progress.
Relying on your older more experienced CNAs and the nursing staff at your facility will help you get through these particularly hard situations.
We won't ever be able to completely prevent them from falling although we try our very best but we can be there to help them through it if they do.
Always follow facility protocol with any fall; witnessed or unwitnessed.
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