Regulations, Frailty and an Empty Vessel

Honestly, I am an empty vessel at this writing.  I’m not really sure what to write about. 

At this moment, Mom is pretty much confined to her bed.  She slept all day today due to her bed alarm going off at a great frequency from her shifting about. 

You see, Mom fell on Monday morning around 530 am, and they’re not sure, yet, if there is a fracture around her hip or if it’s simply bruised; we hope time will tell - in a few days. 

More about that in the next post, Sunday, though. 

I suppose what I want to comment on is the dilemma of regulations for care facilities.   As I visited Mom, yesterday, the facility was undergoing a sort of audit, and they seemed to focus on Mom, probably because of her fall the other day. 

I learned there are regulations on whether or not the bed’s wheels are up or down, where the side rail can be, and there need to be orders justifying the placement of such.  Wow.  Had Mom had rails on her bed would she have fallen?  Can’t really answer that - if you knew her the way we do she would have found a way to get over it.  There is great care that surrounds the use of the rail, though, as some residents could become stuck, some could do great harm to themselves, as well, which might be seen as worse than trying to stand and crumpling down, as I suspect happened with Mom. 

I received an email from someone (not naming names) who wanted to know why Mom wasn’t being tied down to her bed or kept belted in her chair.  Well, first, it’s illegal.   Secondly, it would have to be approved by a physician and we would have to prove obvious self-harm.  In other words, Federal Law Prohibits Restraints except for that specific exception! (1)

Use of restraints has been found to be the cause of the following(2) 

•Falls

•Pressure ulcer / decubitus ulcer / bed sore

•Strangulation

•Loss of mobility

•Reduction of bone and muscle mass

•Incontinence

•Constipation

•Increased stress

  So, what can they do when they have someone like Mom, to keep them from such harm?

We tried brainstorming - from mattresses on the floor (which would create an obstacle for anyone - especially those who might be trying to rush in to intervene), try the side rail, put a table out for her to balance (but if she fell and hit her head, what then?), and I, being the layperson, left the conversation for them to figure out if anything could actually be done. 

The issue at hand, though, is that Mom has become much more severely frail, due to lack of activity and caloric intake.  She has lost a great deal of weight and has no interest in doing much physically (the lack of interest and that it takes, now, at least, two attendants to hold her up while walking - without regarding the recent event). 

According to End-Stage Dementia:

Frailty

Frailty is a state of high vulnerability to physiologic stressors that places patients with end-stage dementia at high risk for adverse outcomes.14-16 Frailty involves intertwined impairment and dysregulation of physiologic, musculoskeletal, cognitive and neurologic systems.15,16 Decreased immune function, metabolic abnormalities, anemia, hypothyroidism and depression are associated with frailty.14-16 This condition is characterized by gait instability, excessive fatigue, general weakness and unintentional weight loss (> 10 pounds over the previous year), with subsequent increased risk for falls and incontinence.11,14

Frailty may be identified by routinely screening for clinical, functional and behavioral changes. Medical management focusing on the early identification and treatment of reversible pathologic causes of frailty will decrease associated complications. Exercise programs to maintain muscle strength and dietary supplementation to prevent loss of lean muscle mass can help delay further decline.

Unfortunately, Mom is, by this very definition, frail! 

There really isn’t much else to state, except to wait and hope for her to have but a bruise on her hip; were she to have a fracture, even a wee one, that could spell the beginning of the end.

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(1)  "Can a nursing home tie my dad to a wheelchair if he has had." 2010. 18 Mar. 2016 <http://www.nursinghomesabuseblog.com/frequently-asked-questions/can-a-nursing-home-tie-my-dad-to-a-wheelchair-if-he-has-had-episodes-of-wandering-around-the-facility/>

(2)  Ibid.

(3) Harrington, CC. "End-Stage Dementia - ADVANCE for NPs & PAs." 2013. <http://nurse-practitioners-and-physician-assistants.advanceweb.com/Continuing-Education/CE-Articles/End-Stage-Dementia.aspx>