Memory Care Patio Monitoring

The ambulance people had a short discussion among themselves as Margaret was being checked in to the emergency room. They finally wrote down, “Unobserved fall in unsupervised area”. This left the fall and the time in question. We will never know the cause of the fall: stroke, heart fibrillation, tripping and tumbling when stepping onto an unidentified sloping surface, and/or dementia.  

Cruising Solo in Late July

Cutting Across the Lower Path Loop

Upper Loop Foliage Trimmed to Reveal
 the Grass Fall Site Which is Not Visible
at the Base of the Fence at the Far End

 
What we do know is the area was not being monitored like the interior of the building; after more than one assisted living resident became lost, or trapped in a stairwell. The foliage hid the sloped area between the upper figure-eight loop of the walking path and the fence from view from inside and outside the building. This lush third-year growth was also of concern as it was extending into the sidewalk. Two people looking at the foliage found Margaret.

Corrective action came quickly. “Be sure this door stays locked. We don’t want someone to get out there (pause) and get hurt.” Two weeks later the foliage was trimmed back to give an unblocked view of the sloped area in question. I am unaware of any staffing changes or changes in the timing of periodic monitoring of each resident (Margaret was checked on about every 10-20 minutes when using her walker).

My experience in the last two months with an Arlo motion-triggered video clip camera suggests one correction for monitoring the memory care patio area other than having a walking guard stationed there as at a swimming pool. (I am practicing using the Arlo camera so that next spring we can make video clips of monarch caterpillars and anything else we find of interest in the 1.5 acre Provision Living Monarch Butterfly Sanctuary). Cameras must be mounted high enough to see down to the base of the fence. There is little need to add to current monitoring if the sloped area were leveled or restricted.

Sloped Lawn

My wife was found lying flat on the ground, 30 Aug 2018, with her right shoulder raised against the iron bar fence (around the memory care patio area) and with her head held straight up by a vertical bar embedded in her forehead; resulting in her body resting at about a 45 degree angle to the fence, heading west away from the patio door. There was no motion and little fresh blood flow. “Don’t touch her; see her neck.”  I was called to the scene.

The Fence

The Slope

The emergency room attendant chuckled, “I know this lady. She grinds her teeth.” Her head and neck were viewed extensively.  Ten stitches were followed by one more to stop bleeding. “Her right shoulder is hurting her. You are not leaving until it is X-rayed" (Her right hand was X-rayed a month later in preparation for therapy).

She was up in a wheelchair Friday, four days after the fall on Monday. After the third glass of cranberry juice hit the floor, we realized she had no control over the fingers on both hands. She was not aware of this either. Her fingers functioned as a club; rather than stretching out in a normal reaching motion.

Monday, a week after the fall, the left hand started waking up, one finger at a time for the next few days. By a month she had taught herself to be left-handed when dining and had the strength to lift a full glass of water. The right hand puzzled her. She feels and rubs it with her left hand.

On our second trip to Peak Sport and Spine, for occupational therapy, we were informed that they would only get paid if satisfactory progress were being made. Fortunately we had been shown how to use an exercise ball, to keep my wife’s fingers limber, on the first session. At two months, now with my three exercise periods a day, the first two fingers have a good grip, the third is erratic, and the little finger is still limp. The fingers appear larger and cooler than on the left hand.

Now that Peak has rejected my wife as a good fit for their facility (too noisy and distracting for her dementia to make progress), I have asked our doctor to request an out of network provider order for the company installed on the third floor; that recently opened an area in the west end of our first floor memory care wing. (The company no longer takes private pay, which cost me less than the deductable last January!) I am getting the feeling that “progress” is more self-healing than therapy. Sheer determination on Margaret's part to feed herself may be the most important.

First Successful Use of Right Hand to Use a Fork Yesterday, 3 Nov 2018

Margaret and I have been very lucky when it comes to falls. This is the first one that put a dent into her health. We dined with a couple, during our first year; that were not lucky. One fell backward in their apartment, striking her head on the edge of an end table and broke her neck; he passed a month after she did, after she spend months in the hospital.

Last week the 3:00 pm exercise class went for a walk on the park trail. Where the trail started down, the instructor cautioned each one to watch their step. He again cautioned each one on reaching the sharper decline on the street, “Shorten your step.” He walked backward, to the side, and ahead of the lead person in preparation for anyone who may start to trip or fall.

As the rest of the group went back inside, he took me to the bank on the south side of the park and demonstrated several times what takes place when you are walking on a flat surface and on a sloped surface. We walked up the slope using the longest steps we could use; then down with short steps. To overstep downhill sends you tumbling. This is fun for little kids.

I could now see Margaret falling down the sloped lawn from the figure-eight walkway to the fence. One knee hit the ground as she tumbled into the fence. Her right shoulder took part of the impact. Her head struck with such force as to cause a concussion but not a broken neck.

This is the second time, in thee years, I am aware of a resident uncontrollably tumbling into the fence. This should be enough evidence to justify the expense of leveling the lawn (in this area) or establishing a barrier to effectively keep residents off such a sloped surface. This attractive sloping landscape design feature does not seem to exist in courtyards surrounded by buildings and solid walls.