Memory Care Operation Boundaries

When is a resident safe and secure? When is a resident enjoying the best quality of life? These questions become: What is safe ad secure? What quality of life can a resident enjoy?

The last question can only be answered by someone who observes and knows the resident well and interacts on a daily basis. A memory care resident can be a different person from day to day. The “State Operation Manual for Long Term Care Facilities”  defines a rapid change of caregivers as a hazard.

The past three posts review other information, situations, and operations that also influence whether a resident is safe and secure within the boundaries of the “State Operation Manual for Long Term Care Facilities”: manual restraints, chemical restraints, and accidents .

During 2018 the minimal, 0.25 gram, dosage of Xanax was doubled in February to 0.50 gram per day. 

Three major falls requiring the emergency room occurred in June, July, and August. Margaret was becoming unsteady on her feet. An ER attendant in July described her behavior as, “Her legs are turning to mush”, when she wanted to walk as we waited to be released.

Her plastic eye glass frame was imbedded in her eye brow in June. This required some stitches. In July she fell backward to the floor, out of her walker, with no visible injury; just unsteady on her feet. These were observed falls and counted as expected.

Did Xanax have any part in these falls? Does the warning from our health insurance company have any bearing here?  “Xanax increases falling in elderly persons.”

Was the August fall just a fall; an expected fall? The first two falls were observed and happened on a flat floor surface. The August fall was not observed and happened on a sloping grass surface that propelled her into the iron bar fence.

The third fall resulted in a concussion and injury to the right shoulder. She lost the use of her fingers on both hands. She was in pain for several days. She taught herself to be left handed.

Now, four months later, the neurologist reports the occupation therapy for the past two weeks is most encouraging. Her right hand is becoming useful again during therapy.

Is the third fall still inside what is acceptable? Is the EMT “unobserved fall in an unsupervised area” outside the acceptable limits of operation? Does the magnitude of the injury make a difference? Was this an avoidable accident? If it happened again with another resident would it be an avoidable accident?

Is an unmarked sloping grass surface a hazard that needs correcting? Considering that Margaret was not found for about 10 minutes (which is acceptable for falls in apartments), does the same limit apply in the memory care patio area that has totally unrestricted access for residents to enjoy during daylight hours?

These questions have a bearing on what risks to expect when living in a memory care facility. What does safe and secure mean to the resident and to the one paying the monthly bill for care? Isolated falls in the normal indoor activities, day or night, are expected and acceptable.