Over the past few years I’ve spent time in hospitals, assisted living facilities, memory units, rehabilitation units and skilled nursing facilities. I’ve observed the medical community’s obsession with avoiding the restraint or even the appearance of restraint of patients. Clearly restraint is a serious matter with legal and human rights implications. However, I find myself wondering if this over vigilance, due to the risk of litigation, has in fact put some of our elders at risk for serious wheelchair injuries.
What I’ve witnessed over the past couple of years enforces my opinion that, as a society, we’ve sacrificed patient protection and safety. Instead, we subject the frail elderly to unnecessary risk of injury to provide legal protection to the organizations and staff caring for these patients. Time and time again patients are left unrestrained in wheelchairs that have no protection against the patient falling out of the chair forward.
I’ve seen too many residents with wheelchair injuries
It takes more than one hand to count on my fingers the number of residents I’ve seen return from the hospital with bandaged heads and bruised faces because they have fallen out of their wheelchairs. It’s painful to watch because the risk of these injuries can be minimized. This happened to my mother and it’s just an awful experience.
Hip fracture is a leading cause of death in the elder population
After being deemed a fall risk, my mother had recently transitioned to using a wheelchair. Faced with the situation, I had to think about the balance between an acceptable level of risk versus the impact on her quality of life. She had adapted to the wheelchair easily and was moving about freely with a big smile on her face. Research indicated that hip fracture due to a fall is a leading cause of death in the elder population. “In usual care, the reported 1-year mortality after sustaining a hip fracture has been estimated to be 14% to 58%.”1 So given the risk and her easy adaptation, it was an easy decision to have mom in a wheelchair. But we were very new to these devices and I had no idea there were risks involved.
My mother had been assigned a fairly standard model of wheelchair, which she moved around in quite nicely. But both I and members of the staff noticed that she had a habit of leaning over forward and reaching with one of her hands. So the rehab department got involved in evaluating her for a different style to head off any potential wheelchair injuries. At the time rehab was evaluating styles of wheelchairs, we went into the Christmas and New Year holiday week. I never imagined at the time that it was an urgent issue.
Shouldn’t we consider safety?
Could we put a seat belt on mom or insert some protective bar across in front of her so that she couldn’t lean so far over? I had seen a comfortable foam insert at rehab that went across the lap and secured the patient. The facility would not accept any type of restraint or restraining device even if the family wanted one. There were a couple of simple and safe solutions to the problem.
New Year’s Eve in the emergency room
At 9 pm on New Year’s Eve, I left home to go and spend the evening with my mother and watch the festivities from New York on television. I wanted to bring in the New Year with her. Five minutes into my journey, I got a call from the floor nurse who informed me that she took a tumble out of her wheelchair and was on her way to the ER. I was horrified and headed for the ER to meet her. This would not be the pleasant evening I had planned for us.
I beat the ambulance to the hospital and paced at the ambulance bay outside the ER. When she arrived and they wheeled her out on the stretcher I could not believe what I saw. I’ve never been one to handle bloody injuries very well and I was only seeing the gauze covered wound. But it was awful. There was my frail, hurting and confused mother being wheeled into a bright, sterile ER with no one holding her hand. Her face was covered with blood and she was fidgeting. They wouldn’t let me near her; even so she could hear my voice, until I proved my identity and was admitted through the main desk.
Hospitals are ill equipped to handle Alzheimer’s patients
When I finally got to her bedside, she was fidgeting a lot and clearly upset. I had no way of gauging at that moment whether she had pain. But she was so glad to see me that she grabbed my hand and held on tight. The next five hours would prove to be a challenge for me and, of course, to her. Late stage Alzheimer’s patients are reactive to their comfort and environment. They also are not capable of hearing, understanding and following instructions. So keeping her calm and in the bed while waiting for assistance required all my energy. I had to be present, holding her hand and talking to her and keeping her from putting her fingers in the bloody gash on her forehead.
Fortunately I have a friend who worked at the hospital and arrived to see us and help out. Mark was a godsend that night because my mother loves him and he was able to take over for me while they worked on the wound. He sent me out to have a soda while they cleaned and stitched the gash on her forehead all the while holding her hand and talking to her to keep her calm. By that time, honestly, I was exhausted from the hours of constant tending to her fidgeting. Hospitals are generally ill equipped to handle dementia patients so actually managing the patient falls on the family member. Fortunately we were there.
Wheelchair injuries like mom’s should be avoidable
My mother survived her fall out of the wheelchair. Her face is scarred from the event and I feel scarred from not protecting her from this totally unnecessary injury. I have asked myself so many times why this had to happen and why so many of our elderly have to suffer the same wheelchair injuries. This issue of unlawful restraint seems ridiculous to me and is only protecting care facilities from litigation. At what point do we decide to rule in favor of protecting the vulnerable? Why can we not enforce a case by case authorization of safety equipment?
1 Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil. 2010;1(1):6-14.
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