There are times when a senior may become a physical threat to themselves or others without notice. If we notice patterns, we will update family members and physicians ahead of time. However, there are isolated cases where those with diseases of the mind, may become violent or put others at risk. In these rare cases, we call 911 and call the family so immediate interventions to keep everyone safe. Generally, the senior is taken to an emergency room to rule out any medical change of conditions which require attention. However, there are specific rules as to what qualifies for hospital admission and meets the criteria for acute care hospitalization needs. Therefore, if the hospital is not able to admit a senior and yet they require 1:1 staffing, family needs to be willing to work with the provider of the home care services to immediately meet their needs. This may mean family and/or friends sitting with senior to help re-direct, hiring outside additional resources, updating physician and exploring a change or introduction in medications.
There are isolated situations where a senior may have a need for a short term placement at a senior behavioral health unit that focuses on monitoring the senior with various professionals 24 hours per day. This is a two week program typically and if new meds are introduced then the senior is monitored for side effects and behavior changes. If the physician recommends a medication and the family is against all medication usages, it may be necessary to call a family meeting to review all the options available to meet the care needs of the senior.
There may be times when negotiated risk agreements are signed between family members and the site to review the pros/cons of any given situation in care planning. If family members feel they need 24 hour on-site nursing, then they can pursue a traditional nursing home setting at any time. However, our care model has 24 hour on call RN schedules to address change of conditions while RN/LPN is not on-site.
At Diamond Willow, we have fewer residents for our aides to care for in each setup. As a prior nursing assistant, I recognize the value of having 5-7 people to care for in my setup versus 10-15 which exists in many setups. Our staffing ratios with aides allows more 1:1 time and personalized cares. We have never reduced our staffing pattern since opening in 2004. Aides are less rushed and frailer elderly with or without dementia, Alzheimer's or memory loss want to feel less rushed. Our smaller homes allow us all a sense of peace, a chance to slow down and be present.
At Diamond Willow Advanced Care, we blend all residents together. Therefore, a certain percent will be alert and oriented to physical/medical needs. There will be a population with great physical abilities and significant cognitive decline also. It has worked well, as our settings are small, and those with memory loss seem to stay higher functioning longer when they are around those who can visit with them etc.
We also have wheelchair/bed alarms as well as motion detectors to use for those who are a higher risk for falls. Please note, these devices will not prevent or deter all falls, in fact, with or without an alarm, a resident could have a fall with an injury such as a fracture or even death. We care for frail elderly. We care for seniors with osteoarthritis, and medical science proves women are always at higher risk for bone loss as they age. Many times a break happens first and the fall is second.
When I started as a nursing assistant in the 1980s, the standard of practice was to tie everyone in their wheelchair and vest restraint, everyone, while in bed. Granted, we likely have fewer falls, but I can still hear everyone yelling "help me" down the halls.