The Empress’ New Wheelchair

Posted 5-29-19

Overconfidence can be displayed most clearly in one of two formats: An arrogant, Emporer’s New Clothes kind of way where nobody would dare correct you; a mistaken (or forgotten) sense of one’s own abilities.

Mom’s unit has none of category one, but one such lady in the second category, presumably.

Ms. F is a “sweet” new backup singer to the ranks of the Sweet 17. She seems to be a nice lady although her volume button on her clicker was turned all the way up and then broken. Her problem is the problem of many of the ladies: she has lived a long and productive life of doing and doing and doing…and she can’t do like she used to now. The most notable do item that she no can do is walking/standing without her wheelchair (sorry for the link…I am in an 80’s music mood). The mere fact that she would fall like an upside-down Weeble in a step or two and the twin fact that I am reasonably certain that she has had a broken hip in her recent past doesn’t prevent her from trying, and trying, and trying, and trying, and trying… She has the alarm on her chair, but doesn’t mind the 200dB siren going off indicating that she is up again. No worries, except for the few that can hear fine and the staff and the visitors. She essentially obligates a nurse full-time right now. They do NOT have nurses to spare…

For Ms. F the task may be standing/walking when she cannot. For another member it is, perhaps, eating…so she might bypass her pureed food and steal roast beef from her neighbor, something she could easily choke on since she can barely swallow. Sadly, it isn’t typically arrogance that causes these damsels problems, it is not knowing their circumstances and/or their history. To us it is as glaring as the huge mistake made by the speaker in this Bible verse, but to them limitations are suddenly inconceivable. It is reminiscent of me trying to run right now in my current bloated puffer-fish weight state. I could possibly run for a little while, but the consequences would be dear.

Why bring this up? I have a bone to pick with some unknown decision-maker who decided that restraints are, in most cases, strictly verboten. Nope. You cannot use a restraint to protect someone in these cases. Here is a summary of what the law says:

Since October I990, the nation s nursing homes have had to comply with a new and significant Federal mandate: that nursing home residents have “the right to be free” from physical and chemical restraints not required to treat their medical symptoms. This mandate is part of a series of reforms intended to improve the quality of care in nursing homes that were enacted by Congress in the Omnibus Budget Reconciliation Act of I987 (OBRA-87).

https://oig.hhs.gov/oei/reports/oei-01-91-00840.pdf

There have been revisions and tweaks, but this ruling is still pretty much in place and obeyed. Here is a more detailed page in the ins and outs of the concept.

Alzheimer’s and other nursing home patients have a “right to be free of restraint” and a “right to fall”. Some right…

What a complex topic that was boiled down to the simplistic “No Restraints” world we live in now. My poor Sweet 17 maiden above would benefit from restraints, or at least some barriers that would help keep her in her seat. My mom, previous to our hospice angel replacing her chair, was falling out of her wheelchair for lack of a seat belt. Falls are super harmful for all seniors and rampant in nursing homes. I hate to throw out a big, fat “Gotcha” here, but they have the right to be free and to fall…and apparently break a hip or their face? Shouldn’t a blind person have the right to drive? There are health conditions that preclude a freedom for the protection of the person, right?

My initial take as someone NOT working in the medical or law world and limited in understanding, but hopefully less limited in common sense: would a happy medium be more in order? How about a chair with a built-in TV tray or connected fidgit blanket? Is it really so freedom limiting to use bed rails?

The problem is two-fold: people NOT in medicine making the decisions and the common occurrence these days of knee-jerking a response to every crisis. I can’t fix problem #1. In addition, I would NOT want to go back to the days prior to this law where patients were strapped down to a bed/wheelchair for hours/days at a time. If you visited a nursing home then, you know the mess that was and how easily that would be exposed by a journalist making a name for him/herself…and rightly so…BUT, shouldn’t people be prevented from harming themselves when they are in a state of not understanding their situation? We don’t leave a month worth of medicine on their table because they have a right to see all of their medicine. We don’t leave hot-tubs filled and ready because they have a right to a bath. I acknowledge that these are somewhat hyperbole in nature, but are they that much different?

My thoughts as far as an answer:

• Hire more employees and pay them well enough to keep them!!! The Sweet 17 are contributing at least $75-80,000 a month for their hotel stay. There are 170 more residents in the facility. Even with liability insurance requirements, that should cover more staff. I shouldn’t have to see new staff every stinkin’ day. The same lady that bathes mom today should do it again in a few days…
• Pay for and approve innovation to find more happy mediums. Don’t bungee strap or zip tie them ala the 1970’s and 80’s (and before), but end the bloodshed and falls and, in my book, (self)abuse caused by lack of reasonable protection. The current system doesn’t promote innovation in fall prevention using mild, comfortable restraints because everyone fears the law as much as lawsuits.
• Consider nursing home tort reform. Fear of enormous lawsuits on nursing homes are harming care and increasing its cost, are driving decisions, and are making things worse. Obvious negligence: throw the book at them. A simple mistake, made with good intentions: limit the liability. I appreciate that the fear of a lawsuit does prevent some harm too…I get it…but somewhere lies a more happy medium. Negligence/abuse at that level has criminal consequences too.
• This topic could also be addressed in living wills/advanced directives before the patient needs them. Future Patient Mrs. Jones, would you rather have mild restraints if needed or fall a lot on your face and force 3am calls every month or two?
• The chemical restraints clause is interesting and important too. If you can limit the mobility of the patient by reducing their anxiety in a way that leaves them tired to rest/sleep more but not fall on their face, is that a good trade-off? Mom is in a really good place right now. She is tired and sleeps a lot, not unlike most late stage Alzheimer’s patients, but she is NOT the zombie she was before we had the meds backed off. Find a balance, but don’t be afraid of them being less active if the alternative is falling on their face.
• Get involved in your loved one’s care. I am thoroughly convinced that being there early, often and in varying times is a very good thing for care. Learn what you can use to help them and what you cannot.
• There are no easy answers and each of these answers is flawed. I welcome your opinions and corrections.

Update: Another great visit with mom. She is still in pretty cogent mode and is very happy. 🙂 Lot of fun with Mrs. N and Mrs. J at the supper table too. They are still a hoot!

Lastly, if you could do me a huge favor, cure this disease. Like today would be good… Or, at least come up with a viable life extending treatment. Thanks. That’s all. 🙁

#EndALZ

• 

• 

•