Monday, August 16, 2010

Falls in Nursing Home Residents

The single biggest challenge facing nursing home staff is the management of resident falls. Over the years we have tried using restraints to STOP residents from moving. It didn't work--they fought to get out of the restraint, fell and often suffered serious injuries. Injuries that we were trying to prevent through the use of the restraint. We are currently trying to make them "buzz when they move" with the use of personal alarms - it's not working! We erroneously think that we can manage their behavior with the addition of an external, negative stimulus when they move.

It is true that CMS has taken a very firm stand against the use of physical restraints. The use of restraints is captured on the MDS and reviewed by CMS with the resulting emphasis on reducing restraint use to less than 3% nationally by 2011. You will see data stating that that national goal has been met. It is true that the use of physical restraints has been reduced.

However, the use of alarms is sky rocketing. Unfortunately their use is NOT captured on any government document and therefore has not surfaced as a national "area of concern". The negative effects FOR THE RESIDENT as a psychological restraint are just starting to be discussed.

I think the saddest aspect of this approach is these devices are used with residents who already have lost some or all of their cognitive functionality. Not only have they lose their ability to think clearly but their dignity is drastically reduced with this attempt to "help" them.

The answer to mitigating falls lies in understanding the person's motivation for moving. After all, if they didn't move, they wouldn't fall! Unless and until we focus on determining the person's reason for moving AND then use our skills to help them meet their need, not STOP them as we have done in the past, we will continue to be unsuccessful in managing falls.

My approach is truly centered on the person. I work with caregivers across our nation to increase assessments that focus on WHO the person is as a social being. Only when we know who they are, not simply their medical challenges, will we be able to address the motivation that prompted the behaviors that lead to a fall. However, once the person is put into the picture, we have more tools than we can ever imagine to capture their attention, redirect their attention, manage (not control) their behaviors and begin to realize success in reducing falls by addressing the motivation to move.

I stand ready to talk with you as you work toward a truly restraint free environment in which residents aren't physically or psychologically restrained while providing days with purpose and less falls, for those entrusted to our care.

Please feel free to enlist my help via this blog as you address the biggest challenge we face in long term care - residents who fall.

Monday, August 2, 2010

Open for Discussions!


As Waugh Consulting steps into the 21st century, we are proud to announce our new blog! It is our goal to assist caregivers, both professionals and family caregivers, as they work with elderly clients.

First we'd like to share the beliefs that drive our work:

A life with purpose.

Commitment to educate staff and caregivers to the level of expert in long term care.

In fulfillment of this vision we are accessible nationally to provide:
seminars presented in a straightforward yet humorous manner while offering innovative solutions with creative ideas for ongoing improvement educational materials that are reality based and immediately usable individual consultation with both professional and family member caregivers dealing with elders with cognitive loss.

Whether you are a professional caregiver working in a setting serving the elderly, or you are a family caregiver dealing with a elderly loved one, we stand ready to discuss challenges and concerns with you.

Please feel free to use our blog to post questions, thoughts and/or concerns and we'll share our knowledge and expertise for your consideration.

Here's to working together to address the challenges we face.