Breaking Bad with Mama

Every day, you write about patient falls. I read your notes and remind agencies to write incident reports and unless there is an injury, we move on to the next chart or patient. Y’all don’t tell the whole story though and I’m not sure that you could.

My Mom fell over the weekend. I was in her living room and heard her go down in her bedroom. I went to investigate and as I rounded the corner of her bed, I almost stepped on her. She was flat on her back and my foot was on it’s way to her upper abdomen when I finally saw her. I’ll be honest with you like I was with her. Had I stepped on my Mom and left my footprint on her, I would have shoved her under the bed and pretended that I didn’t know where she was. I don’t know much but I was certain I wasn’t going to tell Daddy that I crushed his wife by accident and she was no longer with us.

But, she got up. I supervised. If needed, I would have helped her up but she has an arthritic shoulder and I did not want to hurt her or detach her arm. Things happen when Mama is around.

After she was seated in her recliner watching her Hallmark movie with a glass of wine, I was taken aback that Mama didn’t share my relief that she was fine. I have heard that almost any time a person falls, they are embarrassed. I’m not sure if that describes Mom’s feelings but she was definitely emotional. She regretted all the things that she could not do anymore. And these things were good works for those less fortunate for her.

I reminded her of all the wonderful things she has done in her life. She has cooked and served thousands of meals for the homeless, walked almost as many miles visiting parishioners in the hospital, and drove around town visiting the ‘shut-ins’ (as she calls them) to bring them communion. She raised me, for heaven’s sake and two brothers who occasionally behaved as though they were raised by wolves. I was the ‘good’ one by comparison.

When reminding her of all the good deeds she has completed didn’t perk her up, I reminded her that she was a pioneer in the field of medical marijuana before it was even a thing. Okay, she didn’t know it was marijuana at the time or at least that’s what she says.

We lived for a few years in Jamaica and at Christmas time, Mama and the other American women would bring Christmas joy to the men in The Infirmary. The Infirmary was kind of like an inpatient hospice/nursing home for those without anyone to care for them. Together, Mom and her friends crocheted hats for these debilitated men living (and dying) in the sunny, warm tropics, bought pipes and upon the advice of some happy Jamaicans, included a special hemp rope that was actually ganja. Yes, my Mom and her friends got sick and elderly patients high. Surely it could not replace the love of a family at Christmas but it dulled the pain, somewhat.

Mama embraces her status as a Medical Marijuana pioneer and soon we were laughing. I have yet to question the wisdom of making crocheted hats for men living in the tropics but if their situation changed and they went on a ski adventure, they would have been prepared.  I don’t get high but maybe getting high leads to bad fashion choices.

The point I hope you take away, other than my Mom was a drug dealer, is that falls cause more injuries than bruises and broken hips. A fall can be seen as the ‘beginning of the end’ for some people, especially those falls that occur seemingly without a reason. Patients report that their legs just ‘gave out’. I can’t imagine not being able to trust my body parts to do what they are supposed to do. My Mom who exercised before it was cool, is not comfortable with any kind of weakness. I believe she is far from alone in this. I similarly believe that if she had stopped exercising before those Jane Fonda records came out, I wouldn’t be scarred for life.

I can’t tell you what to do but you know your patients. One of the luxuries of home health is that you get to spend one on one time with your patients and understand them better than anything you can document outside of a novel. Home health and hospice visiting nurses are usually sensitive. Use your super powers to help your patients recover physically and emotionally from a fall. Some patients need a little tea and sympathy and others need only as much attention as is required to assess for injuries. Give them a sense of control and safety.

To prevent future occurrences, remember that falls precautions are not just a cute addendum to a nursing note – ‘instructed on fall precautions’. Yippie. Now individualize them for your patients.

Electricity costs money; something that many elderly people find in short supply. Your patient will not be able to provide for adequate lighting if they are having to choose between food and electricity. Call a social worker.

Get real with the family about home repairs and clutter. An unsafe living environment is a valid reason to call Elderly Protective Services. You might want to mention that to a family who has been repeatedly asked to fix loose floor boards or remove clutter. Offer to call their church and arrange for some help if they are unable to participate or don’t know basic carpentry skills.

The world wide web has about a thousand different teaching guides on Falls Precautions. Even though they are redundant, the subject will be brought to the forefront of the patient’s and family’s mind if you bring out a new teaching guide regularly. Make sure they come from a reputable source and ask a therapist to review them for suitability. Yoga may be great for balance but some of your patients are unable to stand on their heads.

With PDGM on the horizon, agencies are understandably hesitant to order Physical Therapy for patients who are not in a diagnosis group that pays for therapy. For those patients with minimal functional impairments, consider a one time visit to determine what is safe for the patient to do and create a home exercise plan that can be managed by nursing and eventually the patient or family. Daily exercise will instill confidence in the patient that they can prevent a fall or two and get up in the event they hit the ground. If a patient lives in an assisted living, investigate what activities are available that involve exercise.

Because not every elderly person has a history of breaking bad. Sometimes you have to go with evidence based practice.