Weighing the risk of a fall versus the expense of 24/7 care

Because of recent lawsuits where families have sued a retirement community because their parent has taken a fall, some communities are now requiring families to enlist 24/7 private aide help in addition to an already hefty monthly fee, taking costs to over $20,000/month.

Posted 10:00 a.m. Oct 25, 2018 — Updated 10:00 a.m. Oct 25, 2018

Liisa Ogburn

I’ve recently had a handful of clients who have been required to pay for private 24/7 care on top of the cost of Memory Care in very nice Memory Care communities. The cost of a room in a higher end Memory Care community can run from $7,000 to 10,000 per month. When you add 24/7 private agency care, which can cost $15,000 up to $18,000/month, it becomes utterly unsustainable (if it wasn’t already). Suddenly families who had budgeted for $8,000/month for their loved one are now looking at $25,000/month.

What’s going on? Fear (and love) is a powerful motivator. According to a study published in The Journal of the American Medical Association (JAMA), one in four Americans over 65 falls every year. Over 300,000 of these falls result in a hip fracture; of those, 20 to 30 percent will die within 12 months and the prognosis isn’t that great for those who don’t. Specifically, according to an article on AARP, “a year after fracturing a hip, 90 percent of those who needed no assistance climbing stairs before the fracture will not be able to climb five stairs; 66 percent won't be able to get on or off a toilet without help; 50 percent won't be able to raise themselves from a chair; 31 percent won't be able to get out of bed unassisted; and 20 percent won't be able to put on a pair of pants by themselves.”

Family members understandably want to protect their loved ones from this risk.

Retirement communities, on the other hand, have experienced an uptick in lawsuits from families whose loved ones took a fall on their watch, and in a couple of cases, even when a 24/7 private caregiver was in the room.

“There will be times when,” Dr. Parsons said, “the caregiver needs to step out to use the restroom or can’t get assistance at the moment they need a second person to get a resident to the bathroom themselves. Falls are inevitable.”

Here are some things a family might consider doing if they really don’t want to move their parent or spouse, but do need to reduce the costs.

Be strategic about when you employ private caregivers. Reduce private caregiver time to those periods when the resident is most likely to need help. Do they need someone there all night? If they have someone now, ask the nightshift to take notes on the resident’s needs between going to bed and getting up in the morning.
If you’re worried about your loved one falling out of bed, there are beds that can be lowered to 12 inches above the floor at night to minimize risk of injury.
One family member worried that their loved one woke every night once a night and wondered if there was a medication that might help. Dr. Parsons said that the majority of the well-known sleep medications also come with an increased risk of falls because of how they work in the brain. He mentioned a newer prescription medication called Belsomra that does not carry this risk and may be worth a try.
On the topic of medications, Dr. Parsons also said it would be worthwhile for a physician to look at the patient’s current med list to see if any of these put them at a higher risk of falls. Specifically, he mentioned that some medications—for example those that treat high blood pressure and diabetic agents that cause hypoglacemia can contribute to dizziness when standing. It may be worth weighing the benefits of the drug versus the fall risks.
What about mattress pad bed alarms or bed rails? While these were widely used for a time, more recently they have been prohibited in many care communities because they are seen as a restraint (in the case of a bed alarm or bed rails) or a safety hazard (in the event of mats being placed on the floor). That said, I do see my clients who still live at home using some of these tools (door alarms, floor mats, and motion detectors) to help with night time wandering.
Finally, if the family would really like to stay where they are, but with reduced private aide time, they may discuss the option with the community of providing a written statement documenting that they will not sue in the event of a fall.

As with so many situations during the last years of life, there is no easy solution. One is always trying to figure out the best solution for the moment, recognizing that the puzzle is always changing.

Should you still worry, it may be helpful to know what to expect in the event of a fall, which I wrote about here.

Suggest A Correction