Tuesday, April 27, 2010

A Right to Fall

A few weeks ago I got a phone call from the head nurse on the wing of the nursing home where my mother lives in Jackson, Mississippi. She calls every time a significant change takes place, and sometimes just to let me know of a shift in procedures. This call was to tell me that the physical therapist had been working with mom again on her walking, in hopes that she wouldn’t have to be in a wheelchair all the time. (She’s been in a wheelchair since October of 2008, when she fell and broke her hip. Her Alzheimer’s prevented her from participating with physical therapy, so she hasn’t been able to walk on her own.) They were removing her “lap guard,” and trying her in a new chair, which not only fit her better and allowed her to navigate around the facility better, but it also did not have a lap guard. Instead, it had a seat belt, to “remind her” not to get up and try to walk alone. I was encouraged. For about 24 hours.

The next day they called to say it didn’t work. Mom quickly figured out how to undo the seatbelt, and would unhook it and try to walk on her own before anyone could prevent her from falling. So they had to put her back in a chair with a lap guard, because she can’t figure out how to get it off.

“Why don’t you just hook the seat belt behind her?” I asked, thinking she would be more comfortable in a smaller chair without the lap guard.

“Oh, we’re not allowed to restrain her in a way that she can’t get loose from,” the nurse told me. “She has a right to fall.”

A right to fall.

Okay, I understand that it takes away her freedom, her independence, her dignity, to be restrained, but I also understand that without some sort of restraint she will surely fall and break her hip again (or worse) and end up in the hospital. But somehow—legally, at least—being in a lap guard, which she could possibly figure out how to remove, isn’t actually being restrained.

When I visited Mom today, she didn’t mention the lap guard, as she sometimes does. Sometimes she points to it and says, “Is this yours?” or “What am I supposed to do with this?”

I always remind her it’s there to keep her from standing up and trying to walk by herself and falling and breaking her hip again. She doesn’t seem frustrated by it, thankfully. And they’ve ordered her a smaller, more comfortable wheelchair with a smaller lap guard, so she should at least be more comfortable.

So, I got to thinking about the legal phrase the nurse used: “She has a right to fall.” And I started wondering how and if it would be wrong to take that right from her, the same way we don’t let an infant or a small child have full “rights” because they would get hurt. In fact, there are laws about children being in car seats, so they don’t have a “right” to be unrestrained in a car. And adults don’t have that right either, in states that have seat belt laws.

So today I imagined myself, fifteen or twenty years from now, possibly in a nursing home with Alzheimer’s. On the one hand, I would want my “freedom” for as long as possible, and depending on my mental state, being “trapped” in a wheel chair with a lap guard might seem awful to me. But I also hope that measures will be taken to prevent me from the pain of falling and breaking something and having to be hospitalized as a result.

I guess freedom comes with risk, and protection comes at a cost.


Mike Mayberry said...

No easy answer there. The institution has to consider: liability, personal freedom, family wishes. One family may come in and say "Why is she restrained?" and the next comes in and says "Why ISN'T she restrained?" The hardest jobs in the world are taking care of someone else's loved ones. In this case, I would think the safety and welfare of the resident would trump other considerations. That is why she is there, after all for her safety and well being.

Discourse said...

At first glance, it seems to be taking away her freedom. But what good (or comfort to her) is her freedom, if it is a freedom wracked with pain from another injury?

If she isn't too frustrated with it, one would assume she understands.

Alzheimer's is prevelant in my family, and my husband's grandmother who had been diagnosed early with it passed a few years ago. She never knew who I was really, since we were married long after her Alzheimer's had accelerated, but always told me that Joe (my husband) had always been her favorite. She was very sweet.

I admire how much you visit your mother and help care for her.

Susan said...

As always, beautifully written and so insightful. There's nothing easy about Alzheimer's. Let's meet for lunch when you're down here. I'd love to visit with you.

kathy kerr said...

I remember you in my prayers for this is truly a time for it. Just know that you are doing a great job and try to take some peace from that. I visited my Dad daily and the three times he was ill and had to be "belted" in a chair he always figured out how to get out, once cutting his calf pretty bad. It wasn't worth the fear of being trapped so we signed off on his walking and sneaking things he wasn't allowed to eat. Thank goodness he never had a broken hip like your Mom. That would make it a bigger decision. Many prayers for you and congratulations on Bill's honor in the previous post. He saves our hearts and souls and you make life interesting to read! Call me sometime when you come to see your Mom.