When residents come to Hebrew Rehabilitation Center, they are here because they need round-the-clock care, often including regular medical attention. But, this is still where they live, and we are always trying to find ways to make our residents feel at home. This often means finding a balance between creating a home-like environment, and making sure that our residents are safe.
One of the greatest risks our residents face is a fall, which can occur upon attempting to get out of bed or standing up from a chair without help. A solution often used in the past was to use restraints that kept individuals in place, but clearly impacted their quality of life.
In the 90s the federal government passed a law called the Omnibus Budget Reconciliation Act. The law mandated changes in nursing home practices, including strict regulations about the use of restraints. As an alternative, HRC put in place pressure-sensitive bed and chair pads, which could be attached to an alarm that would sound whenever a resident started to stand up. The hope was that a bed alarm would alert nursing staff when a resident wanted to get up and had not remembered to call for help first.
Recently, with even more focus on creating a home-like environment for our residents, our care teams started to question how these alarms were impacting the quality of our residents’ lives, as well as the staff. Alarms can be used with multiple residents and are quite loud. “Alarm fatigue” also became a concern.
We examined whether or not alarms even work to reduce falls. When we looked at published research, we found nothing to support the belief that alarms prevent falls, and in some powerful case studies, found that alarm removal has actually led to a decrease in falls. In fact, research indicated that staff commonly thinks the sound of an alarm lets them know when someone has already fallen!
Studies support that by eliminating alarms, our residents’ dignity is upheld, sleep for everyone who lives here is improved, and agitation among memory-impaired residents is decreased. At HRC, we are replacing alarms with pro-active purposeful rounding, which encourages care teams to provide even more individualized care to our residents. By checking in with residents more frequently, nursing staff can anticipate events that may put a resident at risk for a fall. Purposeful rounding is a way to prevent falls rather than waiting for an alarm to sound.