Can the state of New Jersey force a long-term nursing facility to remove patient alarms?

I don't know about your state, but, I did some reading about it, when my LO, who has severe dementia, was falling a lot. It seems that I read that a doctor could prescribe certain things, but, I don't know the details. Basically, the alarms that I am aware of do not restrain. They alert staff of the resident's movements. The resident is free to get out of their wheelchair or out of their bed. It's just that the staff are alerted when it happens and are able to assist them, so that they don't fall. If anyone knows different, please chime in.

From what I understand, it's Medicare/Medicaid. Since 2007 they've been doing studies that "prove" that patients are safer without alarms. Maybe some patients, yes, but to make a blanket statement that all are better is a mistake. I think they should take each individual into account. In my Dad's case...yes, he needs the bed alarm.

I hadn't heard of this until recently - that "the right to fall" is an actual thing. All these stupid things as we're standing on the threshold of the baby boomers are crossing the "senior" line...And when it comes to dementia and Alz - forgetting that you can't walk unassisted...Let's see...right to fall or right to life outside of a body cast...And staff being more attentive by this? Great theory in a rainbow/unicorn world...Until the staff to patient ratio explodes! Our society is so going to go over a cliff.

Dear Lucy,

I would talk directly to the nursing home about this ruling if it exists. Your dad's safety is your number one concern.

You're right, they do not restrain, that's what is so upsetting. The reasoning is that if the patient "decides" to stand up from the wheelchair or try to get out of their bed, the noise will scare them and cause them to fall. If a patient is physically able to remove themselves from the chair, there should be no need for them to be in a wheelchair in the first place. I'm about to go nuts with this!

I live in NJ and my Mom is on a wheelchair alarm and bed alarm.

I did a little quick Google research on this, and it's very interesting, depending on which side is talking about it. The most recent talk, it seems, of removing alarms is in Wisconsin. The nursing homes themselves say that it will improve patient care by making the staff pay better attention and "learn the patients' routines" -- as if these people are robots who will choose to get up at the exact same time every day. But, they claim that the alarms let the staff become more apathetic, and taking them away will force the staff to be more attentive. The lawyers claim that the homes want to take away the alarms because then there will be no evidence of how long the alarm was going off with no response before a patient fell, and therefore the NH will not be responsible for paying medical costs, etc. after a fall that they are responsible for. For my mom, when she was in rehab after brain surgery, and was completely unpredictable, I was really grateful that there were alarms in place.

Well as a current patient I am considered a fall risk which of course is true.
Two hospitals I have been in have used bed and chair alarms that go off like a fire alarm even if you just lift your butt up a couple of inches to reposition
Now I am of sound mind ( in my opinion anyway) so I find it quite handy to set the alarm off when they take too long to answer a call bell. That will usually bring at least three nurses running.
I live in NYS so don't know what the current thinking is here. The NH where I was sent for rehab did not have the alarms so I had to resort to calling the front desk on my cell to get some attention.

Of course we have the right to fall but do we have the right to expect someone else to put us back together??????????

As a gerontological nurse and daughter of a late parent with dementia, I can say that alarms are not necessarily a solution for fall prevention. There is evidence, based on extensive research, to support this. Alarms are often called psychological restraints. Consider this typical scenario: the individual moves and sets off the alarm. Staff (sometimes more than one) respond, often telling the individual to "sit down" or "don't get up". The individual, although confused, becomes conditioned to not move, lest they cause the noise. One of the ideas in support of avoiding alarms is that the staff should check the resident frequently, learning what's causing the individual to want to get up: maybe they have become restless from being in one position too long; perhaps they're in pain; maybe they need to toilet; are they hungry/thirsty? Other reasons for avoiding alarms: noise can be overstimulating for some residents; staff become desensitized to frequent alarms, leading to "alarm fatigue", causing inadvertently ignoring the alarm (that can happen in any environment where there are frequent alarms). Alarms can be especially irritating to an individual who wears hearing aids, as the noise is amplified and can be painful. I had a patient who had begun falling, and we used a chair alarm. He was able to rise so quickly that he would fall before staff could reach him. Although he had some confusion, he complained about the alarm, and he became more anxious with its use. We are required, by nursing and medical standards of practice to try to determine the cause(of falls). In this one patient's case, we had to remove the alarm to decrease the agitation that it caused. At the same time, with investigation, we found that his blood pressure was dropping when he stood, causing the falls. After medication changes, he falls stopped. In yet another case, a patient with a bed alarm asked me if he was in jail, because every time he tried to get up, an alarm sounded. Various interventions helped, and we stopped the alarm, and he was more content.

I was not always a believer in the "no alarms" practice, and used a motion alarm at night on my father who had dementia. I used it to alert us that he was on the way to his bathroom so we could assist him. The noise was so irritating to him that he tried to hide it (the alarm) from us, and was able to say it bothered him.

As for other forms of restraint: by federal regulation, doctors orders and family requests are not sufficient reasons to restrain a resident.

I have many years of nursing experience with the elderly. The problems and solutions are not always clear-cut. Not all falls can be prevented. Even if a physical (or psychological) restraint keeps the person's body from injury, restraints are known to contribute to depression, pressure sores, incontinence, loss of physical functioning, isolation, constipation...

I do sympathize greatly with family members who want only the best for their loved ones. On the nursing side (and administrators and DONs), if family members CANNOT be persuaded on acceptable professional standards of practice, they often revert to telling them that regulations do not allow whatever practice.

Finally, when the "revolution" to eliminate physical restraints came about, many medical and nursing professionals were saying the same as now: "We have to let them fall??!!" Studies showed there was a small increase in falls, but no increase in injury. I would say to those of you who are pro-alarms: The facilities that are caring for your loved ones are demonstrating interest in providing care according to professional standards. Just think: if not for advances in medicine, we would have only penicillin to treat infections; patients would still be hospitalized for days for cataract removal.

My wish is this: that family members be open to discussion for the best treatment plan, and allow professionals to help. I am still in the profession, and want nothing more for my patients than for them to be safe and have a good quality of life, just as family members do.

I am speaking about a restraint for a wheelchair now. They do not allow one even though the surgeon who did the hip replacement said he needed one to prevent another fall. He has ALZ so I had to hire round the clock "sitters" so they can notify the staff if he gets up. We would be arrested if we didn't restrain a young child or baby to prevent harm. In reading the Health Care Law it does allow restraints for those that need it and ordered by a doctor however facilities are choosing not to do so. Guess it makes it easier to have someone else watching - yet they charge more. So very depressed over all this. We need to find someone in Government to support our cause.