Tom’s story: Improving safety and quality of life

Description of case:

Tom is a 92-year-old gentleman who was diagnosed with vascular dementia in 2011. He also has poor vision as a result of macular degeneration. Tom previously lived in his own home with his wife. In November 2013, he required more care than his wife could provide and so was moved into a care home where he was provided with a low rise bed of 350 mm height (including the mattress).

Main issues:

Tom is not orientated to time, place or people (other than his wife). He struggles to follow instructions and is not aware of the difference between night and day; he has very poor insight into his level of function and poor risk awareness. He is hoisted for transfers between the shower chair and bed, as he is unable to weight bear. Tom experiences frequent and vivid hallucinations and becomes fearful of falling, even to the extent of imagining he is falling from an aeroplane or boat. Tom grips the edges of the bed whilst experiencing these hallucinations and appears agitated and anxious.

On one occasion Tom displayed these distressed and agitated behaviours for an extended period of time, thus making his care difficult. He had refused to sit out of bed for several months, becoming confined to bed. Despite this, Tom would still attempt to get out of bed at inappropriate times; when the carers asked him to stay in bed, he would become agitated and raise his voice, telling them to leave him and go away.

Intervention:

Tom was identified as an appropriate candidate for trialling a FloorBed as he was frequently attempting to get out of bed alone, resulting in bed falls; even with the use of a crash mat, these falls caused bruising, head injuries and other damage. Medical intervention was often required and incident reports were being completed on a regular basis.

Outcomes:

The FloorBed was provided for Tom and set very low when he was left alone. The carers and Tom’s wife report that since having the bed, Tom has not attempted to get out of bed at all and so has not had any bed falls. They also report that Tom appears safe and comfortable in the bed and is happy to be left there alone. In addition, Tom has become much calmer throughout the day and night. Since using the FloorBed he appears more alert, more responsive and better able to follow instructions.

Another observation is that Tom has had fewer and less intense hallucinations; Tom’s wife believes that Tom feels safer and more secure when left alone which has led to him being more relaxed and calmer.

The carers report that the FloorBed has not only improved Tom’s overall quality of life but has also had a very positive impact on them. Relationships between the carers and Tom have greatly improved, as they no longer have to cause him distress by repeated requests to stay in bed. The carers no longer have to fill out incident reports or provide such frequent supervision. The need for medical intervention has been significantly reduced, decreasing the carers’ workload.

Comment from Tom’s carer:

“Best thing I’ve seen anywhere for people at risk, no risk of tripping on the crash mats. This helps the carers a lot – makes the residents much happier, no calling doctors, no incident form, not having to monitor him as much”.

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Comment from Tom’s wife:

“He is much calmer in this bed, maybe he feels safer and the hallucinations have become much better”.