Posted By Dave Daniel
There are no "new laws".

I can understand that in principle an academic might suggest that trying to catch a falling person might actually cause you injury, so you shouldn't do it.

In reality any staff member seeing someone falling would try to intervene, regardless of training, even if only to mitigate their fall. I have often advised carer managers that their policies should be "real-world" based, not on theoretical situations.

Likewise, if you're a warden at a residential home, lifting a fallen client might not be what you are paid for... but you'll do it if someone falls out of bed at night, so you might as well be trained to do it properly.

As far as I am concerned whatever you've been told, base your policies on reality. You can't stop your staff acting like human beings.

Dave Daniel
Technical Director
Practical Risk Management Ltd .. and I mean Practical!

Posted By Alec Wood
Care homes have a bad enough reputation in this country (even worse than ours!) without rubbish like this. It makes you wonder what kind of world the guys who write these rules live in.

How can staff be made responsible for themselves after training? What about the employers duty to supervise? Also, one training course does not make a competent person, that generally requires experience, usually gained with supervision and support.

I think most people would regard standing, watching and letting Jack VC fall and split his head open on the door frame to be an act of neglect. I cannot imagine anyone but the most hard hearted bureaucrat would do so.

I am going to have a wild guess and suggest that this "policy" is just part of the public sector's usual campaign of disinformation in an attempt to reduce claims by employees. This would be similar to the "laws" briefed to staff when the equal pay reviews were done in our local authorities.

Alec Wood
Samsung Electronics

Posted By Karen Todd
Jason,

I think it would be morally wrong to let someone fall, knowing what the consequences could be - surely you would have failed in your duty of care? I know that I could not do this.

Although the policy is designed to protect the staff, it could actually put them at more risk.

My own grandmother fell in a residential home a couple of times. The last time she fell she broke her hip. They could not do a hip replacement, therefore she was left not able to walk. She was in hospital for some time, in immense pain and unfortunately she died in hospital and therefore did not go back to a home.

However, before the fall she was able to walk about with a stick. Had she recovered and gone back to a home, she would have required significant assistance. She would not have been able to walk, so would have needed assistance getting around in a wheelchair, getting in and out of bed, being toileted, getting dressed, etc. All of this she could do for herself before the fall.

Therefore, letting someone fall and sustain injury could put the carers more at risk in managing the person after they have become injured.

Karen

Posted By Mark E
The word policy may have been a miss-interpretation of the word guideline.

'The Guide to Handling Of Patients Introducing a Safer Handling policy' Revised 4th edition 1998 (5th Edition currently being updates) states on page 212

'If the patient is collapsing and cannot be persuaded to stand, he/she must be lowered to the ground immediately, by executing the following moves

Release hold of the patient/client

Move behind the patient

Open your hands and take one step back

Allow the patient to slide to the floor

Let the patient remain in a sitting positon on the floor, if they have fainted, position into recovery position' etc

It is important to plan for the eventuality of a collapse, therefore, do not hold or be held which prevents you releasing your grip. Avoid any method of support that allows the patient to grab hold of you.

You must not rush to rescue a FALLING patient, you will not be close enough to get into position in time.

Remember these are guidelines only, although they are qualitative and researched. they have been published and researched by none government bodies. These professional groups are The Royal college of Nursing, Chartered Society of Physiotherapists, College of Occupatuional Therapists and the National back Pain Association(as it was at time of print).

The Fallen patient is different, this is a patient that has already fallen and requires assistance back to a chair/bed.

If a patient/client is on the floor, initially, it is the safest place, they can't fall any further. An assessment can be made then , ie injuries, patients ability, etc, then assistance, hoist or lifting sheet can be used.

One has to remember, that when a person is falling, and you are not close enough, you will not stop them from falling, probably incurr an injury yourself(high risk if you are in this field everyday0 and possibly cause more injury to the falling client.

There are no Department of Health Policies stating you must not catch a falling patient, but with the information above, an informed descision can be made by staff members, as to whether they take on this task.

Posted By Nigel Hammond
Karen Todd and Mark E give some sensible measured and useful advice. You have to balance-up the risks to staff verses the risks of the people they care for. Karen and Mark's advice seems to acheive that balance.

I can't understand why the other comments on this thread are so sensational and over-simplistic.

Posted By Jason Gould
Thanks for the comments as they have been very informative. (Mandy the carer is spitting feathers)

Yes I agree that maybe trying to catch a falling person can cause more damage than good at times but at other times (majority) may well prevent additional injuries and cost.

I also agree that people should be trained in dealing with unsteady residents, and from what Mark has described this would probably suffice theoretically. (taking into account human nature and instints)

I see the message I see I see.

But why is my partner not getting that message. Trust me she has read this forum and states this is totally not the message being put out to carers in her place.

Remember they will probably get a manual handling trainer in for 4 hours, a day at best.

At this moment in time Mandy is at work with others, all caring for elderly residents. They have been led to believe that they should not try and intervene with a falling resident.

That leaves me with a uncomfortable feeling.

Remember this is a proactive care home and not some dingy privatly run place.

How are trainers dealing with these guidlines and is there the possibility of the wrong message being sent out?.

And please I want simplistic answeres as this is not my strong point, in fact its a very weak point of mine. (rough cut diamond of the like)

Regards Jason

Posted By Ken Taylor
There seems to have been some misunderstanding on this training course. Ian, Mark and Greg are quite correct in describing what has been the advised procedure for some time in care homes. This is to protect both the client and the carer from injury. You don't stand there watching them fall if you can turn the fall into a gradual and controlled descent. Please pass the message on.

Posted By Laurie
I have followed this thread with some interest, since I have actually been on the receiving end of this policy.

Prior to my wife being allowed home after a stroke, various agencies – occupational therapists, home help agency, appliances and aids, district nurse etc – met at the house to see what procedures and equipment were needed, or were in place, to continue her rehabilitation.

It was agreed that a carer would come in first thing in the morning to assist with dressing and getting up..

When it came to descending the stair, my wife can only come down backwards, and it was suggested that the best way would be for the carer to stand one step down, behind my wife, holding onto both handrails, to brace my wife should she become unsteady. The carer manager was aghast at this, and said that the carer must be above my wife so that she, the carer, would not be injured if my wife fell. When I asked how this was assisting my wife, she said that the carer would be there to help my wife once she had fallen, and could call the ambulance! This was a requirement under the Health & Safety at Work Act. Like any red blooded safety officer I thereupon produced the said act from my briefcase (I had come straight from work) and asked her to show me where!

This is personally experienced factual information, everybody, not some apocryphal story, so it is happening, and it is happening now.

The bad part about this is that up until this point ( and since) my wife and I have nothing but praise for the nursing, rehab and social care organisation and staff.

There has been some adverse comment about the public sector , and bureaucrats, and having told you the nightmare, it is only fair that I tell you the dream.

When my wife arrived at the local trust hospital, having had her emergency care in another NHS Trust area, she was met by a smiling ward sister, not at the entrance to the ward, but at the front door of the hospital. On the way to the ward she told my wife that she had a nice bed near the window and how everybody was looking forward to meeting her. She also said that they were not sure when my wife would be arriving, but they had kept her some lunch back , but not to worry if she didn't want it as they would make her some soup or toast if she preferred.

When I arrived to visit I was told I could visit at ant time (and I actually did call in once on my way to work at 7.15 a.m.!) and shown where I could make tea and toast if I or my wife were hungry or thirsty at any time. During my wife's time in hospital (she was there for more than six months) I was approached during visiting by a member of the nursing staff who told me that it had been decided at my wife's last case discussion that I was showing signs of depression, and an appointment had been made for me to see the unit's clinical psychologist.

During my wife's stay every few weeks the nurses would, entirely of their own volition, arrange a minibus and take the whole ward to a local hostelry for lunch; this normally meant off duty staff coming in to help with wheel chairs as most of the patients were mobility impaired.

On the real health and safety side, before I was allowed to take my wife out in the car I had to have instruction, and demonstrate to the satisfaction of two physios, transfer from car to wheelchair and back risk of injury to either myself or my wife,

Help was given with application for disability allowance, blue badge, Motability concessionary taxi vouchers and concessionary bus fares. This last was the one area where we received bad advice, since when we went to the council offices to get the necessary concessionary fare bus pass we were told that what my wife should really have was two free bus passes, one for her and the other for any companion who was with her, and these were duly issued within minutes.

Prior to my wife being allowed home we had a visit from have a dozen agencies, as indicated above, to discuss bath lifts, stair rails and other appliances. Once again I also had to demonstrate, to the satisfaction of two physios, that I could pick my wife up off the floor, as a deadweight, both from lying on her affected side and her unaffected side, and not from the floor of a nice clear gymnasium, but an area that had been deliberately obstructed, as it would be at home – that again is real health and safety in the real world.

When my wife left hospital she was told that they were only a phone call away, and they were our (not just her) safety net. This was repeated during the three years my wife made rehab visits. Last year, five years after discharge, we had occasion to ring with a very minor problem and an appointment was made within the week, and when we had to make an outpatients visit last week, some six years on, everyone still remembered my wife's first name, and when nursing staff heard she was in the outpatients they came down from the ward to say hello.

This is the system as it should be and this is also personally experienced factual information, and it is really happening, and it is happening now. Unfortunately of course the story that we always tell, and the actual prompt for this response, is how the home help was simply there to call the ambulance.

It only takes one.

Sorry to have gone on at such length about much that is not really a health and safety issue, but, as I said, it is only fair to give both sides of the story.

Incidentally, for those of you who may just starting in this fascinating business (where else would you be expected to display a detailed knowledge of colostomy bags, fireworks and dead pigeons in the space of one hour!) it is a good idea to keep a copy of the Act to hand for use as described above. It doesn't take up much space, and it isn't heavy, and when somebody says – "It says in the Health and Safety at Work Act......) you can produce it and ask where – they don't normally know about the hundreds of sets of Regs. which are part of our daily life! Childish I know, but oh so satisfying!

Laurie

Posted By John Webster
Laurie

A further footnote

My mother is very independent, but was becoming unsure of herself on stairs and worried what might happen if she fell with nobody there to help.

She now happily mounts the stairs on all fours, and descends sitting down, a stair at a time. Very stable positions initially adopted by toddlers - but not in the "care book".

Posted By Gavin
It is interestin that there appears to be a gap between the training delivered and the training received. It is not a simple 'let them fall' situation but rather a how can I help that person in a way that will, probably, leave me uninjured. I would agree that in the case of falling objects / animals it is best to simply let them fall, however no carer should condone their clients falling like flies whilst they stand around doing nothing.

The solution is for the relevant personnel to carryout a risk assessment, decide on an appropriate strategy for dealing with the situation and then impliment it. This could involve training, individual client risk assessments, choices of furniture, simple maintenance...

The basic priority should always be to prevent / reduce the risk of falling as the top level priority and then work down a hierarchy of controls.

Just because this could be an emotive issue is no reason to stop applying the basic risk assessment and management processes of our profession.

Posted By Richy
Jason,
As a qualified nurse and health and safety professional I agree it does sound sick. Yes a let them fall policy does exist. Speaking from experience I would not personally let an elderly person fall it is not in my instincts as a caring person. However these policies do exist and it is a classic example of where civil claims for back injury in the nursing sector have gone mad. Surely then the answer is to promote and educate the use of lifting equipment to minimise all lifting activities.
I appreciate this is not always possible in the case of an accidental fall.
However in the case of planned manoeuvres lifting equipment should always be used. Always with dignity and always in privacy.
Kind Regards
Richy Marriott