When arriving to see a patient at a memory care facility, I watched the staff load the community bus for an outing. I held my breath the entire time. The residents all have some level of cognitive impairment secondary to dementia. With those conditions, their safety awareness and judgement are impaired. They do not know when they are placing themselves at risk. It is the staff's responsibilty to make sure that they are safe.
The step to get into the bus was very high so a step stool was in place. The stool kept over turning because the legs were not robust enough. A staff member was randomly at the stool to cue the residents and monitor their step height and foot placement. The staff member was joking with the residents at how many times the stool had over turned.
As the residents were preparing to get on the bus, they were all gathered in the foyer of the buidling. There were walkers, wheel chairs, canes and inidividuals without assistive devices. Some were unsteady and bumping into each other. They were all at fall risk already and this just exacerbated this risk. They were getting agitated and pushing because they wanted on the bus. There was no one monitoring this activity in the foyer.
The coordinator of the activity was running around trying to find residents who had voiced intereset in attending the activity. She did not know where they were. She was using names of families who had voiced displeasure at prior events and said that she did not want to get yelled at again for sending someone out without the family approval. This behavior demonstrated that this was not a unique episode.
There were three staff assisting the residents. The bus driver was at the rear of the bus loading residents in wheel chairs. The second was at the door of the bus and the third one was running around the building trying to locate residents and keeping order in the foyer. One of the three would not be attending the outing. If three staff were here and there was this level of confusion and disarray, what was going to happen as these same residents would be getting on and off the bus at the site of their outing.
External activities for residents is important to quality of life. Staying engaged is great, but it must be done safely. The staff must be trained to be cognizant to the potential issues and plan proactively. It will take a fall, injury or care issue to get their attention. How sad for the residents under their watch that the staff are so unaware.