Dear CJ,

Thanks for sharing the story about the restraint. My FIL is a tall guy so it would be hard to handle him physically. His home care nurse keeps saying restraint is cruel but I wonder how else can one contain such patient? I think your way makes sense. This way everything is in balance. One cannot always worry so much about the elder endlessly without a clue. Sometimes it is dangerous. e.g, when my FIL had very bad nose bleeding in end of 2008, the restraint would help but the home care tried the gloves and all that. In the end, he still pulled the dressing out of his nose. He was ok just by luck and the bleeding stopped eventually. But your way seems to be proactive.

Unfortunately, nothing is perfect. Restraining could also endanger the elder. I guess it is up to the family what to do about it.

Regards,

Nina

Dear Nina,

If you are trying to keep him at home, and if you don't have a sufficient number of people there to spell each other (one person watching him, say, from 9-2 or 3 AM and another from 2 or 3 AM till 8 AM or so), then the restraint might help you all get some rest. If you have one person staying with him overnight, he might overpower just one person, if he is a large man. My father was not huge - he was about 5' 10" and weighed a normal weight, maybe 160 or 170 in his last years. But he was quite strong. He'd get himself into fixes when trying to wander about. One night, he fell in the bathroom, and it turned out he broke a vertebrae, which then ended up pinching nerves. We couldn't get him up, he was wedged in in such a way that we couldn't get to him. He was angry with us, angry with his situation, physically hurt, and determined that we were supposed to help him. We finally used the leverage technique to get him up, but it was very hard trying to explain to him that while I was on my hands and knees, he was supposed to grab onto me, lean on my torso, and work to raise himself. He had dementia, after all. Such a method is difficult enough to explain to someone who has no dementia.

At any rate, we finally, a day later, got him in the car and got him to the hospital. When they saw what we were dealing with, they put him on Haldol immediately, and he was placed in restraints thereafter. As I said, it was hard to watch them put him into this restraining top, but it did keep him from getting himself into trouble. In his lucid moments he would lift his trapped arms and say very sad things like "You know, I didn't ask for this." He also apologized for being such a problem. He would try to get us to release him, "Come on, untie that knot over there; you can let me go now." It was hard.

I'm not sure what is cruel and what is not cruel. Watching him flounder that night, after he had injured himself because we couldn't control him, well, that seemed cruel, too. Physical pain is not my idea of pleasure, and he was in physical pain.

We all are treading difficult roads, watching our elders begin to walk this path. I have learned a lot from your posts, Nina. You and your family are amazing.

Dear CJ,

The nursing homes have some recent ruls (for 20 years) that they cannot restrain the patients. The thing they do is send them to the hospital's psychiatric unit for elders and get medications to calm them down. However, the hospital can restrain to calm down the patient. Nowadays, they try intervention by talks as well as medications. Like you said, it may not be cruel to restrain. I think it is more cruel to dump them in the hospital with strangers and pour drugs into their body to calm them down. When one has to calm down the patients, we need to consider the reality. The patient won't like to be restrained or controlled but we have no choice. So far we have tried intervention to calm down my father-in-law, but I am not sure how long this method can last.

Nina

Thanks, Nina.  I think this might have been the rule at the time my father was hospitalized, back in late Jan 1993.  My mother refused to have him at home (she was, like my sisters, in denial about his failing mind), and the nursing home insisted they would keep him sedated rather than tied up.  We liked that, except that Haldol was the pits for him, in my estimation.  At any rate, my father's death the night before we were going to move him to the nursing home made the decision to move him into a nursing facility moot.

My father's instance -- multi-infarct dementia, now called vascular dementia -- makes it so clear to me now about finding an early diagnosis and trying to do something about the situation, early on. 

My family was in denial, as I've said.  I was trying to get them to read up on things, taking book after book with me on my weekly 4-day stays over there (3 1/2 hours from my workplace and home).  My sisters essentially tried to ostracize me in my mother's eyes, because I was trying to get them to see the reality of the family's situation and my father's condition. 

I was not at that time living in a home where we could have taken care of him.  Now, we are in a house sufficient to handle nearly anything, and my husband recently renovated the room my mother is in, so we're going to be able to use a wheelchair to get to the toilet, supply a bed lift, if necessary, and so forth. 

I learned from that experience that preparedness was everything.  And my sisters learned, I think, that however hard it was for them, they needed to try to listen to me when I had to say things that they might not want to hear.  The one professional among us all, I am information hungry.  They now know, I believe, to trust this.  Thank goodness! 

The internet helps immensely, too.  If the internet had been around then, it would have made it much easier to explain to my sisters about the situation my dad was in. 

I hope your situation with your father-in-law will come out okay for you all.