Finding Alternatives to Restraining Dementia Patients

Caregiver, patient expert

Yahoo News recently ran an article by AP writer Kevin Freking titled, "Nursing homes cut back on restraints." I addressed restraints here on OurAlzheimers in an article titled "For Dementia Patients, Drugs Shouldn't Be Used to Control." While that article focused on drugs, I also wrote about what any type of physical restraint would do to my dad, and how hard it was to accept that he would sometimes get hurt because of his choices.

I've heard complaints from families about nursing homes using restraints, and I can understand that. I hadn't thought too much about the amount of static nursing home staff could get from families for the lack of  restraints, but I can understand that, as well.

Sometimes we're all between a rock and a hard place.

Freking begins his article with, "The use of physical restraints on nursing home patients declined nearly 40 percent nationally in recent years as the federal government, states and the nursing home industry placed greater emphasis on eliminating what once was a common practice."

In talking with a nursing home representative in South Dakota, Freking was told that families had reported them for not using restraints. The families mean well. I know because I've been there. It's very hard to know that your loved one will likely fall and possibly get seriously hurt, if not physically restrained in some way.

Alzheimer's and other dementia often prevents affected people from exercising good judgment about what is safe and what is not. The patient will simply decide to do something and do it. That may be wandering out into the cold, or, as in my dad's situation, deciding he could just get up and walk wherever he wanted to go, without getting a good grasp on his walker or even remembering to grab it.  Of course he'd fall.

The South Dakota nursing home uses many techniques and technologies that make the need for restraints less necessary than years ago. With units that require codes to open doors and the knowledge that low beds make for fewer falls, many nursing homes have cut back on problems. There are also alarms that attach to clothing, so when the patient moves too far, the alarm goes off and nursing personnel come running. They had those for Dad, too, but he hated those as much as any other restraint. He may have had dementia, but he wasn't stupid. He knew they were trying to restrain him and he resented it.

Of course, as with all elder care, more attention from staff will definitely cut back on falls and need for restraining behavior. And the better homes are learning that consistent staff is important. The staff gets to know the elders and their needs. This knowledge helps them interact with the elder and helps them keep the elder safe. Human interaction will win every time.

The use of restraints has always had an ugly sound and certainly restraints have been used, historically, at  some facilities, for the convenience of staff. However, many homes used them rationally and with the best intentions. They just didn't understand that the psychological use of the restraints was often more damaging that the physical harm that could come from a fall.

It was horrible to see my dad fall. He had good care, but the staff wasn't there to keep an eye on him at all times. And he would be full of energy one minute, and literally fall asleep while standing up the next. The staff and I agreed that there were risks in whatever we did. But the total hysteria that resulted when there was any attempt to physically restrain him was too hellish to bear. And drugs were not the answer. Attention to need was and is the answer. And recognizing that he had rights and could make choices was also part of the answer.

Yes, he was vulnerable, but he had rights. Everyone should be able to make some choices. And when they are terrified because they are restrained in some way, then they have made a choice to be without restraints. With most choices there is risk. It's the responsibility of the caregivers to keep dementia patients as safe as possible. But there will be times when things happen. Finding some kind of a balance is about all we can do.

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