Do You Believe in Restraints for Alzheimer’s Patients?
April 20, 2008 by Mary Emma Allen
Filed under Diseases & Conditions
The use of restraints, to keep Alzheimer’s patients from wandering, getting into unsafe areas, escaping out-of-doors, raises much controversy, especially when connected with nursing home residents. There’s a balance with a fine line that separates safety from abuse in most people’s eyes.
More nursing homes and elder care agencies continually research ways to keep patients safe without severe restraints.
*The use of alarms that go off when a patient tries to get out of a wheel chair.
*Alarms that signal the opening of a door into an area where the patient may be unsafe.
*The use of a tray across a chair that might latch in place but not deter normal movement.
*The use of a half rail on the bed so the patient doesn’t roll out. I was informed, that in some cases, a full rail was considered a danger because the patient might try to climb over, whereas with a half rail they would be stopped from rolling but not restrained.
Restrain for safety, yet allowing enough freedom has become an issue in many situations. Perhaps when you see that someone in a care facility or a private home appears to be restrained more than you consider appropriate, inquire first about the reasoning before jumping to conclusions. What is safety and what is not?
What are your thoughts on this issue?
(c)2008 Mary Emma Allen
This is such a touchy subject for so many people, I know. Having had family members with Alzheimer’s (and, consequently, having gone through the fear of confused and wandering family members becoming injured), my personal opinion is that various restraint methods seem quite beneficial to the health of the patient as long as they’re used appropriately and not a “babysitting” devices.
Last year, a friend of mine lost his grandmother partly due to the nursing home not using the night time restraint method the doctor had ordered (bed rails). She rolled out of bed, struck her temple on the nightstand, and suffice it to say it was too late by the time anyone checked on her.
It’s stories like these that make me feel some kind of restraint may be necessary in some situations, though, again, I feel it should be for protection and not to help caregivers “babysit.”
Alicia, thank you for stopping by Alzheimer’s Notes and sharing your thoughts. I agree, it’s a very touchy subject to many people. When my mom, tended to escape outdoors, tried to get up from her wheel chair when her legs no longer held her, wanted to get out of bed when she needed assistance, I preferred to have some kind of restraint for her protection and safety, yet wouldn’t be one solely to keep her confined when it wasn’t necessary.
Since I’d taken care of Mother in her home and mine, I realized the challenges involved in watching out for the Alzheimer’s patient’s safety and knew how quickly they could circumvent the methods you might try.
“how quickly they could circumvent the methods you might try”
This is very true!
You know, I expect making the decision to use restraints of some sort (or, coming to terms with the doctor’s decision to use restraints of some sort) is probably just as difficult a decision as deciding to place a family member in a nursing home. In some situations, it gets to a point when you hate to do it, but you know that it’s for the best (given your personal situation, that is). Your primary goal is to keep them safe, and sometimes in order to do that you might have to use methods you’re “iffy” about or feel uncomfortable with. I think that’s a big reason why many people are so against the idea of using restraint methods. I mean, just the word itself – “restraints” – probably carries a negative connotation for many people. “We had to use restraints with Dad” – not a sentence we want to say.
I know it is heartrending to see your loved one with some type of restraint, but on the other hand it is painful to watch your loved one suffer with an injury after a fall.
It is indeed a thin line to walk between using restraints for safety, and trying not to cause mental and emotional suffering and loss of dignity to a loved one.
It’s a hard thing to do, and you are bound to get many negative comments from people who have never had to deal with an Alzheimer’s patient, but there comes a time when there is no choice. The only option is to carefully choose the minimum practical method of restraint. The less visible the restraint the better. Alzheimer’s patients can injure themselves struggling with restraints. It’s better if they can’t see what is holding them back. A locked door should not look like a door if possible, but a doorknob or elevator button on a blank wall can keep the patient occupied for hours. The type of seatbelt that usually comes with a wheelchair is too obvious but discreetly attaching the patients own belt to the chair is less likely to result in a struggle. A patch of black on the floor (tape, a small rug, etc.) was all I needed to keep my Father away from a door.
Thanks, Bob, for stopping by Alzheimer’s Notes and leaving these suggestions for choosing restraints carefully. It is a difficult situation, but one that needs to be addressed for the patient’s safety and caregiver’s sanity. Sometimes in order to “appear” humane to the general public (who have never had to care for an Alzheimer’s patient day in, day out), the patient’s safety gets pushed into the background.
The nursing home where Mother resided also had buzzers that would go off when the patient tried to get up from a chair, open a door, etc. I like that idea of a door knob or elevator button on a blank wall. I can see that this would occupy some residents for a considerable time.
I’d rather have a nursing home properly restrain someone than drug them so much they were drooling zombies. We’ve had both happen when family members with Alzheimer’s or dementia were in nursing homes for a few weeks of rehabilitation after hip replacements, etc.
We were really upset by the over medication. Their response – He was giving them trouble. Of course he was! He had dementia.
Thanks, Katelyn, for stopping by Alzheimer’s Notes and sharing your thoughts. Yes, too much medication to make the dementia patient less active can have undesirable effects. The use of passive restraints may require more thought and watchfulness for the staff, but definitely is preferable to over medication. I’ve experienced both, too, and preferred Mother not to be medicated.
I am dealing with this situation currently. My mother is in a nursing facility and is a fall risk. She broke a hipnin a facility that would not restrain. She has parkinsons, dementia, and is a stroke victmim. Thankfully, the new facility does not mind using restraints. Recently, they were told that they must come up wih something different for my mother because she is in a low chair with a belt. They say it is a double restraint. I guess it is against state/accreditaion rules or something. But it has been working. She flipped the wheelchair 6 times and had a head injury from it. They are speaking of putting her back in the wheelchair. Does anyone know if there is a way to get special approval depending on the patients needs?
My mother is now in a nursing home due to a fall at her Alzheimer’s Care Facility. She had surgery to relieve the pressure on her brain due to a subdurral hematoma. Because of this the nursing home has kept her somewhat sedated and restrained by a bed rail and a belt on her wheelchair. Since she has aggressive behaviors they also requested that she have a private sitter from 7pm to 7am. As her function has improved (and because they say that policy have them remove all restraints) they are requesting a sitter 24/7 indefinitely. We are already paying $8 thousand per month and the sitter would cost an additional $10 thousand per month. Needless to say, finances have become an issue. We want the best for our Mom, but at this point we don’t know what to do. Is it normal for nursing homes to ask for sitters, and if so , what are they charging the patient for? If anyone has any ideas, my siblings and I are ready to listen.
Becky