If you look up moderation in the dictionary, you may see one of these definitions: (1) the act of restraining, containing, controlling, or controlling; (2) the state or fact of being restricted; deprived of freedom; lockdown. But what does the term “restraint” mean in a nursing home or hospital? You may be researching the facilities and discover that one has a no restrictions policy. The section of the Virginia Administrative Code that refers to nursing home facilities defines a “Physical restricted“as” any manual method or physical or mechanical device, material or equipment attached to or adjacent to the resident’s body that the individual cannot easily remove and that restricts freedom of movement or normal access to one’s own body. “12 VAC 371-10 . same section defines a “Chemical restraint“as” a psychopharmacological drug (a drug prescribed to control mood, mental state, or behavior) that is used for discipline or convenience and is not required to treat medical symptoms or symptoms of mental illness or mental retardation that they prohibit a person from reaching their highest level of functioning. “12 VAC 371-10.
Although these are more technical definitions, they mean the same thing: something tangible or a drug that restricts an individual’s movement or level of function. So why would you want to restrict someone’s level of function or movement?
Imagine an Alzheimer’s patient who has little awareness of his surroundings. Would a device that prevents you from leaving the nursing home be helpful? Or consider someone who becomes aggressive towards others due to dementia: Wouldn’t a psychopharmacological drug to help control that behavior be appropriate? The answer as to whether or not these physical or chemical restrictions should be used is not simple or clear. Families and friends of nursing home residents should educate themselves on the use of restraints, their pros and cons, and make decisions regarding their use accordingly.
For starters, what are examples of physical restraints?
- Bed rails
- Wheelchair straps / seat belts / lap companions
- Meri-walker
- Rollator with wheels
- Door restrictions
Why would a facility consider using any of these with your loved one? Perhaps to prevent falls, which is always a goal, but other consequences can be just as devastating. Hundreds of people are trapped in bed rails each year, suffering injury, strangulation, and often death. Keeping someone in bed or limiting their ability to get up can also put the individual at risk for developing pressure sores or bed sores and incontinence. Additionally, there are mental and psychological effects that occur when you limit someone’s freedom and take away simple decisions, such as when to get out of bed.
Meri-walkers can provide some stability to a wandering resident, but accidents frequently occur when residents of meri-walkers are faced with stairs, changes in floor level, etc. Not only will the momentum of the walker help cause a fall, but the device itself can become entangled in the person and cause further injury.
Wheelchair straps can prevent someone from getting out of the chair, but again, what if they hit a ladder and have no way to stop, get up, or avoid falling? The wound can be fatal.
Chemical restrictions can be just as dangerous. If a resident is given too much medication, they may have a decreased appetite and may become dehydrated or malnourished. They can also be less mobile and at risk for pressure sores. If they are mobile, many medications can cause problems with concentration and balance, increasing the risk of falls. The risks are many and must be considered by the prescribing physician to assess dosage, frequency, etc.
Sadly, thousands of families have faced accidents, injuries and deaths caused, in whole or in part, by the use of physical and chemical restraints in healthcare settings. Our office has handled cases involving each of the above restriction scenarios. Unfortunately, injuries involving restraints are not uncommon. The lesson we draw from these experiences is that restraints should only be used when absolutely necessary, and only if families have had the opportunity to speak with a doctor about the known risks and benefits. So while they may seem like a great idea at first, do your homework and ask the center the following:
- How many other residents use this restriction?
- Will it make my father more mobile or less? Will you control it accordingly?
- What will you do to make sure it doesn’t get caught in the bed rails or wheelchair strap?
- Will you review the use of the restraint system monthly? If so, can I attend?
If the facility does not provide any additional controls due to the restriction, then its use should be very limited. At the very least, make sure the doctor and facility are on the same page and understand your concerns.