Monday, May 17, 2010

Safety for Elderly without Restraints

Here is a paper by one of the students in the social welfare policies course.

History has shown that elderly people have always been vulnerable to abuse. They were forced to retire at an early age, society didn’t want them around, they received little health care, and were written off as a group of people who are needy. Laws and legislations have stopped this type of abuse, but have let another form emerge. The use of physical restraints are being used to keep elderly people safe has become common trend in our society. This controversial procedure has good arguments for and against it. However, in more recent years legislation has attempted to make this treatment illegal. I for one, think physical restraints should be used in the least invasive way only when necessary in the best interest of the patient, when no alternative intervention can be utilized.

A restraint is defined as a manual method, physical or mechanical device, material or equipment that’s attached to one’s body or processions that cannot be easily removed and affects one’s mobility. Examples of restraints are tying one down to a hospital bed, bedrails, wheelchair belts, wheelchair trays, or anything else that restricts one’s independence. In an extreme case in Chicago a nineteen year old chained her eighty-one year old father to a toilet for seven days. She also hit him and tied his legs together. In a telephone study, by More and Pillemer in 1989, of 577 nurses and nursing aides over one third of them said that they had seen physical abuse, including unnecessary use of restraints. Ten percent of respondents admitted to using physical abuse to residents.

Doctors must specify the reason for the device, how it’s to be used and how long the patient should use it. As restraints are potentially dangerous the restraint must be continuously evaluated for the effectiveness and the least restricted method should be used to promote the most independence. However, in this economy nursing facilities have reduced their staff and increased the use of restraints. Another study concluded that restraints cost than more staff members.

Overall the use of restraints has declined during the last decade. In the 1990s thirty to forty percent of nursing home residents were restrained. In July of 2007 this figure had become reduced to nine percent. In European countries, this rate is as small as five percent. This could be due to a number of reasons. Perhaps the biggest cause in reduction of the use of restraints is due to a law that was passed by the state of Minnesota in 1999.

In 1999 Minnesota Statute 144.651, subdivision 33) which established explicitly the right of residents or residents' decision makers to request physical restraints. It also specified that legitimate medical reasons for using a physical restraint include: "1) a concern for the physical safety of the resident; and 2) physical or psychological needs expressed by a resident. A resident's fear of fear of falling may be the basis of a medical symptom."

There are alternatives for using restraints to keep the elderly safe. Basic everyday needs, such as toileting, bathing, providing fluids throughout the day, closer supervision by staff socialization activities, and removing barriers to create a safer environment are ideas that would be free for nursing homes to intervene when necessary. Assigning the same staff person to a resident to improve function and decrease unwanted behaviors is another priceless alternative to restraints. Rehabilitation programs, walkers, hearing aids, vision aids, bed and chair alarms for residents to use when they need help, and wheelchairs are a little more costly, but are still ways to keep elderly people safe. Door alarms are used with residents who wander off.

In my opinion restraints, such as bed rails, wheelchair belts or trays should only be used for safety, under a physician’s orders, when no alternatives are possible at the time of need, or in emergencies. No one should be tied to a bed! I guess I’m at the same dilemma as I read in one of my references; safety verses independence. Fostering and promoting independence will be big issues that I advocate for as a social worker. However, I think safety is more important than independence. My solution for this problem would be to use the least invasive restraints as possible. I think that assigning staff to a particular resident as he or she would be able to change unwanted behaviors and get to know the resident’s potential for independence and help them to be as so is an excellent idea. Restraints are used basically for incompetent older people with dementia and Alzheimer’s disease and those who may not know enough to consent to treatment. On a very personal note my grandmother and my sister would fit into those categories. Grandma suffered from Alzheimer's disease. When she was in a wheelchair she wore an ankle bracelet that would sound off an alarm when she would try to go outside. Hospitals had to restrain her in the rare cases that family wasn’t around her. My sister has Down’s syndrome and doesn’t understand that in the long run, being poked with a needle will make her feel better. She has to be held down to get one in her. Once again these cases prove my point that safety trumps independence.

There’s a history of restraining elderly people for their own safety. Restraints are anything that restricts movement. Rates of these occurrences were between thirty and forty percent until Minnesota passed this Minnesota Statute 144.651, subdivision 33) law in 1999. Assigning staff to particular residence, having closer staff supervision, and providing socialization activities are only three of many alternatives to using restraints. I don’t like the idea of restraints. They should only be used under a doctor’s order, in emergencies, or when alternatives are not available at that time. Safety is more important than independence, so in the case of an incompetent person, the least invasive restraint should be used. There are alternative ways to keep elderly people safe without restraints.


Greg said...

I would agree with the point of your paper, Eric. We should apply restraints to seniors only when these are positively needed by the patient. The use of such should not just be the caregiver's or even the family member's misconstrued prerogative because it goes beyond the senior person's human rights, and considering, too, that he is not as mentally capable as he was before.

Since one focus of the Obama administration is set at health care, I think the government should take a closer look at the seniors' health situation and act more forcibly to get sufficient monetary provision for it. More nursing and senior residences with good amenities and peaceful environment, like senior living communities Charlotte, should be built nationwide to accommodate, according to statistics, the growing high number of aged or retired men and women at present.

Anonymous said...

Restraint is certainly not the best option. I’ve found that the best thing for the elderly is to have a medical alarm system. I wrote about how having a medical pendant has allowed my grandparents to remain independent. You can read my post here: