When can restraints be used?

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When can restraints be used?

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My dad has very advanced Lewy Body Dementia. He is completely aware of his toileting needs but has a difficult time verbalizing it and of course can’t use a call light. He has also lost his ability to stand alone or ambulate but can assist with a single person transfer. Since he feels the need to relieve his bladder or bowels, he stands to get up. The staff see this as agitation and want to medicate him. After 10 years of living as his caregivers we know his agitation means one of two things. Need for toileting or pain. The staff at night have begun to park my dad at the nurses station in his Geri chair after his first trip to the bathroom for his safety. I realize that he is a huge fall risk and there are rules against restraints him in bed but this feels like a worse restraint and it doesn’t allow for position changes. He is forced to sleep in the hallway on his back all night. I feel like we should be able to override the side rails rule as they are allowed for paralyzed patients. Since dad can’t remember that he can’t stand, he should not be allowed the chance to try. He is a danger to himself.

The place dad is in, is overall giving excellent care and I know they truly care for him and they are only trying to keep him safe at night. Is there any way around these rules for bed restraints so he can sleep in bed at night on his side? It doesn’t help that his room is the furthest from the nurses station with no possibilities for room changes

Lewy Body Dementia Mobility Skilled Nursing Facility Toileting

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I have a solution for you but the facility will need to agree to it. My mother had dementia and was blind but insisted she could get up and walk. She had rheumatoid arthritis and could not stand anymore. I watched my mother climb over the rails because she had a strong will and was determined. The administrator found a workaround for the restraint laws. They just put a mattress down in the floor beside her bed and lowered her bed down so when she decided to try to get up, she would just roll right onto the cushioned mat! No harm. It was the ONLY solution left that was acceptable by law. It worked! Please try it for your Dad. They can prop it up during the day when he is in the geriatric chair. When he goes to bed, lower the hospital bed and put down the cushioned mat. They will find him since they have to check regularly anyway and get him to potty or back in bed. It is the only humane way we could handle Mama. Before the mattress, she was scratching her hands up and falling out of bed getting a knot on her head. It was pitiful. Talk to them about this. Been there.

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"They will find him since they have to check regularly...." No. The law may say check and turn every two hours but it is not done. Two people died in the NH I worked in b/c they were not "checked on" all night. Most residents there were put to bed and forgotten until morning.

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I work in the field. Very low beds are a good intervention as well as "fall mats" (soft mats put on the floor on either side in case someone does manage to roll out of bed). Also, you might look into getting a "scoop mattress" which has built up sides of soft foam and makes it especially hard to get up and out. A scoop mattress may technically be considered a restraint, in which case a doctor's order is required. But that can be done if there is a good reason.

Unfortunately, with dementia, people's sleep cycles can be thrown completely off with A LOT of restless activity at night (which is demanding for a smaller night staff who are trying to keep people safe). It's not uncommon for someone who causes many repeated visits to the person's room to end up close to the nurse's station at night. They may spend the day sleeping (and that could be in the bed). Just something to think about. Maybe you should set up a meeting with the facility and review the care plan.

Good luck!

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Yes. The facility should be able to provide the kind of bed that lowers to just a few inches (7"?) from the floor and place a mattress next to the bed. This saved my husband from further injuries after the first two times he attempted to stand up by himself. Not a perfect solution for him because it was more work for the staff and I think they were trying to avoid him. They needed to move the mat out of the way to care for him in bed which was a bit inconvenient. He also sometimes scooted himself on his back all the way into the hall. But mostly it was hard to get him back into bed, requiring 4 people to lift him or even to use the Hoyer lift which was not stable that low. They did let him stay on the floor for hours, which was probably okay but difficult for care. The only other solution is a 24-hour sitter. We finally brought my husband home with 24 hour care. After exhausting most of our countable assets, he was able to qualify for Medi-Cal (California Medicaid) and (In-Home Supportive Services) which pays for some of the hours of care, and the Home and Community Based Alternatives (HCBA) waiver program will pay for more hours if they ever get to him on their waiting list.

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There are alternatives to bed rails, one that I like best are beds that can be lowered to within inches of the floor making it nearly impossible for most elders to get up, it also means any falls from bed are measured in mere inches.

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This is a difficult one to answer. On one hand, the staff is trying to keep your father safe. My mom was a fall risk as well so I understand their point of view. However, this comes really close to violating the unfair restraint regulations. To be forced to stay in one position for hours overnight would be hard on anyone’s body. In my mother’s situation, the staff moved residents around to open up a room directly across from the nurse’s station.

Here’s what I would do: call a Care Meeting with as much of the staff who care for your father as are available. Brainstorm ideas of how to keep him safe but not parked in a chair all night. Be open to all suggestions, but mention the pressure sores. That’s serious business. Infections from those can be deadly. Let us know what happens.

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This is a difficult situation as restraints are a dignity issue for the resident. The state department of health views this as a serious violation of care. Because of fear of sanctions as a result of using restraints, facilities have the position of restraint free. Side rails are not without dangers. There have been reported instances where agitated residents have attempted to climb over the side rails with serious injury as a result. Has the facility tried any sleep promoting measures? Lavender diffuser, for example? Sometimes giving an older adult arthritis strength Tylenol at bedtime may be beneficial to address any possible pain or stuffiness. How about melatonin or perhaps a consult with a geriatric psychiatrist to address the dementia as well as the sleep disturbances.

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Peanuts, she said he wants to get up to pee. These old men get up 4-5 times a night to pee. Seems like staff too lazy to get him on a bladder schedule, especially at night. May be she can speak to nurse director about this problem.

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I am surprised that they would have him all night in the hall rather than bed.
Have you been there at all hours to see if this is actually happening? If not I would stop in at various times during the night to see where he is. Or if it is legal in your area place a camera in the room so you can see when he tries to get up and if and when they bring him back to bed.
Bed alarms can be used.
Beds can be lowered to the floor.
If they are in fact leaving him in the hall all night I would report this, I would almost consider this abuse. It feels like some punishment. Not to mention there is no way he could get a restful night sleep in a well lit, noisy hallway.

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Please do not restrain your dad. That is very cruel. Side bedrails can be dangerous--their leg can get caught in it and they topple over on the floor. The injuries can be quite serious. Nursing homes can actually be sued for using restraints or side rails because they are long-term. Beds can be at floor level in advanced Alzheimer's units.

Restraint vests are incredibly dangerous--they can slide down and hang themselves.

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Lower the bed and put down a mattress is what the administrator came up with for my mother. It was all that worked and saved her from injuries and knots on her head. It worked and DHEC approved it.

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In all my Years of Nursing and so Forth, I have NEVER heard of such a Sick thing. call on Social Services at this Facility, Or if you Need To, protective Adult Services to Intervene. Are they lacking Help where No One can GO to his Room to Assist him this FAR AWAY? Keep on it.

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My relatives that were there are dead. I did ask for restraints to be removed from my brother. They did when we were there. I started staying as long as I could. It was hard because it was a long drive for me.

Otherwise the service was good. The home where my godmother was in was just a rotten home. Nothing about that place was good. Yes, shortage of help, theft, closed door so they could watch soap opera while working. You would not believe the crap I caught them doing in that home. She was constantly bruised. I would bring it up and they said she was violent. So who knows what goes on when visiting hours are over in some places. I cried every time I went to see her.

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A lower bed with a mattress on the floor should be tried.

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At the end of life hospice facility I remember them putting restraints on my brother when we were not in the room. I walked in and saw the restraints. I asked them to remove them. They did remove them while we were there.

So, they do still use them. They had him so heavily drugged and I suppose it was for his own protection so he wouldn’t fall. Still, it’s heartbreaking to see because he kept trying to turn and get comfortable and he couldn’t.

I saw restraints used in a nursing home when I went to see my godmother. They still use them. Perhaps they are not supposed to but my godmother became violent and they used them on her. Her ALZ had progressed pretty far by then.

It’s sad.

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When can restraints be used?

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