I keep reading about patients that have suffered broken hips in hospitals and nursing homes. In March my dad was hospitalized with a nasty UTI. he was totally out of it. The hospital had him tied in bed and in a chair at different times. Basicly the whole time he was hospitalized ,he was tied up. When I questioned this, I was told that it was for reasons of liability.
My friend's mother is in a nursing home and keeps falling out of bed. She says the snf is legally not allowed to restrain a patient even if for their own safety.
If you were to restrain a patient at home, I believe it would be concidered elder abuse.
If there are laws regulating restraining patients, who makes the decisions? Do family members have any say in the matter? Is there a difference between what a hospital and a snf can do? Are there different types of restraints that would be more prefered to others?
When Dad was in the hospital, it just tore me up to see him tied up the way he was. First of all, they used a size med. posie jacket with little flowers on it. Dad weighs 200lbs. and is only 5ft 2in. He is a little rolly polly man and this posie jacket was like a corset on him. They told me that it was the only size that they have. I have kicked myself in the butt many times for not insisting on something else. I guess the good news is that he doesn't remember it. I would like to know where I stand if this comes up again.
Thanks Everyone. I know you will be able to steer me down this path with your expertise.

My mother and hubby had to be put in light retraints at one time.Nothing drastic that could allow them to harm themselves.If they were not they would have harmed them selves.
To me, they carry this no restrain too far.Just my opinion.I saw the end justified the means and believe me I would not allow either to be put in any dangerous situation.
As long as they do not use them all the time to do their job

This is a hard one.
Right now I don't have to deal with that issue.
But if it comes down to having to restrain my mom, it would depend on her level of awareness. But personally,IMHO if it came down to it, I would rather use meds as a restraint. I could not imagine someone in her confused state having to go thru pain,tests, surgeries, hospitalizations, examinations, etc. for injuries due to a fall.

Just my opinion, disturbed daughter.

I will give you my usual advice to loving CGs:
trust your own feelings to make decisions, you will have no regrets!

It may be different in other states, but in my state the decision whether to allow restraints is typically a policy of the facility itself, based I imagine on laws governing use of them. As noted, these restrained patients need more frequent checks and some places choose to use their available staff in other ways.

If this is the case, and he needs restraining, he may need to go to another facility which is set up for this.

Our LO is in a "no restraint" facility. She has an alarm and was intentionally placed in a room next to the nurse's station. There have been some falls, but because of the alarm she doesn't lie there for more than 30 seconds or so. What we decided was that restraints would perhaps keep her alive longer, but what kind of life would it be? In our case, she has just enough cognitively to know that she is restrained. The alarm, she forgets about. LOL

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Any suggestions???

DD, first, let me say how sorry I am that you or ANYONE has to deal with this kind of situation with their LO. Although it never appears in the official symptoms of this group of brain destroying diseases, this is the kind of stuff that causes a LOT of heart damage to those who love them...

I would discuss this with his doctor. If he's medicated, he may be a greater fall risk, but unless he is restrained somehow, he will continue falling. It is unconscionable that the NH "patient coordinator" (apparently she doesn't help his coordination...) is unable to offer any suggestions other than to let your poor father fall and flail... I don't like what you said about "finding him" under chairs, etc. Something is wrong and he is not receiving enough supervision. Have you discussed this with the ombudsman? Which would they like? A seatbelt or a skull fracture?

Whether folks like it or not, when people's brains become so dysfunctional, SOMETHING has to be done to prevent injury to themselves and to others. Some folks even argue a "right to fall" point of view!

The problem with physical restraints, safety belts, etc. is that they MUST be CHECKED every 30 minutes or so and many facilities will not do this. If not closely monitored, the "safety" belts can actually cause as much or more harm to the patient. I have seen how people just seem to ooze under them... not to mention that if the belt is snug, it could cut off circulation and prevent him from adjusting his position, which would lead to pressure sores quickly. Being belted in a chair would also cause your dad to lose whatever ambulation ability he has more quickly and cause difficulty with other issues, such as toileting, etc. Some patients are annoyed by safety devices and become more agitated because of them.

I really think his doctor should be consulted as he/she may not be aware of how often he is falling, etc. It is possible that one or more of his meds may be contributing to his loss of balance.

Sometimes, there IS no good solution - both chemical and physical restraints cause patients to deteriorate more rapidly and lose dignity more quickly and completely. It's a sorry situation...

Good luck and please update us about how things go...

Welcome disturbeddaughter, This is a dilemma, I have not faced. I know from reading that use of restraints are tightly regulated. I can only welcome you and hope that some one else with experience in that area comes in. Weekends can be slow, so don't give up. The balance that the law and docs take between freedom and safety is a wall banging issue.

Again, welcome.

okay, I'm prepared to take some heat for this but... my Dad has been in care for a year and a half and has Picks disease. He is very unstable on his feet yet has this will to walk. Thus he is very suseptible to falling and has gotten injured numerous times. He can't see very well either as he is stooped over in half and bumps into walls, furniture, other residents etc... I have found him in others rooms, fallen on the floor with chairs on top of him etc... My Mom and I would like to see him belted into a properly fitted chair (as he has the ablility to move still) so to prevent these falls. The 'safety belt' is considered restraint and the patient coordinator is dead set against this. I was there tonite and witnessed him fall over backwards and hit his head and heard him cry out in pain and because he was afraid. At this point I'd like to see him sedated and belted in. Any suggestions???

MB and May
Here I was trying to get my ducks in a row for the next time the issue of restraints came up and you flew in a whole flock of geese to line up.
I was trying to find out if there are laws regulating restraints and different types that might be used if need be. I think I was also trying to sort out my feelings about restraints. You guys helped a lot. I think I know where I need to go on the restraints issue. Now my question is did you need to fly in the flock of geese too?

MB you made a good point about camping out at the hospital. I have spent many nights sleeping in a chair next to Mom's bed. I had never thought that the same thing would be needed for Dad. Prior to his hosp. visit I would say that he was in the very early stages of dementia. Now he is in the high end of middle stages. The reason they told me he was restrained was because he was disorientated and they didn't want him falling out of bed. I accepted this because years before my great aunt was in the hospital, fell out of bed, broke her hip and two weeks later was gone.
When they took him to the hosp. Mom and I discussed what would be best as far as she was concerned. It was decided that she would stay home so that it would be easier for me to see after Dad. Knowing how long trips to the ER can be and the fact that Mom is on oxygen 24/7 we decided that she would be better off at home. There are also issues of her handicaps that would make it difficult for her to move around in the little tiny ER rooms. I don't know exactly what I would do if the rolls were reversed and it was Mom going to the hosp. in the middle of the night. I sure couldn't leave him home alone and he would be very difficult in the ER situation especially with the stressof an emergency.

I pride myself on being prepared for emergency situations but have not looked down the road far enough when it comes to this darn dementia stuff. (I guess that is why I am here huh!) When Mom was in the hospital to have her pacemaker changed, I did make arrangements to have someone with Dad for the day of surgery but didn't have any plan in the event that I would need to stay at the hosp. overnight. DAH! You opened my eyes to a whole new can of worms. Thank you very much. It looks like I will be brainstorming and setting up some different emergency plans now. Since there are two of them to plan for, I will have lots of ducks and geese to get lined up.

Thank You! Thank You! Thank You!
This is an area that I just had not thought about yet. You mentioned having someone sit at the hospital, What kind of agency would I need to contact? Also are there adult sitter agencys for the home environment that would be less costly for the one left at home? What are we talking about money wise? They do not have a lot of extra spending money and I am not working so my funds are very limited. Would Medicare cover any of the charges?
I knew I could count on you guys, Thank you again!

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The hospital had him tied in bed and in a chair at different times.

Posey vests have their uses, but the recommendations on using them usually prohibit most facilities from their use because the patient must be monitored every 20 minutes when in a chair. The problem is that Posey's can slip and actually strangle patients. To use one that is the wrong size is a violation of law. Most hospitals & SNFs follow strict guidelines about what is considered "restraint" and when restraint can be used.

For example: when Mom is in the hospital, the beds have 4 rails - left and right front and back. The hospital says they cannot have all rails UP at once because this is considered "restraining" a patient and they are not allowed to do that... I raised holy living hell about that because my mom NEEDED the rails up as a deterrent to her attempting to exit the bed and also to prevent her from falling out of the bed. Bed alarms are the hot setup but only work if staff RESPONDS to them in a timely manner. If they are set to be too sensitive, they will go off at every little thing (god forbid you should sit on the edge of the bed when one is on!!).

In general, I find the policies confusing and believe that they should be questioned and requestioned if they do not make sense to you for YOUR loved one.

My feeling is that the hospital may have overstepped their boundaries... if you objected to his being restrained, you certainly should have complained and demanded that he be released from the poorly-fitting Posey. If they didn't have one the right size, most hospitals know how to obtain them within 24 hours; that they persisted in using one too small was bull.

When Mom is agitated while inpatient, I stay in the hospital with her, especially at night when she is most likely to pull out tubes, etc. If I could not do so, I would hire a sitter to stay in her room with her.

Hospitals are in a real no-win situation here and I do sympathize with their problems... If they restrain a patient who is a fall risk, they are damned; if they do not restrain a patient who is a fall risk and they fall, they are damned and sued. Hospital do not provide 24 hour nursing care for individual patients, which is why many families employ private duty nurses & CNAs to sit with patients with difficult circumstances like dementia.

When Mom was in the surgical ICU after her car wreck, they put wrist restraints on her so she could not remove her IVs and monitor thingys stuck everywhere. She didn't know what was going on and was in an insanity-producing environment of 24 hour light, no eyeglasses, strangers everywhere continually, etc. WHen I arrived to visit her, I was able to tell her to STOP thrashing around or they would restrain her... that's all she needed and she didn't pull out her stuff again... that time.

You didn't say WHY the hospital put him in restraints - Was he pulling out tubes? Hitting nurses? Trying to exit the bed? Or what?

The problem with restraining people is that they actually require MORE monitoring when restrained, especially if they are fighting the restraints or in a sitting position. There just isn't any restraining method that does not pose hazards and problems...

My best suggestion to avoid this in the future is keep someone with him, especially at night. That way, you have the added benefit of being able to help reorient him (the hospital staff may have a tough time with that cause they don't know him). It also enables you to advocate for him by monitoring everything that is done with him while in the hospital. Some really bad stuff can go on from wrong meds to outright abuse! Helpless, sick, disoriented people don't make good advocates for themselves!

One time my mother was in restraints.She was in the hospital and the put in a chatherator.She was so agitated she kept trying to pull it out and climb out of bed.She did cause physical harm to her body.The restraints they used were harmless.They were bands with velcrow aroound her wrists and legs and attached to the bed.They did not harm her in any way.They actually protected her.This behavior was ongoing until she was placed on Geodon.Then she was such an excellent person.The behavior improved 100percent.The dementia remained .The dementia is not problem , the behavior was so out of control.She would holler 24/7.Sometimes just holler or some times holler help.So dam sad to see a human reduced to such a level.