What Dementia Caregivers Should Know About Restraints

In which of the following situations would you say a person with dementia is potentially being restrained (not permitted free movement):

• The person is lounging comfortably in a reclining chair, similiar to a "lazy boy" chair
• Your loved one is on medication that helps with behaviors but keeps her drowsy
• Your neighbor with dementia sleeps with bed rails up each night

If you answered "all of the above", you have a better than normal understanding of restraints and the difficulties they present for persons with dementia.

A restraint, whether it is physical or chemical, prohibits a person from having free will to go about their day. We haven't even discussed items like seat belts for wheelchairs or actual body restraints that anchor a person to a location such as a bed or chair.  Restraints are not a favorable method of modifying any behavior, especially for those with dementia. 

Even though I am talking about restraint use in the home, you should be aware long-term care facilities must follow strict guidelines if restraints are used at all.  For the record, the facility I work in has not used restraints for about 9 years and we are proud of that fact.

I find that families are often confused about what constitutes a restraint and why they aren't a good idea. The examples above never mentioned "tying anyone up" but all of the scenarios along with others can happen in the home environment with potential safety consequences.

So what can happen?  In each of those cases, the person cannot remain at the highest level of independence because a restraint is preventing that.  The person in the lounge chair who can't sit up and get out of the chair on their own has just lost some of their independence.  An individual whose caregiver gave them a slightly higher than normal dose of medication to "help her", in fact has just chemically restrained her and seriously impacted her quality of life.  Bed rails appear to be for safety, so the person doesn't roll out of bed.  But if the person with dementia is trapped in there and decides to climb over the rails, the fall could be even more severe.

In health care, it has been generally regarded as "best practices" that care be person-centered and we give persons with dementia the opportunity in every way possible to be independent and experience the day.

I'd love to hear from any readers about this situation:  how have you handled the issue of restraints at home?  Has it even been an issue?  What have any outside professional caregivers said to you about restraints when they did a home assessment?  Please comment and let me know your thoughts.