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What's you opinion on restraints?
Old 04-12-2009, 08:04 PM   #1
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What's you opinion on restraints?

My 95-year old MIL in now in a nursing home. She is doing okay considering her situation and age but it is clear she is dying (aren't we all?). The really big problem is she has a blood clot in her upper left leg and her leg is basically dying below the knee. Ultimately, it's going to kill her. She is on very strong pain medication (intravenous and patch) to reduce the pain but she remains quite lucid virtually all the time. The doc's at the hospital tried drug therapy to remove the clot but it didn't work and no surgeon will touch her, not that surgery is appropriate in this particular situation anyway.

She sometimes likes to sit in the chair next to her bed. Once in awhile, she tries to stand up and walk and the result is she falls because her left foot is not working anymore. She was completely mobile until about 8 weeks ago so I guess she thinks she still is (and wants to be). She fell twice today but nothing hurt. My husband was talking to BIL today about the possiblilty of restraining her in her bed.

I am vehemently opposed to this. She is dying. What the heck can she do to make things any worse than they already are? To me, restraints are humiliating and inhumane and unnecessary. So what if she breaks something. Her opinion is they have no right to do that to her and I agree with her.

What is your opinion?
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Old 04-12-2009, 08:12 PM   #2
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There are much stricter guidelines on the use of restraints, often requiring that someone other than the attending physician must attest to their use. They are generally not helpful and often make an agitated person even more agitated. They need careful observation to avoid skin damage or worse. So all in all, they are a last resort. Judicious sedation, and more and more having sitters in the room all the time is the current trend, very expensive as you can imagine.

But there are times when restraints are needed to prevent serious self-injury or harm. In these cases restraints should be used for as brief a period as possible. A "Posey" or vest restraint to keep the patient seated is the lest bothersome of all. I hate ordering them, and do so rarely. When I do, I try hard to get the family's buy-in. If nothing else, I tell them that if we decide NOT to restrain, there is risk of serious injury; if that trade-off is clear it helps keep everyone on the same page in the event that something untoward occurs. Think about getting her a sitter if it's affordable - it provides company, as well.
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Old 04-12-2009, 08:13 PM   #3
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With our very recent and ongoing experience with my FIL's stroke and admission to a nursing facility, I can sympathize with both sides of this argument.

What about a geriatric chair pictured below? If she lacks the ability to get out of the reclining position, this could serve as a means of keeping her out of danger.
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Old 04-12-2009, 08:14 PM   #4
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I'm not sure what the word "restraints" means in today's environment of patient's rights and BIL and DH may have been using the word without knowing what it means today but I didn't like to hear it.
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Old 04-12-2009, 08:17 PM   #5
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Restraint Free Care - Fact Sheet - CANHR

Most Long Term Care Units discourage the use of restraints. They are dangerous and there are options short of restraints. Please read the article above. If it is at all financially feasible you may want to hire some one to stay with your MIL to prevent her getting up. Your MIL should be allowed to die with her dignity intact.


Re. sitting in a chair. When I worked in Long term care we would use a wedge pillow
positioned with the narrow end facing the back of the chair. This raises the knees up making it difficult for the resident to slip out of the chair. It bought time for a care giver to get to the resident before they fell it also acted as a reminder for the resident to ask for help to get up.

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Old 04-12-2009, 08:24 PM   #6
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DH and/or BIL have been by MIL's bedside for almost every daytime hour for the last 6 weeks. DH comes home for the weekends (nursing home is 3 hours away from our house) so there is less family coverage on the weekend. In addition, we are learning both hospitals and nursing homes are basically 5-day-a-week operations with staffing very thin on the weekends. It seems MIL gets the bug to move about when supervision is at a minimum.

I like the ReWahoo chair suggestion. No formal restraint but even I would have trouble getting out of that thing!
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Old 04-12-2009, 08:29 PM   #7
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Buckeye, be aware that chair may also be considered a 'restraint device' if she cannot get out of it. Same with bed rails.

My sincere best wishes for you and your spouse as you deal with this difficult situation.
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Old 04-12-2009, 08:39 PM   #8
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Sorry about your Mil . I would avoid restraints if possible .
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Old 04-12-2009, 08:44 PM   #9
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I've tried to stay out of the day-to-day and let the sons handle it but I will go sit with her all-day every-day if it comes to it. I truly have nothing more important to do than be by her side.
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Old 04-12-2009, 09:05 PM   #10
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My MIL is in a nursing home. She has a simple low-tech alarm (not connected to the front desk) on her bed--I think a cord is clipped to her nightgown and if she tries to get out of bed or falls, the cord yanks the alarm on and the staff comes in.

For the past few weeks she's had a lower leg infection and has been in exactly the kind of chair Rewahoo pictured above. She hates it because she can't move around the room now.

Both of these appliances/pieces of equipment could be considered restraints, but they both are for my MIL's benefit.
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Old 04-13-2009, 07:18 AM   #11
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The chair alarms are helpful provided she is close enough to the nursing station for staff to hear them, and that staff actually come in time once the alarm is heard.

The wedge cushions are also helpful.

There are also devices called self-release alarm belts. They are attached to the wheelchair. The patient can open the belt (it is velcro), but when they do, an alarm goes off. This gives staff a little more time to respond compared to a traditional chair alarm (activated when the pt stands up).

Also, you may want to be sure she is on a toileting schedule, i.e. how often are staff checking on her to find out if she needs to use the restroom? Many times this is why residents are getting up.

If she is getting out of bed, a fall mat next to the bed on the floor is helpful.

Sitters are the ultimate solution if you have the $.

You have to weigh independence vs. consequences of a fall. If you (and she) are comfortable with the potential consequences (i.e. death from hitting head, hip fracture, etc.) then discuss this with staff/MD. In my experience, a restraint will not be applied unless cleared by the family, but the family must fully acknowledge the risks of allowing the resident to ambulate.

My thoughts are with you; these are difficult decisions and a difficult time.
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Old 04-24-2009, 06:57 PM   #12
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Well, MIL died peacefully this morning at 8:18 am. DH was with her. She was about two months short of her 95th birthday and had been sick for about 9 weeks, seriously ill with the blood clot/gangrenous foot for the last 3 weeks. Pretty close to her wish to never be sick but die in her sleep. She had a long and happy life. We would offer to take her on a cruise and she would ask if she could just go to Steak and Shake for lunch. She was always upbeat and positive and her glass was always half full. I loved her very much and she will be missed.

Long ago she decided she was donating her body to science. All the paperwork was signed years ago and we checked in February to be sure everything was still a "go." The transport service was there one hour after they were called and she was on her way to the University of Cincinnati. She will now assist with research and training. I'm pretty proud of her for doing it.
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Old 04-24-2009, 07:01 PM   #13
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You have every reason to be proud.

It sounds like she was a wonderful and giving lady....even at death. My thoughts are with you and your husband Buckeye....
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Old 04-24-2009, 07:34 PM   #14
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What a beautiful tribute to your MIL, Buckeye. Take care, will be thinking of you.
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Old 04-24-2009, 07:58 PM   #15
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My MIL, Dot, at her 92nd birthday party.
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File Type: jpg PICT0014 (Small).JPG (32.2 KB, 3 views)
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Old 04-24-2009, 08:06 PM   #16
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Sorry, Buckeye. A life well lived, it seems.
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Old 04-24-2009, 08:22 PM   #17
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Buckeye, we should all be so fortunate to live life as your MIL did. My sincere condolences.
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Old 04-24-2009, 08:30 PM   #18
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Great pictures! She looks like she was a hoot! Good on you both for the way you dealt with her last stage.
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Old 04-25-2009, 08:56 PM   #19
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She looked great at 92, and must have been a fox 30+ years ago. Your story is sad and I know you must be grieving, yet it is uplifting too. Plus, I learned useful things from this thread. Thanks for posting your MIL's story.

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Old 04-26-2009, 02:53 PM   #20
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Your MIL sounds like a pretty special person. My sincere condolences.
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