What's you opinion on restraints?

[Buckeye]

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?

 

[Rich_by_the_Bay]

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.

 

[REWahoo]

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.

 

[Buckeye]

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.

 

[Cattusbabe]

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.

 

[Buckeye]

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!

 

[REWahoo]

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.

 

[Moemg]

Sorry about your Mil . I would avoid restraints if possible .

 

[Buckeye]

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.

 

[Bestwifeever]

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.

 

[simple girl]

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.

 

[Buckeye]

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.

 

[bbbamI]

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....

 

[CuppaJoe]

What a beautiful tribute to your MIL, Buckeye. Take care, will be thinking of you.

 

[Buckeye]

My MIL, Dot, at her 92nd birthday party.

 

[Rich_by_the_Bay]

Sorry, Buckeye. A life well lived, it seems.

 

[REWahoo]

Buckeye, we should all be so fortunate to live life as your MIL did. My sincere condolences.

 

[calmloki]

Great pictures! She looks like she was a hoot! Good on you both for the way you dealt with her last stage.

 

[Amethyst]

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.

Amethyst

 

[simple girl]

Your MIL sounds like a pretty special person. My sincere condolences.

 

[Buckeye]

She was a great gal, no doubt about it.

Even though she was not seriously ill when things started going a bit haywire in February, we realized the end could not be very far off because she wasn't worried about her hair and make-up and dressing up when she was in nursing rehab. For virtually every day of her 94+ years, she made sure her hair looked good, she put on her make-up, and she dressed. The word "casual" didn't exist for her. She never owned a pair of tennis shoes and wore low heels right up till the end.

Another wonderful thing she always did was thank us for everything we did for her in writing even though she had done it over the phone or in person. Birthday, Christmas, Mother's Day, just thinking of you gift......we always received a thank you card. Even her verbal 'thank you's' were always heartfelt and conveyed to us how truly thankful she was for the small things we did to make her life easier. Classy lady.

 

[Buckeye]

Here is some interesting info with respect to retirement and pensions and what you can live on....

When I called to notify the State of Maryland she had passed, I asked about her pension. She had been retired for 30 years and I was curious what her pension had been when she retired. It was now about $440 ($368 after medical insurance and drug plan deducted) after 30 years of COLA's. The lady on the phone did not have the starting pension amount but she said Dot's starting salary had been $6,000 and her ending salary in 1979 had been $9,000. I'm not sure how long she worked for the state and the person on the phone couldn't tell me.

Her social security after 30 years was $1033 a month and that was after a "huge" raise this year.

That meant her gross monthly income per month was about $1500 and that was after 30 years of COLA's. For the last 3 years, we have been sending her $150 per month to give her some extra spending money and to ease her mind from worrying about her rent going up at the assisted living facility. She didn't spend it all and the the balance in her savings account grew to $3,000 from about $400!

She was married to DH's father until about 1960 (bum). Another man lived with her for about 15 years until about 1990 when he died. Several years before his death, he lost all his money in a "get rich quick" scheme and she was supporting him. About 10 years before he died, he had her change her last name to his so he could collect on her social security since apparently he did not have enough credits of his own. I guess it was back before they checked all the paperwork because they were never legally married. Dot's mother died when Dot was about 8. Her dad remarried and they had a son. Although Dot's step-mother died loaded after Dot's dad died, step-mother left all her money to her son who did not share ANY of it with either of his two half-sisters. Dot never let it bother her and she had a great friendship with her brother until he died about 18 months ago.

Life was not fair to her but she was always upbeat and positive. Her most valuable asset was her health. She had fantastic health insurance that picked up the Medicaid co-pay and virtually anything Medicaid did not cover but she really didn't use it. Before things started going haywire, her meds consisted of a generic blood pressure pill, water pill, potassium pill, and (for the last year) a generic anti-depressant. Total cost of meds was $16 per month from Sam's.

About $20,000 a year to live a full and happy life.

 

[Jay_Gatsby]

Here is some interesting info with respect to retirement and pensions and what you can live on....

When I called to notify the State of Maryland she had passed, I asked about her pension. She had been retired for 30 years and I was curious what her pension had been when she retired. It was now about $440 ($368 after medical insurance and drug plan deducted) after 30 years of COLA's. The lady on the phone did not have the starting pension amount but she said Dot's starting salary had been $6,000 and her ending salary in 1979 had been $9,000. I'm not sure how long she worked for the state and the person on the phone couldn't tell me.

Her social security after 30 years was $1033 a month and that was after a "huge" raise this year.

That meant her gross monthly income per month was about $1500 and that was after 30 years of COLA's. For the last 3 years, we have been sending her $150 per month to give her some extra spending money and to ease her mind from worrying about her rent going up at the assisted living facility. She didn't spend it all and the the balance in her savings account grew to $3,000 from about $400!

She was married to DH's father until about 1960 (bum). Another man lived with her for about 15 years until about 1990 when he died. Several years before his death, he lost all his money in a "get rich quick" scheme and she was supporting him. About 10 years before he died, he had her change her last name to his so he could collect on her social security since apparently he did not have enough credits of his own. I guess it was back before they checked all the paperwork because they were never legally married. Dot's mother died when Dot was about 8. Her dad remarried and they had a son. Although Dot's step-mother died loaded after Dot's dad died, step-mother left all her money to her son who did not share ANY of it with either of his two half-sisters. Dot never let it bother her and she had a great friendship with her brother until he died about 18 months ago.

Life was not fair to her but she was always upbeat and positive. Her most valuable asset was her health. She had fantastic health insurance that picked up the Medicaid co-pay and virtually anything Medicaid did not cover but she really didn't use it. Before things started going haywire, her meds consisted of a generic blood pressure pill, water pill, potassium pill, and (for the last year) a generic anti-depressant. Total cost of meds was $16 per month from Sam's.

About $20,000 a year to live a full and happy life.

Sorry to hear about your MIL. As for the numbers, it's amazing what you can live on if your needs are small and you take pleasure in the simple things in life.