Nursing Home Does Not Use Restraints - Should we be worried?

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Nursing Home Does Not Use Restraints - Should we be worried?

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My 91 year old dad has Parkinson's and dementia and is in hospice. We are currently caring for him at home with a live-in caregiver. But things are getting more and more difficult and we are looking into transferring him to a nursing home. He has been bedridden since being released from the hospital in late August. Hospice has supplied a bed with full rails but he tries to get out of bed a few times a day. He can get his knees over the rail but then wears himself out. He does not remember that his legs can't hold him. We have applied to a nursing home with really good ratings and recommendations, but they do not use full bed rails or alarms because they are considered restraints. I have read that more and more nursing homes are moving away from restraints. The good news is that the nursing home will have the ability to get him out of bed and into a chair. Should we be worried about the lack of restraints?

Alzheimer's & Dementia Mobility Skilled Nursing Facility

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Usually the bed is lowered as low as it can possibly go and a mattress or other padding is placed on the floor to cushion.
Alarms are not considered a restraint but they are often not reliable as they go off very easily. What is used more is an alarm that is attached to the chair and the resident and when they try to get out of the chair the alarm will sound. Less likely to go off with just normal movement.
The use of restraints in Facilities have not been used in many years. (thank goodness)
Even the use of hand protectors to prevent scratching at wounds can be considered a restraint.
I would not be concerned about the lack of restraints, I would be concerned if they used them

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Yes, all licensed facilities are moving away from restraints. People have died in them unfortunately. Facilities can actually lose licensure for using them. There are many ways to get around them; have you discussed options with both hospice and the facility? To tell the truth, one place I know of has foam pads below the beds for frequent fall people. This is such a tough dilemma. Just occasionally, on very fragile patients, net beds are used. They have basically a zipped larger than mosquito net hole canopy with sides. They were what was most used in my nursing facility before my retirement. They were called either "vale" bed or "veil" bed, and I am uncertain whether they are still used or not. I retired about the time that restraints became an absolute no-no. Please update us if a solution is found that you can share with us.

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Alva,

I bought a netted cover at a specialty baby shop for my daughter’s crib. My youngest daughter was an escape artist!

She was a tiny little thing but was very agile and climbed out of her crib. She was too little to put in a ‘big girl’ bed so we had to do something.

I didn’t realize that they made those for adult beds. Good idea!

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Like others have said, they aren't allowed to use restraints. Staff are supposed to call you every time LO falls even if not injured. They are also then supposed to tell you of the plan to prevent it from happening again.

I know that hearing about a fall after-the-fact doesnt ease worries about falls and injuries, but it does give you a way to monitor safety.

Ask about their falls and injury reports to get an idea of their safety record. You certainly don't want to see a high number of falls and injuries, but you also dont want to see absolute zero. If it's 0, most likely they are doctoring their stats, because unfortunately, falls arent 100% preventable without restraints.

My dad has fallen out of bed at most rehabs he's been in. Luckily, he never got hurt. He tends to fall more in placement than he does at home. THe plan to fix things for him is usually to put the bed down as low as it can go and put mats on the floor when in bed.

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I volunteered through a Hospice at a locked memory care unit. They had special beds that literally went all of the way to the floor. Most standard hospital beds can be lowered and should be. Also, sensored mats on either side of the bed to alert staff should they fall out. Never have side rails up. People have done more than break bones getting caught...patients have accidently hung themselves. Restraints are against the law in most states now. I would advise against nets above them. A determined patient could pull that done and get it wrapped around themselves. In my first year nursing, we had an alcoholic patient in locked leather restraints. My colleague was dealing with a screaming patient in the next room. Our 'restrained' patient walked into that room, dragging a broken IV bottle (yes, glass in the old days) and handing her the leather restraints! "here, I think you need these".
Also, determine if the facility is using chemical restraints as in heavy sedatives. Not a good solution ever.

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My grandma, this was in the 70's, was in a chest restraint with rails up. She manages to squirm her way out and off the bottom of the bed! She had some impressive scrapes after that. Not bad for a woman with rheumatoid arthritis so bad she couldn’t walk.

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Its against the law to use restraints. Has been for a long time. There are concaved mattresses. Mats they put on the floor. Alarms are used but have heard that these may stop to.

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I think I recall that this was a federal law. It was very strictly observed when my mom was in residential care.

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There are beds that go to within inches of the floor. Pads and alarms that can trigger unusual movements.
I don't like restrints or full rails because going over them is 😥.
If there is an iv, feeding tube , catheter then weigh risk / benefits

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Almost all residential facilities have gone away from restraints since there are a lot of issues with restraints: need for a lot of eyes on supervision, need to offer fluids and potty every 2 hours, and it doesn't always work keep folks from falling. Instead, facilities put people on "falls precaution" with beds at lowest height, thick mats placed on floor next to beds, checking on folks more often,,,

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We have been having problems with my Mom getting up at night and falling. Her memory care facility , which also does not use restraints, cranked her bed down to the lowest level and since she can’t stand without assistance she usually just rolls onto the floor. They have mats put down to cushion her. So far so good. I was told they can also put her mattress on the floor if it continues to be a problem.

Also, the rooms have motion sensors so if the staff detects unusual movement in her room at night an aid is sent to check it out.

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This is how they had to do my mom who was as stubborn and head strong as she could be. Unfortunately, she decided to get up without calling for help even though she had the call cord pinned right beside her where she could have easily used it but refused. She got up, fell, hit her head on the bed frame. That was in July of 2018. She never recovered and we could visit and she could give yes or no answers by blinking. She had congestive heart issues and kidney failure. She went into a coma right after my weekly visit in mid December. She passed exactly 1 week before Christmas.
The staff tried to help her but, it wasn't to be. She didn't want anyone to bother and refused all help. In a way, I am glad she didn't have to hurt any more and definitely didn't have to go thru this Covid mess.

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Nursing home are able now to put the bed lower to the ground, and have a mat on the floor to set off the alarm. Talk to the boss person as you have to give them the ok to do this. If they can’t help go to someone higher. Your father has a right to be safe. God bless.

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Restraints are against the law in many if not all states. What differs is "What is a restraint?"

In some states a restraint is anything that could prevent a patient out of or off of whatever they are on/in ie chair, bed . If fact in some states or large cities
geri-chairs are considered a restraint if they are even used, in others only if it is reclined, and still others any use is o.k.

Nursing Home Does Not Use Restraints - Should we be worried?

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