There are two kinds of restraints: Physical restraints and chemical restraints:

Physical restraints prevent a person from moving about freely. The most common types of physical restraints include:

Vest restraints used to tie a person to a bed or chair Wrist restraints used to prevent a person from moving their arms Chairs with tray tables. roll bars, or lap cushions to prevent rising Bed side rails to keep a person in bed

Chemical restraints are psychoactive or mind-altering drugs used to control behavioral symptoms. These drugs effect a person’s thinking, feeling, and reactions. The most common types of chemical restraints include:

Antipsychotics or major tranquilizers Sedatives/hypnotics (to treat insomnia /sleeplessness Antidepressants (to treat depression) Anxiolytics (to treat anxiety)

Research has shown that restraints can be dangerous and destructive. Physical restraints often only increase a resident’s anxiety and aggression. Professional caregivers have learned how to eliminate restraints by studying the care of the elderly in other countries. Unfortunately, many nursing homes still use restraints inappropriately – often as a way to reduce the amount of time and attention a caregiver provides to a resident.

STRATEGIES FOR REDUCING RESTRAINT USE

Although reducing restraint use can be frightening for some families and staff members, there are many facilities that have successfully committed to a restraint-free environment without an increase in resident injuries. Committed families and staff members working together to follow an individualized care plan can make this a reality which can benefit both residents and caregivers. In fact, research confirms that non-restrained residents require fewer minutes of direct nursing care when compared to similar residents who are restrained. However, a Federal government report notes that in order to be effective, restraint reduction activities must involve the whole facility, including administrators, nursing directors, physical and recreational therapists, service delivery staff including nursing assistants, and housekeeping personnel. Family members should expect and insist that the facility be responsible and proactive in:

Completing a comprehensive resident assessment: Assessments gather information about how well residents can take care of themselves and when they need help. They identify strengths and weaknesses, plus lifelong habits and daily routines. Formulating an individualized care plan: Based on strengths and weaknesses identified on assessment, a care plan is developed for how staff will meet a resident’s individual needs. It should describe what each staff person will do and when it will happen. The care plan is designed at a quarterly care-planning conference, attended by staff, residents, and their families. The care plan should change as the resident’s needs change. Training staff to assess and meet an individual resident’s needs — hunger, toileting, sleep, thirst, etc. — according to the resident’s routine rather than the facility’s routine. Supporting and encouraging professional care giving staff to think creatively of new ways to identify and meet residents’ needs. Providing a program of activities enjoyed by the resident, such as exercise, outdoor time, or small jobs agreed to and enjoyed by the resident. Providing the resident with companionship, including volunteers, family, and friends. Creating a safe environment with good lighting, mattresses on the floor to cushion falls out of bed, appropriate, comfortable seating, alarms, clear and safe walking paths inside and outside the building. Making permanent staff assignments and promoting staff flexibility to meet residents’ individualized needs. Meeting with the resident’s doctor or the facility’s Medical Director to discuss ways to care for the resident without the use of chemical or physical restraints.