The Hidden Restraint (Part 1)

http://goo.gl/d6mG9f

Imagine if we considered locked doors in memory care wards as restraints.

Having given many seminars on restraint reduction 15-20 years ago, I am very familiar with how CMS defines a restraint. It’s any device, attached to or adjacent to a person’s body that prohibits freedom of movement.

So obviously a Posey vest fits the definition. But also a low chair from which a person cannot rise independently is also a restraint, even when not tied. The bottom line is that if you could move freely by yourself otherwise, and now you cannot, you are being restrained.

So by those criteria, what is another device adjacent to a person that prevents freedom of movement? How about…a locked door?

Imagine that the person feels a need to leave because of one of a variety of reasons—that her children may need attention, that he has to go home from work, that she needs some exercise and fresh air, or simply that this place just does not feel like a place where he wants to stay all day. What will the reaction of each of these individuals be when confronted by a locked door? “You cannot go to your children,” “You cannot leave work,” “You cannot get any fresh air,” or “You must stay in this place that you do not like.

So once again, we have a staff-centered solution that actually decreases the person’s sense of security and increases both the level of anxiety and the very desire to leave as well! The person returns repeatedly to the locked door, bangs on the door, calls out for help, or otherwise expresses her distress. It is another self-fulfilling prophecy,  as the “special care unit” proves to be the home of the “most agitated residents.”