Restraint: is it still ok?

Image source: Kate Swaffer
This photo was taken at the World Health Assembly, 2017 in Geneva, Switzerland.

Yesterday Ms. Ita Buttrose, the current Chair of the ABC in Australia, and an Ambassador and a past President of Dementia Australia gave a key note presentation at a Symposium hosted by DA.

In the Q&A after her speech, she responded to one mildly defensive comment that there are ‘good aged care providers’, by saying

‘With only 11% of aged care providers deemed good, it is time aged care providers and staff got over their sensitivies and worked together to make sure it is good for everyone, not just the 11%’.

Ita’s comment is relevant because my blog today is about restraint; it is definitely time all aged care providers realised the human and legal rights of people in their care, not to be restrained against their will.

Some key facts about restraint:

  • Use of restraint in residential aged care is extremely common
  • Restraints have a range of adverse psychological and physical effects.
  • Restraints do not prevent falls and may cause death.  
  • There are a wide range of environmental, strength-promoting, surveillance and activity-based alternatives to using restraints.
  • Restraint should be an intervention of absolute last resort.
  • Consent and necessity are paramount considerations in regards to restraint. Jurisdictional variations in Guardianship legislation govern the roles of proxy decision-makers in giving consent to restraint on behalf of people unable to give informed consent themselves. 

We all have human rights and legal rights.

Yes, even people with dementia, and anyone living in a residential aged care facility or any other residential institution. As defined by the Australian Human Rights Commission (2013), human rights;

“… recognise the inherent value of each person, regardless of background, where we live, what we look like, what we think or what we believe. They are based on principles of dignity, equality and mutual respect, which are shared across cultures, religions and philosophies. They are about being treated fairly, treating others fairly and having the ability to make genuine choices in our daily lives. Respect for human rights is the cornerstone of strong communities in which everyone can make a contribution and feel included.”

Importantly, I do recognise no-one goes to work intending to treat their patients or clients poorly, and that a significant percentage of the aged care sector (community, respite and residential care) are trying to dothe right thing.

However, we do have to question why people are being involuntarily detained with physical or pharmacological restraints. 

This is being done without the same stringent sanctioning guidelines required in the mental health sector, from which the guidelines for restraint being used in the aged and dementia care sector come under, and even though dementia is not a mental illness.

Australians and most others all around the world take considerable pride in their constitutionally defined and guaranteed civil liberties, yet our government and a number of institutions often abridge or completely ignore those rights when it comes to certain classes of people.

Included in this group of people whose rights have been frequently ignored are people with dementia and people living in residential aged care [which has been verified, without doubt, by the current Australian Aged Care Royal Commission]. 

All Australians are meant to be protected by The Universal Declaration of Human Rights, a significant document that took many years to design and get countries to sign up to.

Many people in Asutralia have spoken up about the lack of human rights of many, for example, cattle in overseas countries, prisoners, asylum seekers, refugees, people with mental illness, and so on, and yet until recently most did not speak up about the human rights of the infirmed elderly and people living with dementia.

It would appear though, that many are still uncomfortable about The Universal Declaration of Human Rights applying to everyone within to the health and aged care system. When we look at this declaration, we fall short for people who are chronically sick, aged or who are diagnosed with dementia. 

As a society, we should not be allowed to simply place a keypad on the front door, or the door of a specialised memory unit without adhering to some very strict guidelines. Yet, without any thought of basic human rights, the sector systematically locks people away, and worse, segregates them..

In the majority of aged care facilities, the residents are not able to go outside of their own free will, often even those residing in a low-care facility.

This is a blatant abuse of human rights. My father-in-law asked every time we went to visit him: “Why have I been locked in prison? and even in residential low-care he used to stand at the front door trying to escape. It seems we are allowed to be our own masters, until we enter residential aged care, regardless of capacity.

Beyond the concept of being restrained with a keypad at the front door, there are many other forms of physical restraint and chemical restraint. These include:

  • Antipsychotic and psychotropic* medications used as chemical restraint*
  • Physical and/or verbal assault, including personal insults
  • Other chemical restraint*, for example, now that the spotlight is on just how harmful antipsychotics are, some prescribers are using high dose antihistamines, as they have the same sedating effect!
  • Detinue (withholding a person’s possessions)
  • Withholding a person’s finances
  • False imprisonment includes confining a person to a particular space, for example 
    • locking people in a house or room
    • using a tray table to keep a person in a chair
    • using a particular type of chair so the person can’t get up on their own
    • using a particular type of mattress so the person is unable to get out of bed
    • using a papoose style bedding (see the image) to restrain a person
  • Physical restraint*, for example, with shackles or keypads, and also including locking a person in a secure dementia unit

They are all gross forms of restraint and are often done without first trying to address the needs of the person with dementia; many times they are being used as a ‘default’ response to challenging situations rather than a last resort. 

They are all against a person’s most basic human rights.

Restraint of any form is not ok.

* Chemical restraint: the intentional sedation or control of a person’s behaviour through the use of medication. 

* Physical restraint: the use of any device, material or equipment attached to or near a person’s body and which cannot be controlled or easily removed by the person and which deliberately prevents or is deliberately intended to prevent a person’s free body movement to a position of choice and/or a person’s normal access to their body (Retsas,1998). 

* Psychotropic medications: these are medicines that act on the central nervous system to affect perception, mood, consciousness cognition and behaviour. Psychotropic medications include antidepressants, antispychotics (“typical” and ‘atypical”), benzodiazepines anticonvulsants and sex hormones.

Footnote: This blog post is a modified excerpt from a chapter in my first book, What the hell happened to my brain?: Living beyond dementia.

9 thoughts on “Restraint: is it still ok?

  1. WOW!!ever been in an a physically abusive environment as a staff member on an hourly basis who is physically assaulted by a man twice your size whilst trying to protect an elderly lady or the staff member who has to provide 1;1 care to a an aggressive high falls risk resident who hits you every 5 seconds. we are NOT as aged care workers the enemy but we do have rights to be safe at work. we love all our residents & try to implement every strategy before restraints are used. some cases just are too extreme. please give us the magic fairy wand to use that families & the like think we possess. Rach xo

    Liked by 1 person

  2. Great blog Kate. My Dad was physically restrained also in a locked ward because he tried to scale the facility yard wall a few times.

    Like

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