Commentary
To restrain or not restrain?
Key is striking balance between safety, independence
Tuesday June 3, 2008
While some people who move into long-term care are ambulatory, others, as a result of cognitive impairment or physical conditions, require assistive devices. For some residents, the use of a wheelchair for physical conditions helps promote mobility and independence. But for others, who have dementia, a wheelchair sometimes simply isn't enough to keep them safe. This poses consideration for the use of lap belts, to keep them secure in their chairs.

It's a huge dilemma for healthcare workers. For OMNI, which has a 'least-restraints' policy, other supports are encouraged to keep residents safe.

The use of restraints are generally considered by the public as unacceptable. A recent death in an Ontario long-term care home has brought the issue under media scrutiny as well. Many families don't support the use of them either.

As long-time administrator Mary Lynn Lester will tell you relatives don't want restraints used on their loved ones. At the same time, they want their family members to remain safe.

With a one-employee-to-12-resident staffing ratio in long-term care, people cannot be monitored during every second of every day. When it comes to the issue of restraints, healthcare workers have the difficult, delicate job of making a judgment call. But they are trained to make these calls. Most people who work in long-term care are good people who care about seniors. They're certainly not in the business to get rich.

With their training, in conjunction with the support of nursing staff, care teams and care plans, they make these decisions with residents' best interests in mind. Not all decisions will be the right ones but they are usually not ones made with malice or ill-will.

OMNI's policy on restraints is a good one. The key is balancing a resident's right to independence with the need to keep a person safe.

When something goes wrong, fingers are pointed at the long-term care sector as a whole. The media zeroes in and the public is mistakenly left with the opinion people are being neglected. The sector is no doubt under-funded and the staffing ratio is far too low. But until that changes, we need to believe the majority of healthcare workers are doing the best they can with the resources available to them. They are experts at providing care for seniors. They are people who care.