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Difference between revisions of "Six Pressing Issues when Living in Residential Care"
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Six Pressing Issues when Living in Residential Care (view source)
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However, depending on the circumstances, the use of physical or chemical restraints for the involuntary immobilization of the resident may not only be an infringement of the resident’s rights, but can also result in patient harm, including soft tissue injury, fractures, delirium, and even death. Harms to residents from restraints can arise for many reasons. | However, depending on the circumstances, the use of physical or chemical restraints for the involuntary immobilization of the resident may not only be an infringement of the resident’s rights, but can also result in patient harm, including soft tissue injury, fractures, delirium, and even death. Harms to residents from restraints can arise for many reasons. | ||
Staff may not recognize the practice actually is a form of restraint. Staff may not be adequately trained to identify and address the underlying cause of the problem (why the resident wanders or why the resident is showing this responsive behaviour).([[{{PAGENAME}}#References| | Staff may not recognize the practice actually is a form of restraint. Staff may not be adequately trained to identify and address the underlying cause of the problem (why the resident wanders or why the resident is showing this responsive behaviour).([[{{PAGENAME}}#References|43]]) As a result, the staff may rely on restraints as the “only tool in their care toolbox”. Also: | ||
* staff may not recognize the risks associated with the restraint (e.g. recognize that the person will likely try to leave the bed, escape the restraint, or become more agitated) and | * staff may not recognize the risks associated with the restraint (e.g. recognize that the person will likely try to leave the bed, escape the restraint, or become more agitated) and | ||
* Staff may be untrained in the proper use of restraints. | * Staff may be untrained in the proper use of restraints. | ||
In many cases in residential care, restraints efforts intended to be a "last resort” become the “first resort”. The Alzheimer Society of Canada notes the special risks for people with Alzheimer’s disease or other dementias. For people with Alzheimer’s disease, the restraints are a restriction of freedom, can decrease a person’s physical activity level and ability to function independently, and can cause injuries.([[{{PAGENAME}}#References| | In many cases in residential care, restraints efforts intended to be a "last resort” become the “first resort”. The Alzheimer Society of Canada notes the special risks for people with Alzheimer’s disease or other dementias. For people with Alzheimer’s disease, the restraints are a restriction of freedom, can decrease a person’s physical activity level and ability to function independently, and can cause injuries.([[{{PAGENAME}}#References|44]]) | ||
===The law on restraints=== | ===The law on restraints=== | ||
Under the Residential Care Regulations, a "restraint" is defined as “any chemical, electronic, mechanical, physical or other means of controlling or restricting a person in care's freedom of movement in a community care facility, including accommodating the person in care in a secure unit."([[{{PAGENAME}}#References| | Under the Residential Care Regulations, a "restraint" is defined as “any chemical, electronic, mechanical, physical or other means of controlling or restricting a person in care's freedom of movement in a community care facility, including accommodating the person in care in a secure unit."([[{{PAGENAME}}#References|45]]) | ||
Division 5 of the Regulations describes situations in which restraints may be used and the minimum standards for their use. Section 74 (2) specifically stresses that the operator must ensure that a person in care is not restrained: | Division 5 of the Regulations describes situations in which restraints may be used and the minimum standards for their use. Section 74 (2) specifically stresses that the operator must ensure that a person in care is not restrained: | ||
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Restraints may be used in two circumstances: | Restraints may be used in two circumstances: | ||
:(a) in an emergency, or ([[{{PAGENAME}}#References| | :(a) in an emergency, or ([[{{PAGENAME}}#References|46]]) | ||
:(b) if there is a prior written agreement to the use of the restraint. ([[{{PAGENAME}}#References| | :(b) if there is a prior written agreement to the use of the restraint. ([[{{PAGENAME}}#References|47]]) | ||
The term “emergency” is not defined in the regulations. The term “emergency” in everyday language usually refers to events that are out of the ordinary that cause or are very likely to cause serious immediate harm to the person or others. Schedule D of the Regulations describes certain reportable incidents and defines an "emergency restraint" as “any use of a restraint that is not agreed to under section 74 “(a prior written agreement). If a resident is in care facility where issues are not recognized and appropriately addressed fairly early on, situations involving staff or other residents can easily deteriorate, turning into “emergencies”. This is not the intention of these sections of the regulation. The proper focus is on prevention and early intervention to avoid the emergency. | The term “emergency” is not defined in the regulations. The term “emergency” in everyday language usually refers to events that are out of the ordinary that cause or are very likely to cause serious immediate harm to the person or others. Schedule D of the Regulations describes certain reportable incidents and defines an "emergency restraint" as “any use of a restraint that is not agreed to under section 74 “(a prior written agreement). If a resident is in care facility where issues are not recognized and appropriately addressed fairly early on, situations involving staff or other residents can easily deteriorate, turning into “emergencies”. This is not the intention of these sections of the regulation. The proper focus is on prevention and early intervention to avoid the emergency. | ||
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===Post emergency restraint requirements=== | ===Post emergency restraint requirements=== | ||
If restraints have been used in an emergency situation, after that emergency the Operator is required to talk with and provide “information and advice” to the resident who was restrained, anyone who witnessed the restraint’s use, as well as any employee involved in the restraint.([[{{PAGENAME}}#References| | If restraints have been used in an emergency situation, after that emergency the Operator is required to talk with and provide “information and advice” to the resident who was restrained, anyone who witnessed the restraint’s use, as well as any employee involved in the restraint.([[{{PAGENAME}}#References|48]]) This “information and advice” is to be documented in the resident’s care plan.([[{{PAGENAME}}#References|49]]) | ||
The regulations also set out a stringent process of reassessment of the need for the restraints. If restraints are used longer than 24 hours or continuously, the Operator must: | The regulations also set out a stringent process of reassessment of the need for the restraints. If restraints are used longer than 24 hours or continuously, the Operator must: | ||
* have agreement in writing from the resident or their representative, if applicable and | * have agreement in writing from the resident or their representative, if applicable and | ||
* the medical practitioner or nurse practitioner responsible for the resident’s health care. ([[{{PAGENAME}}#References| | * the medical practitioner or nurse practitioner responsible for the resident’s health care. ([[{{PAGENAME}}#References|50]]) | ||
==References== | ==References== | ||
