Restraints and Restrictive Interventions during Essential Personal Care in Elderly People Living with Dementia in Care Homes
Matthew Crooks
Mental Health Nurses, Behavioural Support Teams in Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, UK.
Katherine Wakenshaw
Mental Health Nurses, Behavioural Support Teams in Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, UK.
Julie Young
Mental Health Nurses, Behavioural Support Teams in Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, UK.
Kayleigh Purvis
Mental Health Nurses, Behavioural Support Teams in Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, UK.
Karin Smith
Mental Health Nurses, Behavioural Support Teams in Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, UK.
Jennifer Loan
Mental Health Nurses, Behavioural Support Teams in Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, UK.
Laura Bell
Clinical Psychologists, Behavioural Support Teams in Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, UK.
Ian Andrew James
*
Clinical Psychologists, Behavioural Support Teams in Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, UK.
*Author to whom correspondence should be addressed.
Abstract
Care home staff are frequently required to provide invasive personal care for their residents, and on occasions need to use restraint and restrictive practices with people with dementia. This often occurs in situations where the residents no longer have the insight that they require help and may misperceive the personal assistance as an assault. On a practical level, a significant number of people with dementia are currently being admitted to inpatient units due to their level of resistance around essential personal care. Often these same people are settled at all other times. This paper provides practical advice on how to support residents and their caregivers, and gives clinical, legal and ethical guidance. Previous work undertaken by the present authors have shown that care staff require supervision and coaching on this topic.
The paper includes training materials used by the authors. This includes a composite, fictitious case example that illustrates approaches that are compliant with UK guidelines. It addresses the training of staff working in care homes.
As such this paper provides a review and practical example of the appropriate use of restraint for residents unable to consent to the ‘intimate’ care they are receiving. It describes a method delivered in a person-centred manner and within a legal framework. Having read this paper, care home staff should feel more confident, competent and secure in the assistance they are providing in this contentious area.
Keywords: Geriatrics, forced care, residential care, assault cycle, formulation, care plan.