Use of Restraints on Elderly in Care Homes: The Debate (UK)

Clearly it is most important to see restraint from the perspective of the person
being restrained.

Clarity about the rights of the older person Sometimes we try to ‘protect’ others, of all ages, but particularly children and older people, because we feel anxious. This should not stop an individual making decisions that may lead to risk taking, as they often know
more about their capabilities than carers do. Finding the right level between common-sense decisions and risk taking is difficult and we need to constantly review decisions made with and for others. (Social services care manager)


Participants in the online survey and group discussions stressed that older
people may not get the “information, advice, advocacy and general support
that enables them to lead the life they would wish to lead” (Older person).
Needless to say, people should be full participants in decisions about their
lives and care.
There are times when consent for restraint is sought from a person with power
of attorney or a solicitor. The use of outsiders may conflict with the authority of
the older person. Indeed, there may be confusion between using people such
as general practitioners or physiotherapists as expert advisers and using them
to authorise the use of restraint.


Staff shortages and the use of restraint
There is widespread suspicion that actions presented to ensure people’s safety and well-being are designed to help staff manage workloads.
· “There weren’t enough staff to work with residents individually or even supervise movement, so their explanation was it was for her own safety” (Older person).

“Staff often justify restraint by stating that relatives complain and want their [relative] to be kept safe, or that they [the staff] do not have time to do things in the way they would like to do” (Older person)

The following inspector’s account captures the complex interplay between
staff shortages, the wish to ensure that residents were supervised and staff
who appear not to understand the rights of residents:

All of the residents were up and dressed by 7.30 am. In order to supervise the 13 service users the staff members endeavoured to ensure that they were all seated in the lounge. A female resident who had dementia insisted on going downstairs to the lower ground floor. A member of
night staff attempted to persuade her to go upstairs to the lounge. The situation rapidly became a confrontation with the member of staff becoming more frustrated and the resident becoming increasingly angry. Eventually the member of staff ‘grabbed’ her by the arm to get her upstairs
but this only exacerbated the situation. The situation was only resolved when the member of staff left her sitting on the stairs. (Inspection report)

Key findings and the implications for practice, care provision, commissioning, regulation and government policy.
The key points:·

• The report shows the balance between keeping people safe and always respecting their rights is not just a matter for staff alone to resolve in their daily contact with people needing care and support.
• This is a human rights issue where government, regulator, commissioners and care providers have responsibilities to support staff and improve services to older people.
  ·
• There needs to be clarity of policy and guidelines about what constitutes restraint that puts the rights of older people at the forefront and is based on sound evidence.
  
• There also needs to be adequate training and everyday support to care staff to ensure best practice.
• Most importantly, there need to be the resources and working conditions that enable staff to provide the highest quality of care.
  

Human rights
This study has found examples of the use of restraint in ways which are
unacceptable and infringe people’s human rights to dignity and choice. We
have no evidence whether or not these are widespread, but every one of these examples gives cause for concern. Older people who need care and assistance have the right to take decisions about their lives, unless their freedom to do so is constrained by legislation.The Mental Capacity Act 2005 provides the proper framework for reaching decisions as to what is in people’s best interests.After October 2007, when the Mental Capacity Act 2005 comes fully into force, staff using restraint must:
demonstrate the lack of capacity of the person before they take action

• record their assessment and the action taken


• review their actions.
  
  Reducing restraint
  The following values are inherent to the evaluation of any possible use
  of restraint:
  · respect for the dignity of older people
  · respect for autonomy
  · promoting overall well-being
  · promoting self-reliance.

SOURCE: Commission for Social Care Inspection (UK)