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My 91 yr old husband with vascular dementia and incontinence has become aggressive (attempts to grab, threats of breaking and biting) when we try to change and clean him. Meds either don't work or totally knock him out (we are working on finding the right ones). In the meantime, for safety, we would like to use restraints for safety.

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N curren in South Carolina the law is very clear on restraint in NHs so I cannot think it would be different anywhere else.

It states:

When it comes to the resident, the Bill of Rights states that each resident must be free from mental and physical abuse, as well as free from any chemical or physical restraints except those ordered by a physician.
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I don't know ability South Carolina. I do know we are not allowed to use them in Minnesota. I have been kicked, hit, grabbed, etc. I have to just remove myself from the situation because I know with dementia they can't help it.
That being said, you may need to look into a memory care unit. When my Grandpa had Alzheimers, it was too much for the family to be able to care for. He needed more attention.
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I think the expert opinion is helpful, I would like to recogize early signals and identify the triggers. I think the triggers are not external however, so not much to see I fear.
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ncurren, please get him to a hospital for inpatient titration of medications. Trial and error at home obviously is not working. He really needs a hospital setting to sort this out.
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Here is the article. I just googled Dr. Kyomen's (who is not Dr. Roberts who referenced the article and I think was just being helpful) and agitation in older adults. There are other articles that also came up. Good luck this is not a quick fix.
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I've been in a similar situation with my mother. Try giving him a few minutes to calm down alone, return with a calm soothing tone. Remember you must stay focus
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a soiled pad not a smile pad
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As t legality - As far as I could tell if and I mean IF you have tried and tested every other route and have documented it then you can go to your doc and say I have done this this this and this and every time violence is the result. What do you recommend we do so that we as caregivers are safe to continue giving care? If he documents that you can use wrist restraints for 5 minutes when cleaning or changing a smile pad then you are following docs orders.

If you can't get an answer here can I make a really viable suggestion? Ring a care home that takes dementia patients and you will need the manager here or a very senior person (purely because i the event of malpractice they would be the person who is prosecuted) and ask to visit them or ask them what the law is....they MUST know (at least I hope they MUST know!)

In general restraint is usually the last resort because next time round you will experience the violent outburst when you try to put the restraint in place. If it is at all possible you need to get to the 'why' the outburst starts. Sometimes you can sometimes you can't but I believe you h ave t be seen to have at least tried.
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I assume adult protective services are available in SC like here in MN. I would ask them for advice on this. They have resources to refer you to for help, too. When my friend Beth first became incontinent, I had a local home health agency provide some care and they were able to work effectively until she became resistant to all care. Someone trained in doing this work could help you, too. Of course, you have to pay them, but they have skills and experience that make them worth it. It's hard to imagine wrist restraints working for long once he starts fighting their use.
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An extract from our NHS (bear in mind that the National Health Service is a UK organisation NOT an SC one ) states this:

Leave and return
‘Leave and return’ is a strategy when someone is resisting care. There is a (sic) need to employ good judgment here. If a person (sic) absolutely needs medical intervention, or another essential intervention e.g. a soiled incontinence pad needs changing, physical intervention may be necessary. But in the majority of cases things can wait (washing or shaving, for example). Constant informal risk assessment is needed, along with adequate supervision, and opportunities to discuss and debrief dilemmas and people (sic) being trusted to use their judgment.

I have looked and SC doesn't appear to be overly VISIBLY helpful but I did find one article which we could all do with looking at

Google

DEMENTIA DIALOGUES - Arnold School of Public Health

It will bring up a very useful presentation on combative dementia and may not sort the problem but you may get some tools that you could use to deflect the issue
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The comment that contained the plug for the book was deleted/edited.
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I thank everyone for their helpful answers. I said "we" as there are two of us working on this problem, but usually only one doing the actual work at a time. I don't think anyone has yet addressed the legality in SC of using wrist restraints.
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I saw the plug that is mention - some how it has magically been edited from the post.
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I was having the same "fighting" problem with a client in late stage AL in a facility. I asked for another set of hands, & she shared a wonderful tip. The person holding the hands should pull back on the middle finger (away from Palm) & hold onto it until finished. Doing this, they can throw their arms around, but are unable to establish a grip. IT DOES NOT HURT THEM. If the 2nd person is quick, by the time the patient realizes what's happening, it's done...just be quick to grab the finger. Good luck, & God bless you through this journey
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Right. I just saw the person providing references to online articles professional medical specialists wrote, not their own book.
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What book is being plugged here? I saw online articles mentioned, but no book.
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Why isn't plugging his book not right if it can provide information to help people?
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I also agree that plugging a book you wrote is not appropriate for this site.
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Rather than use this site to plug the sale of your book (which is not the purpose of this site), I'm sure people would appreciate actual advice about the problem(s) they are having to face. Unless you are willing to post a free digital copy for all to reference, encouraging people to read your book when they must purchase it first is inappropriate.

To address the OP with the issue at hand, unfortunately there are no approved medications to treat vascular dementia. Your husband has no choice and must be cleaned and changed, but he is probably very strong and when he grabs you, it hurts. I'm not sure restraining him during those times is going to do anything. You have to turn him to clean and change him, so restraining him will prevent you from turning him. In facilities, there will often be 2 people to handle people with aggressive behaviors----one stands in front and allows the patient to grab their hands while the 2nd person does the actual cleaning and changing into clean disposable underwear. (I hate calling them "adult diapers") Your post stated that he gets aggressive when "we" try to change him and clean him----I am assuming that there is more than one person there at those times. Unless your husband has to be sedated all the time because of the aggression, medicating him just to clean and change him is overkill. In order to "break" you, he has to get both hands on you, and in order to bite you, he has to get your hand/arm up to his mouth. It is very difficult to clean and change a person with aggressive behaviors yourself----if you can get a second set of hands, that would be very helpful. Of course, you don't want him to hurt himself and you don't want to get hurt either. I wish you good luck in this.
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Federal laws and regulations talk about restraints on people who are residents of care facilities. Under Federal law, patients have the right to be free from:
"any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms.
Restraints may only be imposed—
(I) to ensure the physical safety of the resident or other residents, and
(II) only upon the written order of a physician that specifies the duration and circumstances under which the restraints are to be used.”
42 U.S.C. § 1395i-3(c)(1)(A)(ii) and 42 U.S.C. § 1396r(c)(1)(A)(ii).

These broad guidelines may be helpful as you search for solutions to the combative behavior. Talk with a social worker at your local ASAP (Aging Services Access Point) and an elder law attorney, to learn about laws and regulations in your state that may protect people in your home care situation.

Continue talking with the physicians to see if you can spot behavioral triggers that can be alleviated. Dr. Helen Kyomen, a geriatric psychiatrist, has written online articles on Agitation in Older Adults, suggesting the questions you can ask when an elder show signs of agitation. Paul Raia, Ph.D. of the Alzheimer’s Association has explained how a behavior plan can be developed to identify triggers for agitation and anxiety in dementia patients.
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I agree with JohnnyJ. ONly medications will reduce the aggression.
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When this happened with my friend Beth who was incontinent and needed cleaning in her memory care unit in an assisted living place, I was advised to take her to a geri-psych ward at a local hospital where they had the staff and training to deal with this. I had to try 3 different hospitals to find one with an opening. They worked with the anti-psychotic drugs to find the right ones at the right dosage and frequency so she would be calmer but not doped up. It took 3 1/2 weeks in the hospital before she could return to her apartment. As her condition continued to decline--she had frontal temporal dementia--the hospital doctor could advise on minor changes in the meds to help her. Her stay there was covered by her health insurance. The drugs worked great while they were needed, but in Beth's case, her decline was pretty rapid.
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I don't have the answer for you but we are in a similar situation with my dad and I just want to wish you the very best. God bless you as I know you are in a very difficult and stressful situation.
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