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kwriter13 Asked June 2015

What are the rules about seat belts with wheelchair?

My Mom has advanced vascular dementia and is a memory care facility. She is confined to a wheelchair but can use her legs to get around. She sees to have a need to move the chair a lot roaming the hallway and common area over and over. In April she crashed the chair into a door jam and fell against the doorway resulting in a big lump on her head and broken nose. Yesterday she had a similar accident resulting in a baseball sized bump on the forehead and lots of bruising. The emergency room doctor said Washington state prohibits the use of a seat belt. Does anyone know of this is true? Mom only weighs 89 pounds.

Would like to prevent any more such accidents but I don't want to take away her ability to move either. Are there any other steps we can take to prevent these accidents?

Irishgram Feb 2018
I am so determined to find something that works...Just today, when I visited with him, he mostly slept and even in his sleep, he's moving around and trying to get out of the chair...Of course they still have the buzzer on it and it would go off but with me being there, they didn't come running...Most of the time, they do keep him close to the nurse's station or pushed up against the big table, close by...I do feel sorry for the nurses and aides, it has to be so frustrating...I noticed one little lady who had fallen the day before and had a terrible gash on her forehead, she must have had 20 stitches...Just so sad!

JoAnn29 Feb 2018
Seatbelts in wheelchairs do not go across the body. They can be used in the state of NJ but...the person has to be able to get out so it's not considered a restraint. They are shown the red button they can push to release the seatbelt. Since Mom kept trying to get out of a wheelchair the home gave her a chair with wheels that looked like a beach chair. The seat could be slanted back to keep Mom from being able to get out.

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Irishgram Feb 2018
You have no idea how much I appreciate the answers and hopefully some help might be forthcoming...I can see how some restraints can be dangerous but even if a simple pillow, the alarms on the chairs or bed or as in my husband's case, that little saddle horn on the cushion has to help prevent so many falls...I sometimes wonder who in the world comes up with these laws! Hospice has made sure my husband has a rocker type chair that is tilted back to make it harder to get of by he's found a way, lol and also, he does have a hospital bed that is lowered and a mat on the floor...And I have noticed, they have gotten what looks like bumper pads that fit around the edges to keep him in bed but I'll bet they'll have to remove that also... Something has to be done to keep these people safe and I have a feeling, my "fight" has just begun....Thanks again for answering.....

cwillie Feb 2018
From my observation the alarms are mostly useless, those who need them are moving and setting them off almost constantly so they tend to be ignored, and if someone does actually fall the alarm will only bring help after the fact.
Does he have a tilt in place wheelchair Irishgram? That coupled with freqflyer's pillow idea and asking that he be kept by the nurses station might help.

geewiz Feb 2018
I had this situation with my Mom. I BEGGED the memory care place to do something so she wouldn't fall. Like most states, there is a no restraint law here. BUT they did (finally) agree to install a lap belt. They followed some permissible rule and showed my Mom how to open the seat belt. Then someone watched her open it and signed a statement that she could open it upon someone telling her to do so. Following this, they put a sweater on her lap to cover the seat belt. This (mostly) worked and she soon forgot how to open it --- things were peaceful after that! : - ))

freqflyer Feb 2018
Irishgram, when my Mom was in long-term-care, she kept trying to escape from her wheelchair, thus falling. The facility even tried using a regular car seat-belt, but within seconds they heard the familiar sound of a seat-belt being unbuckled.

Eventually what did work, and you can try this with your hubby is to have the nurse/aide place a large pillow under hubby's knees if he is in a geri-recliner [don't know if that would work in a wheelchair]. That worked for my Mom until she was able to wiggle that pillow out from under her knees, it took a long bit of time, but it did give the Staff some relief for awhile.

My Mom's brain thought she could stand and walk, but in reality she couldn't. Again, a lot of falls. Her bed was lowered and fall mats were placed. Ok, she did fall, but not as far. Again pillows came to the rescue. The nurse/aide would tuck pillows in all around Mom which made it quite difficult for her to climb out of bed. Only problem, Mom wasn't able to turn over. Rather have the pillows then her falling.

If there were bed railings, my Mom would be the one who would get her legs all tangled up in the rails, or her head caught between the mattress and the bed rail. Both would be dangerous and even fatal.

Back in the olden days, patients with memory issues were placed in asylums, and at times would be chained to their beds for what the staff was for the patient's own safety. Now a days, that is viewed as being cruel. There seems to be no inbetweens.

Irishgram Feb 2018
Reading all these posts really hits home with me...My husband is in a Memory Care unit and is constantly trying to get out of his chair and/or bed and has fallen way too many times...He's also under the care of Hospice and they have tried every type of wheel chair possible and he still manages to slide out...Just this past week, I've been told, it's a state law, here in Pa. that prohibits any type of restraints and that includes the alarms on the bed as well as on the wheel chair...Last night, I got another call, saying he had tried to stand and once again fell...What is the answer??? There are safe restraints and I for 1 would want them to be used but the Homes aren't allowed...We buckle up the babies, we use seat belts but for the elderly, just let them keep falling and getting injured more and more...This makes no sense!

JoAnn29 May 2017
Just had this happen. My Daughter works rehab-longterm facility. Mom was in a wheelchair with a belt that was loosly buckled. There was a big red button with "press me". Daughter said this is legal as long as the patient can unbuckle it. Now they have Mom in a chair that the back can be slanted making it hard to get out.

Livesforcolor May 2017
I have the same frustration. My mother with Alzheimer's was living with me until recently and we kept her safely in her wheelchair by using a safety belt. It was a lap belt. She also enjoyed propelling herself around the house. Because she tends to lean far forward while doing this, she had a couple of substantial falls directly onto her face which is when we implemented the seatbelt. The seatbelt worked very well for us. I recently placed her in a memory care facility here in Washington and find that all the facilities tell me that they cannot legally "restrain" her with a seatbelt. I don't understand this policy since safety belts are routinely used in cars, on high chairs, baby changing tables, etc. My mother has no idea that by leaning forward she will cause herself to fall. One place even told me that a patient has the right to fall. This statement assumes that the patient understands that she may fall and is willingly taking that risk. What about protecting those who cannot protect themselves? The solution that we went with is to buy her a new wheelchair, a tilt in space chair that reclines her in a position that makes it difficult for her to lean so far forward. What we gave up is her mobility as she cannot wheel this chair around by herself. It is sad that we had to take that away from her.

xxxxxxxx Jun 2015
I have seen a tray used that fits over the arms, much the same way a high chair tray fits. Perhaps they can do something like that. I found many options doing a Google search, but the facility probably has some.

kwriter13 Jun 2015
They do have a large common area but they also have access to the hallway where their rooms are. It is a large wide doorway but she has no logic when it comes to bumping into something whether it is a chair, sofa, doorway or even person. She just backs up a bit and tries again, hitting the object again. I wasn't thinking of a shoulder type restraint but just something that goes across the lap. Yes, maybe locking the wheels help but she likes to wheel and her legs will go anyway and it makes her very unhappy to have to stay still. They do lock her in place for meals and to give her some rest or she would never stop going until bedtime. They also put her in a recliner which she can't get out of on her own to get rest. Maybe the OT suggestion is a good one. She doesn't get that. Not sure how to access that as I don't live in town where she is and I know they don't have one. Some of the patients do have one who comes but it was from a dr. recommendation and an outside resource.

MaggieMarshall Jun 2015
That restrictionist not unusual. What's UNUSUAL is that she fell twice. What is WRONG with those people?

She needs to be in a facility that uses the large dining room as. Common room all day long. Large flat screen, like 60", on wall. Then wheeled to the table with a bird'seye view of the screen and wheelchair wheels LOCKED.

Move her if they can't accommodate that need. Sorry, no more moving on her own.

BarbBrooklyn Jun 2015
I believe that seat belts in wheelchairs are considered "restraints" and thus not allowed.

There are various kinds of wheelchair cushions that might help in this situation. OT are usually the folks who know about adaptive gadgets, so contact the therapy department and get them working on this problem.

freqflyer Jun 2015
One would think that a seat belt would be in order to help the patient be safe... but I just read a short article from the National Institute of Health that such seat belts caused numerous deaths due to the elder chocking on the part of the belt that goes across one's chest. Part had to do with Staff not understanding how the belts works [kinda like when one uses a child car seat the first time].

One would think someone would come up with something easier and safer to use. Maybe a large pillow high enough that the elder's upper body doesn't cross the pillow and into the door jam. The pillow would need to be attached to the chair somehow. Maybe there is something out there that does work.

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