"Chemical Restraints"

[Anonymous]

My dad was actually very gentle until he got Alzheimer’s. In a nursing home he hit a nurse and at that point he was heavily drugged. We moved him to a place that had a special unit for dementia patients but he never spoke after the heavy medication. He died two months later. It’s such a terrible disease in the end. I understand why the first place did what they did, but it made me so sad for him.

[Anonymous]

I knew a man with dementia who almost killed his roommate in confusion and caused thousands of dollars in damage pulling fixtures out of the walls of memory care. Sedating him was the only way to keep him and those around him safe.

[Anonymous]

Anonymous wrote:I knew a man with dementia who almost killed his roommate in confusion and caused thousands of dollars in damage pulling fixtures out of the walls of memory care. Sedating him was the only way to keep him and those around him safe.

It probably wasn’t. The idea that dementia patients must be sedated to a zombie like state is no longer the standard of care. Psychiatric medication is often part of the plan, but that’s it. Google person centered care.

[Anonymous]

There’s always an option to do it better, do it oneself. Then see how soon you’ll be ok with meds.

[Anonymous]

Anonymous wrote:Some older people with dementia can get very aggressive and confused.

Medication is hopefully not the first choice in managing aggressive patients. Ideally a whole bunch of other methods are tried first, and tried again. But facilities can also evict aggressive patients. Their staff does get injured. At home elderly spouses can be injured by such family members.

+1 it’s usually an anti-psychotic that is used in place of wrist restraints, etc if someone is at risk of pulling out their feeding tube, or constantly trying to get out of bed, or having violent outbursts at staff. It’s only used in the most extreme cases of advanced dementia, when other options have been exhausted. No nursing home or assisted living will accept a volatile person, though some might be okay if the family hires a 24x7 caregiver at the bedside.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I knew a man with dementia who almost killed his roommate in confusion and caused thousands of dollars in damage pulling fixtures out of the walls of memory care. Sedating him was the only way to keep him and those around him safe.

It probably wasn’t. The idea that dementia patients must be sedated to a zombie like state is no longer the standard of care. Psychiatric medication is often part of the plan, but that’s it. Google person centered care.

That’s not realistic, though. Sedating is easier, cheaper, safer.

[Anonymous]

Anonymous wrote:My dad was actually very gentle until he got Alzheimer’s. In a nursing home he hit a nurse and at that point he was heavily drugged. We moved him to a place that had a special unit for dementia patients but he never spoke after the heavy medication. He died two months later. It’s such a terrible disease in the end. I understand why the first place did what they did, but it made me so sad for him.

You are incredibly lucky he died after only two months. And so was he.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My dad was actually very gentle until he got Alzheimer’s. In a nursing home he hit a nurse and at that point he was heavily drugged. We moved him to a place that had a special unit for dementia patients but he never spoke after the heavy medication. He died two months later. It’s such a terrible disease in the end. I understand why the first place did what they did, but it made me so sad for him.

You are incredibly lucky he died after only two months. And so was he.

+1

[Anonymous]

Anonymous wrote:

Anonymous wrote:I knew a man with dementia who almost killed his roommate in confusion and caused thousands of dollars in damage pulling fixtures out of the walls of memory care. Sedating him was the only way to keep him and those around him safe.

It probably wasn’t. The idea that dementia patients must be sedated to a zombie like state is no longer the standard of care. Psychiatric medication is often part of the plan, but that’s it. Google person centered care.

What about the roommate? Do they get person centered care too, or do they have to be assaulted and die on the altar of not medicating dementia patients?

[Anonymous]

Anonymous wrote:Chemical restraints are against the law. I'm asking what that means. Does it mean over-medicating or sedating residents?

Chemical restraints are not against the law.

It’s against the law to sedate a patient for nursing convenience or to punish them for bad behavior. It’s not against the law to sedate them for their safety or the imminent safety of others. If your loved one is confused and angry and trying to punch the nurses, the choice is a chemical restraint (aka sedation) or a physical restraint (aka soft wrist restraints that tie their arms down). If you are confused and angry with dementia in your old age, which one would be more terrifying? Being tied down, or being given a med to make you sleepy/ relaxed?

[Anonymous]

To answer your question a chemical restraint is the medication alternative to a physical restraint. If a patient needs to be restrained because they are being violent to themselves or others, the options are to physically restrain them or chemically restrain them. Each option mandates that the least restrictive restraint is used- so only tie down their arms, not their feet, if they’re staying in bed but trying to strangle the nurse. Or, give the dose of medication that is enough to stop the behavior but not any more than that amount. Usually the need for the restraint (whatever type) needs to be re evaluated incredibly frequently by the ordering physician and the patient has to be checked on almost constantly, so it’s not easier for anyone involved to order any kind of restraint. But it’s done when safety necessitates it

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I knew a man with dementia who almost killed his roommate in confusion and caused thousands of dollars in damage pulling fixtures out of the walls of memory care. Sedating him was the only way to keep him and those around him safe.

It probably wasn’t. The idea that dementia patients must be sedated to a zombie like state is no longer the standard of care. Psychiatric medication is often part of the plan, but that’s it. Google person centered care.

What about the roommate? Do they get person centered care too, or do they have to be assaulted and die on the altar of not medicating dementia patients?

What happened is an example of the results of outdated practices and was terrible for both patients. It never should have progressed to that point.

[Anonymous]

It's unfortunate terminology that gets misused. There are elderly who can be incredibly verbally abusive and can lash out physically. When it's physical I suspect at one point it was allowed to physically restrain the person, but now that is no longer allowed. Now for both verbally and physically abusive behavior there are medications than can calm the person down.

It's a balance. The elder has rights and contrary to what some people will say, medicating is not taken likely and involves assessment and team input. The elder has many rights until those rights infringe on the rights of others from the poorly paid aide to the well paid, but overworked nurses and doctors. They have a right not to experience verbal and/or physical abuse.

My mother requires consistent medication to treat people respectfully, but she has the right to refuse and she does, so her workers are a revolving door. In more acute situations like hospital stays her verbal abuse escalates to the point nobody will work with her and she upsets the patients who hear her down the hall and the visitors, so she must be medicated to receive care. With sedatives and sometimes antipsychotics she can comply with and be receptive to treatment for her physical ailments.

As someone who suffered a very challenging childhood because my mother did not get psychiatric care, I am a firm believer in the importance of medication instead of allowing abuse.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I knew a man with dementia who almost killed his roommate in confusion and caused thousands of dollars in damage pulling fixtures out of the walls of memory care. Sedating him was the only way to keep him and those around him safe.

It probably wasn’t. The idea that dementia patients must be sedated to a zombie like state is no longer the standard of care. Psychiatric medication is often part of the plan, but that’s it. Google person centered care.

What about the roommate? Do they get person centered care too, or do they have to be assaulted and die on the altar of not medicating dementia patients?

This. Anyone who criticizes using medication to manage abusive behavior even if it means heavy sedation, needs to go spend the day with the most challenging patients when they are UNMEDICATED.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I knew a man with dementia who almost killed his roommate in confusion and caused thousands of dollars in damage pulling fixtures out of the walls of memory care. Sedating him was the only way to keep him and those around him safe.

It probably wasn’t. The idea that dementia patients must be sedated to a zombie like state is no longer the standard of care. Psychiatric medication is often part of the plan, but that’s it. Google person centered care.

What about the roommate? Do they get person centered care too, or do they have to be assaulted and die on the altar of not medicating dementia patients?

This. Anyone who criticizes using medication to manage abusive behavior even if it means heavy sedation, needs to go spend the day with the most challenging patients when they are UNMEDICATED.

And you need to research how standards of care have evolved. This situation never should have happened. Most patients don’t need to be sedated into semi consciousness and thus level of violence did not erupt out of nowhere. The patient who acted violently probably never received appropriate treatment, the facility knew his condition, and he shouldn’t have been with a roommate.

Learn. Advocate. Find better facilities.
I started helping my mother take care of elders long ago when those barbaric treatments were the standard of care. I’m so thankful for the advances over the late 20ish years.