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.
"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.
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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