Restraint-free facility?

[reussir1]

My facility is making the change to restraint-free. Does anyone here work for one? I don't know how well we will do without side rails/lap buddies/etc will work, but our facility said if they fall then they can be put in therapy because they will be able to get a lot more $$$ per resident....

[rosey2007]

The last LTC place I worked at was restraint free also and it was a nightmare at times. Bed rails had to be a doctor's order before they could be placed on the bed. They say it is a dignity thing, but lets get real it all about the bottom line. If they fall they make more money.

[ctmed]

Expect a lot more one on ones for CNA or (more likely) bringing in agency sitters.

Restraint-free is a philosophy that it is cheaper and more attractive to families and inspectors to have someone constantly redirecting than tie someone down or drug someone up.

Restraint-free does not just apply to tranquilizers and restraints, but bed siderails, trays on geri-chairs, etc.

It is sometimes cheaper to pay cheap labor sitters than attract inspectors, complaints, bad press, or potential lawsuits.

It also means you may have issues getting drugs/help if a patient gets way out of control. (At least at some of these kind of facilities I have been in.)

[reussir1]

Someone in charge actually gave that to you, the staff, as a rationale?

yes, straight from the administrator's mouth. our administrator also told us in a meeting that he wished all patients were medicare therapy ones so he could get the max $$$. when that got out to the resident's families who weren't medicare/therapy they were pretty ******...but I would be too. one family member asked me do they treat her mother less because she isn't a therapy patient...i said of course not, but with a special medicare/therapy hall with a 10:1 resident to cna ratio, flat screen tv's, private rooms, fancy bedsheets and curtains etc while the rest of the residents have to deal with 18:1 ratio, no bedspreads just blankets, and broken blinds, it's not hard to imagine that they would be treated differently. when we run out of diapers the medicare hall even has priority on them because if visitors come "they need to look and smell good..."

[KimberlyRN89, BSN, RN]

yes, straight from the administrator's mouth. our administrator also told us in a meeting that he wished all patients were medicare therapy ones so he could get the max $$$. when that got out to the resident's families who weren't medicare/therapy they were pretty ******...but I would be too. one family member asked me do they treat her mother less because she isn't a therapy patient...i said of course not, but with a special medicare/therapy hall with a 10:1 resident to cna ratio, flat screen tv's, private rooms, fancy bedsheets and curtains etc while the rest of the residents have to deal with 18:1 ratio, no bedspreads just blankets, and broken blinds, it's not hard to imagine that they would be treated differently. when we run out of diapers the medicare hall even has priority on them because if visitors come "they need to look and smell good..."

Yup the medicare/rehab wing @ my last job was like this too. The building was run down & the wings were soo old..some of the beds were so old they had hand cranks on them! I had the rehab/medicare wing, but not with a 10:1 ratio..I would have loved that! It was a 13:1 ratio!!:devil:

[DolceVita, ADN, BSN, RN]

OMG that is horrible.

[reussir1]

Yup the medicare/rehab wing @ my last job was like this too. The building was run down & the wings were soo old..some of the beds were so old they had hand cranks on them! I had the rehab/medicare wing, but not with a 10:1 ratio..I would have loved that! It was a 13:1 ratio!!:devil:

wow...you must find us ancient because all of our beds have hand cranks

[*4!#6]

We have 1/4 siderails at our facility and I wouldn't work without them, can you image rolling a 300 lb combative person?? I'm sure I would accidently roll them right out of bed. It just isn't safe, and 1/4 siderails aren't really a restraint at all as the residents have plenty of clearance to get out of bed (and fall, as we found out a week ago with one lady).

[KimberlyRN89, BSN, RN]

wow...you must find us ancient because all of our beds have hand cranks

I must admit though, they do help you develop upper-arm strength

[yousoldtheworld]

My current facility has about half hand crank beds. I'm glad we're not the only ones!

[Dorali, BSN, LPN, RN]

About 75% of our beds are hand cranked.

My facility is changing to restraint free. We use a lot of personal alarms, mostly the clip kind and a couple of the ones they sit on. Most of the people that used to have the bed rails now have low beds and the floor cushions. The ones that still have bed rails only have the 1/4 or 1/2 rails they use for rolling.

[CoffeemateCNA]

I must admit though, they do help you develop upper-arm strength

Yeah, because you use your arms to break your own fall after the CNA before you forgets to push the cranks back under the bed, leading you to trip over them.

[Hospice Nurse LPN, BSN, RN]

Sometimes I hate working a restraint-free facility.

I miss Lap Buddies the same way hippies miss being able to smoke pot in public.

We have SOOO many falls that could easily be prevented if a Lap Buddy or seatbelt were in place. Just last night, I was sitting and fantasizing about restraints as I struggled to keep 5 residents in their wheelchairs, all of whom seemed to think they were still able to walk.

Many facilities are now restraint free. I think it's not a good idea at all. "The resident has the right to fall"....what and crack open their head? I see hospice pts in a LTC facility and only 1 has s/r order. The others have mats on the floor. You are right, so many times these folks think they can still walk and it's impossible to watch every one of them constantly. A facility needs to have a smaller ratio CNA : pt, but we all know this isn't going to happen. At least with my home pts, I know the s/r can be used.