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Introduction
This module looks at decisions about using restraint in care homes - what to consider, how to go about it and who should be involved.
The ideas presented in this module are based on best practice approaches to care, specifically person-centred care and relationship-centred care. To find out more about these, click here.
In this introductory chapter we consider the link between risk and restraint, and explore how positive approaches to risk can help with minimising restraint.
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Introduction
A care home is just that - it's a home, and as such it should have a positive atmosphere that promotes the health and wellbeing of all its residents.
This sounds simple, but we know that care homes can be complex places.
The decision to use a form of restraint is usually related to concerns that the resident may come to some harm unless they are restrained. So when we talk about restraint, it's important we talk about risk too.
If you would like to read more about the reasons why restraint might be used, read SCIE's review of research on restraint (2009), pages 9-10.
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Introduction
Before we get started let's think about a few questions.
Question 1
Is restraint an acceptable approach to difficult or risky situations?
Question 2
Is it the resident, their relatives or the care home that is responsible for decisions about risk
Question 3
When it comes to decisions about restraint, all a care home can do is complete a risk assessment for every resident, and this should cover everything.
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Introduction to restraint
Question 1
Is restraint an acceptable approach to difficult or risky situations?
Both the law and professional guidance makes clear that restraint can be acceptable in limited circumstances, but it should be used only as a last resort, and in the least restrictive way possible.
Generally, approaches that do not involve the use of restraint should always be tried first. Care homes should be aiming to minimise the use of restraint at all times. It may be that all parties agree that restraint is the best option, and this should be written into the care plan.
If you want to explore this more, have a look at Module 1.
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Introduction to restraint
Question 2
Is it the resident, their relatives or the care home that is responsible for decisions about risk
This depends on the circumstances - if a resident has mental capacity, then they are responsible for the risks they take. All residents have rights to continue to take risks when they come to live in a care home, but the home also has a responsibility to look at the risks carefully and balance this information against the needs and rights of the person themselves (for example, if the resident lacks mental capacity), other residents and staff. Relatives should be involved in discussing these decisions too, if at all possible, although they do not have the right to make decisions for a resident.
Care homes can never be places that are free of risk.
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Introduction to restraint
Question 3
When it comes to decisions about restraint, all a care home can do is complete a risk assessment for every resident, and this should cover everything.
Not true. The decision to use restraint may come about because staff have completed a risk assessment and everyone has agreed that a form of restraint (say, an alarm on the front door) is the best, least restrictive approach (in this case, to the risk of the resident leaving and getting lost). The risk assessment would be part of a full assessment, and a care plan would record the outcomes.
However, at other times, staff will have to deal with a situation that no one had expected or prepared for.
A risk assessment is a very important part of making positive, clear decisions about managing risk and safety, but other things need to be considered too.
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