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.
To address the OP with the issue at hand, unfortunately there are no approved medications to treat vascular dementia. Your husband has no choice and must be cleaned and changed, but he is probably very strong and when he grabs you, it hurts. I'm not sure restraining him during those times is going to do anything. You have to turn him to clean and change him, so restraining him will prevent you from turning him. In facilities, there will often be 2 people to handle people with aggressive behaviors----one stands in front and allows the patient to grab their hands while the 2nd person does the actual cleaning and changing into clean disposable underwear. (I hate calling them "adult diapers") Your post stated that he gets aggressive when "we" try to change him and clean him----I am assuming that there is more than one person there at those times. Unless your husband has to be sedated all the time because of the aggression, medicating him just to clean and change him is overkill. In order to "break" you, he has to get both hands on you, and in order to bite you, he has to get your hand/arm up to his mouth. It is very difficult to clean and change a person with aggressive behaviors yourself----if you can get a second set of hands, that would be very helpful. Of course, you don't want him to hurt himself and you don't want to get hurt either. I wish you good luck in this.
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
If you can't get an answer here can I make a really viable suggestion? Ring a care home that takes dementia patients and you will need the manager here or a very senior person (purely because i the event of malpractice they would be the person who is prosecuted) and ask to visit them or ask them what the law is....they MUST know (at least I hope they MUST know!)
In general restraint is usually the last resort because next time round you will experience the violent outburst when you try to put the restraint in place. If it is at all possible you need to get to the 'why' the outburst starts. Sometimes you can sometimes you can't but I believe you h ave t be seen to have at least tried.
That being said, you may need to look into a memory care unit. When my Grandpa had Alzheimers, it was too much for the family to be able to care for. He needed more attention.
It states:
When it comes to the resident, the Bill of Rights states that each resident must be free from mental and physical abuse, as well as free from any chemical or physical restraints except those ordered by a physician.