My previous post about “Untie the Elderly” provided an example of how a creative plan for a wandering, agitated resident made a huge difference in the person’s life and avoided the use of physical restraints. That sort of individualized attention was at the heart of what became a multi-decade, national campaign by Kendal to reduce or eliminate the use of restraints in nursing care.
One high point for the program came in 1989 when the US Senate Committee on Aging held a symposium, “Untie the Elderly: Quality Care Without Restraints”, which Kendal co-sponsored and was largely responsible for organizing. Over 400 people, from across the US, attended the symposium. The 256-page Senate report, which includes a full transcript of the day’s testimony and supporting materials, is downloadable as a PDF from the Senate website: https://www.aging.senate.gov/imo/media/doc/reports/rpt589.pdf
Though it is over 40 years old, it is still a great resource and an interesting document to read.
The Senate symposium garnered national attention, including an article in the New York Times (paywall) and wire-service stories in many newspapers. Kendal’s role was central: four staff members were on the 16-member planning committee for the event. Jill Blakeslee (Kendal’s Director of Nursing) and Alan Hunt (Kendal’s board chairman, testifying as a lawyer well-versed in the legal issues of nursing) were among the witnesses. Lloyd Lewis, Kendal’s Executive Director, moderated the day-long symposium.
If you want in-depth information on this topic, the symposium transcript (in the Senate document linked above) is a great place to start. It has lots of personal anecdotes from caregivers and relatives of nursing-home residents. It presents the success stories, but also the major counterarguments to the “untie the elderly” philosophy: the claims that there will be more injuries, that you would be sued if a resident falls and gets hurt, that the staffing costs would be too high, and so on.
Jill Blakeslee’s introductory remarks provide a great overview of what physical restraints are, how they are used, and how they can be avoided. The articles and research papers in the symposium appendix provide information on implementing a restraint-free program and academic research on outcomes when restraints are reduced or eliminated.
In his closing remarks, Bill Benson (Chief of Health and Housing Policy for the Committee on Aging) said: “When Kendal came to us this past spring and said, ‘We are on a mission. We have something we are deeply committed to and we think there is a role for the Senate Special Committee on Aging to play,’ we thought that it was an interesting notion, certainly something that sounds terribly important. But: is it the kind of thing that we should devote a symposium to, whether for 5 hours, 3 hours, or 8 hours? Is it the kind of thing that will merit the attention we would like it to see? Is the timing right for something like this?” He concluded that the timing was perfect.
In 1990, Federal regulations went into effect limiting use of restraints and psychoactive drugs in long-term care settings.
In Pennsylvania, one legacy of Kendal’s efforts was the PA Restraint Reduction Initiative (PARRI), an educational initiative for nursing facilities which Kendal administered from 1996 to 2016. During that period, hundreds of training sessions were held, educational materials were developed and distributed, and the use of restraints was eliminated from most Pennsylvania nursing facilities.
It is clear that Kendal put a tremendous amount of time and energy into Untie the Elderly. Although grants and bequests helped finance the effort, a significant commitment by the Executive Director, the board of directors, the medical staff, and residents was required to make this project a priority. Could a comparable project happen today? I’m convinced that it could, given the right kind of leadership and commitment throughout the organization.
In a future blog post, I will take a closer look at some of the myths and obstacles that the Untie the Elderly campaign had to overcome in order for the elimination of physical restraints to become common practice.
A really fascinating post, George. Makes me feel lucky to be at a Kendal! Especially this one.
Did anyone address that question about alarms to prevent falls when getting into/out of bed or chairs? When I first visited Kendal I was shown an elderly, demented resident trying to go outdoors, and the door just refused to open, with no audible alarm. I imagine we still have that good solution.
I’m not sure about alarms when getting in/out of bed and chairs. I haven’t heard about that. But we do still have doors that lock when bracelet-wearing wanderers get too close. My understanding is that the bracelet system may ultimately be replaced by electronic ID cards that all of us will need to carry if we want to enter or leave the Center. Can other readers confirm this, or answer Conrad’s question about the bed/chair situation?