Julie Mitchell recalls seeing her father in restraints during visits to see him in long-term care in 2011 when his dementia advanced to the point he could no longer live at home.
“In waking hours, if we weren’t there, he was restrained in a chair with a belt around him,” said Mitchell, one of 13 children raised by John Joe and Elizabeth Pidgeon in Marystown, N.L., population roughly 5,300, located 300 kilometres from St. John’s.
A report released last week by the Canadian Institute for Health Information (CIHI) found that 12.1 per cent of seniors in long-term care homes in Newfoundland and Labrador are kept in daily physical restraints, second only to Yukon, at 14 per cent. The Canadian average is 5.7 per cent.
Pidgeon, who died in 2014 at 81, was a local celebrity, an accordion player who loved to play for community events and who took great pride in teaching the tricks of the trade to young traditional music enthusiasts. Dementia changed all that.
In 2010, Mitchell and her siblings decided their father had to be placed in long-term care for his own safety because of his tendency to roam. At the time, the only available space was at the Burin Peninsula Health Care Centre, 16 kilometres away from the family home where he would spend eight months while he waited for a bed in a facility that specializes in caring for people with dementia.
Restraint seen as punishment
Mitchell said during his time there her dad was only freed when he had a visitor.
“It was really sad to look at,” said Mitchell. “I remember one particular time when I went in, gave him a kiss and I went to touch the restraint … on the chair to unhook it, and he said, ‘But I didn’t do anything.’
“We took turns visiting him every day,” said Mitchell. “He was always so happy to get that restraint off so he could get up and walk.”
Mitchell said her father experienced the psychological effects of being restrained even though he had dementia.
“He really felt that he was being punished and he didn’t know why.”
CBC News made repeated attempts to interview the province’s health minister, John Haggie, and was instead directed to the four regional health authorities in the province, who all said that long-term care homes employ a “least restraints” policy, using physical restraints only as a last option to protect residents’ safety. Eastern Health, which oversees the Burin Peninsula Health Care Centre, declined to be interviewed.
“Restraints are used when there is potential serious risk of harm to the resident or others, and when all other strategies to maintain safety and minimize restraint use have been exhausted,” a spokesperson said in a statement.
“Use of physical restraints is tracked by all long-term care sites in Eastern Health with efforts to reduce restraint use wherever possible.”
Not a way to ‘manage people’
Restraints come in many forms, such as belts and straps used to prevent seniors from getting out of their chair or out of bed. Sometimes a tabletop is used to block a person who is sitting from getting up.
Newfoundland and Labrador’s Seniors’ Advocate says what to do about seniors who require 24-7 care is a complex problem that will require a shift in thinking, better training and more staff in long-term care facilities.
“We should not be restraining the most vulnerable, the … frailest, sometimes the most confused people in our population,” said Brake, who worked in seniors homes as a social worker and in other roles in the 1980s and 1990s and was appointed in 2017 as the province’s first seniors’ advocate.
“A restraint should only be used in exceptional circumstances, not as a way to manage people,” she said. “We know that, we all know that, but yet we continue to do it.”
1 in 5 prescribed anti-psychotic drugs
Brake is also concerned about the use of anti-psychotic drugs to restrain seniors in long-term care.
One in five seniors in long-term care in Canada is potentially being prescribed anti-psychotic drugs despite having no diagnosis or history of psychosis, according to the CIHI report. Once again, Newfoundland and Labrador tops the list, at 35.4%. Alberta has the lowest rate of the provinces surveyed, at 19.1%.
“Putting in good training, solid training … in terms of how to address people who live with dementia is a much better approach to take,” said Brake.
Mitchell says the staff were “exceptionally good” to her father but says she recognizes they had many other patients they were responsible for. She questions the staffing levels in long-term care.
Brake says staffing levels are definitely falling short.
“If you have 20 [patients] on your unit all night and … there’s only one or two people there, it’s definitely a challenge,” said Brake.
“They believe that they’re protecting that person, but the flip side is that the person who is being restrained is experiencing trauma.”
Brake says the system can and should do better, but that it would be impossible for long-term care facilities to provide constant care to patients who need it.
“That discussion has to be had with families about risk, because there is no such thing as 24-hour supervision.”
CIHI is a taxpayer-funded non-profit organization that collects data about various aspects of Canada’s health care system. Not all of the provinces and territories participate, but the latest report includes full coverage in British Columbia, Alberta, Saskatchewan, Ontario, Newfoundland and Labrador and Yukon, and partial coverage in Manitoba, New Brunswick and Nova Scotia, representing approximately 60 per cent of long-term care facilities in the country.