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Restraint

Abuse and use of restraint


The ways in which freedom is restricted may be broadly defined as measures or means of restraint. Examples include physical and psychological restraint as well as the use of mechanical, chemical, environmental, electronic and other means or devices. Coercive measures could also be considered as a means of restraint as they restrict a person’s freedom to choose not to do something (Alzheimer Europe, 2012). Inappropriate or unlawful use of restraint is considered as a form of abuse.

Several countries did not find any legislation for restraint in the context of residential care (Belgium Wallonia, Bulgaria, Cyprus, Croatia, Italy, Latvia, Luxembourg, Poland, Portugal and Slovakia).

Table 16 provides information on legislation/National Standards of relevance to this topic. The legislation on restraint in Lithuania, the Netherlands and Norway is currently under review. In Finland, the Ministry of Social Affairs and Health established a working group in 2010 to work on this topic. An Act (the “Autonomy Act”) was published in 2014 which should have come into force at the end of 2014. However, this proposed Act lapsed at the end of the term of the previous government. The preparation of the Autonomy Act is expected to continue in 2017 (Hoppania et al., 2017).

In the majority of the cases (see for example Belgium – Flanders, Czech Republic, France, Ireland, Malta, Switzerland and the UK) residential care facilities are required to have a written procedure or clear policy that should guide the use of restraint. In Belgium and the Czech Republic, the types of restraint mentioned are physical restraint and isolation of the resident. In Latvia, there should be information about the procedures to follow if a resident needs to be isolated (if necessary, with supervision and only for a period of time no longer than 24 hours). In Malta, the references are to physical and chemical restraint. In Sweden, the Social Service Act and the Health and Medical Service Act have no provisions on the use of restraint in dementia. Current legislation regulating the use of physical restraints in geriatric care does not allow staff to strap a resident to a bed with a belt or a similar device or to lock residents in their rooms (Pellfolk et al., 2012).

Also, in all the cases, the requirements include that restraint should only be used in exceptional situations (in Belgium-Flanders, Czech Republic and Lithuania, if there is danger to the physical integrity or health of the resident or other residents, and in Switzerland also in case of important disruption to the daily life of the residential care facility), for the least amount of time possible and in the least restrictive form possible. Any decision with regard to restraint should be appropriately assessed, recorded in the resident’s care plan with a summary of the nature and duration of the measure and its motivation. A medical doctor should be involved in decisions related to the use of restraint in Belgium (Flanders), France, Finland, Ireland, the Netherlands, Slovenia. In Ireland, Malta and the UK, there are references in the National Standards to staff training in restraint.


Table 16

 

Country                            Regulation/National  Standard

Belgium (Flanders)

  • —Nursing and care home standard B.10 e
  • —Quality legislation 2003

Czech Republic

  • —Social Service Act No. 108/2006 Coll art 89

Finland

  • —The Autonomy Act – not yet into force

France

  • —Code of Social Action and Family (amended by Law No.2015–1776 2015)

Germany

  • —§ 1906 Civil Law Code

Ireland

  • —National Standards for Residential Care Settings for Older People in Ireland 201

Latvia

  • —Regulation No. 291 of the Cabinet of Ministers on “Requirements for social service providers”

Lithuania

  • —New Law on Mental Health Care is being drafted
  • —Social Care Act

Malta

  • —National Minimum Standards

Netherlands

  • —The new Care and Coercion Bill is currently under preparation.

Norway

  • —A special committee, appointed by the Government, has been established to review existing regulations (§4A in the Health and Social Care Act) concerning restraint. The Norwegian Health Association is represented on the committee

Slovakia

  • —Act No. 578/2004 Coll. on healthcare providers, healthcare professionals and professional organisations, and amending certain acts

Slovenia

  • —Mental Health Act

Sweden

  • —The Social Service Act and the Health and Medical Service Act contains no specific provisions about restrain as regards to people with dementia. This means that such measures are not permissible. In emergency cases, however, the necessity law can be cited.

Switzerland

  • —Law on Protection of Adults

Turkey

  • —Quality Standards

 UK (England)

  • —Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
  • —Mental Capacity Act 2005

UK (Northern Ireland)

  • —Minimum Standards for Residential Facilities and Care Standards for Nursing Homes

UK (Scotland)

  • —The Human Rights Act, 1998 makes it unlawful for any UK public body to act in a way which is incompatible with the European Convention on Human Rights.
  • —Mental Health Legislation Adults with Incapacity (Scotland) Act 2000; Adult Support and Protection (Scotland) Act 2007; Mental Health (Care and Treatment) (Scotland) Act 2003.
  • —Promoting Excellence: A framework for health and social care staff working with people with dementia and their carers.
  • —Rights, Risks and Limits to Freedom (Mental Welfare Commission for Scotland Good Practice  Guidance).

Use of restraint in residential care facilities

UK – England and Wales

In England and Wales, older people living in a residential care facility (a care home) should be treated with respect for their dignity and human rights and “must be assumed to have capacity unless it is established that they do not”. Therefore, unless older people do not have capacity, restraint may only take place with their consent or in an emergency to prevent harm. The Mental Capacity Act (England and Wales) allows restraint and restrictions to be used, if they are in a person’s best interests. Extra safeguards are needed if the restraint used will deprive a person of their liberty. These are called the Deprivation of Liberty Safeguards. Care homes must request a standard authorisation to the local authority. If a standard authorisation is given, one key safeguard is that the person has someone appointed with legal powers to represent them. Restraint must be proportionate to the harm that is been sought to prevent and the least restrictive measure should be used.

 

 

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Last Updated: Friday 31 January 2020

 

 
  • Acknowledgements

    This Dementia in Europe Yearbook received funding under an operating grant from the European Union’s Health Programme (2014-2020). The content of the Yearbook represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.
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