'A startling statistic': 14% of N.L. long-term care residents in physical restraints

Thinking about the number of people in long-term care homes in Newfoundland and Labrador who are in restraints every day brings back uncomfortable memories for Julie Mitchell of Marystown. 

Her own father spent time in restraints at the Burin Peninsula Health Care Centre while he waited for a long-term care bed to open up. Well-known accordion player John Joe Pidgeon had dementia, and a tendency to wander.

"He looked at me and said, 'But I didn't do anything,'" Mitchell said, remembering visiting her father one morning in 2011.

"He felt like he was being punished, and that was pretty heartbreaking."

He felt like he was being punished and that was pretty heartbreaking.- Julie Mitchell

Figures from the Canadian Institute for Health Information for 2016–2017 showed that the use of restraints in Newfoundland and Labrador is double the Canadian average. 

Fourteen-point-two per cent of long-term care residents in the province spent time daily in physical restraints, compared with the Canadian average of 6.5 per cent.

High numbers a concern 

"It's a startling statistic," Mitchell said. 

She wondered why the number was so high, and whether there were more long-term care employees in other parts of the country. 

Debbie Forward, the president of the Registered Nurses' Union of Newfoundland and Labrador, said she has seen restrained residents when she's walked through facilities.

Forward said it's disturbing. 

"There are times when it's needed, but those numbers are telling me that we're using restraints at times that they shouldn't be needed," she said.

"And when I talk to staff, they say, 'Debbie, we just don't have the staff here.'"

When I talk to staff, they say, 'Debbie, we just don't have the staff here.'- Debbie Forward

Shirley Lucas, the CEO of the Alzheimer Society in Newfoundland and Labrador, agreed that the high numbers are a concern.

"We don't recommend the use of restraints for anyone with dementia," Lucas said.

Almost 4 out of 10 residents getting antipsychotic drugs 

She also says figures for the use of antipsychotics for long-term residents who have not been diagnosed with psychosis are significant.

Statistics from the institute for 2016–2017 show that 38.3 per cent of residents — almost four out of 10 — in Newfoundland and Labrador get those drugs, compared with the national average of 21.9 per cent.

The institute says drugs can be used to control behaviours in people with dementia, but are sometimes inappropriately prescribed. 

Change is coming 

But Lucas said change is coming. 

"We're certainly really optimistic that the provincial government and other stakeholders are really looking at this," she said.

The Alzheimer Society of Newfoundland and Labrador is working on a pilot project that would bring specialized training on dealing with dementia to health professionals in the province, including those who work in long-term care.

We don't recommend the use of restraints for anyone with dementia.- Shirley Lucas

A health department spokesperson also confirmed that a program aimed at reducing the use of antipsychotic medications in long-term care homes is in the works. Details are expected in early June. 

Forward said she's keen to see the details, including whether additional resources will be included. 

"You can't say to current staff, 'We're going to add in a new program and you're going to have to add it to your additional duties,'" she said.

"It's impossible to do."

Making residents less lonely and bored 

The Canadian Foundation for Healthcare Improvement has been involved in an initiative to reduce the use of antipsychotics in long-term care facilities across Canada. 

The group reported that a project involving 56 homes showed significant results, including a 20 per cent decrease in falls and a reduction in aggressive behaviours. 

Some relatives have described their loved ones as becoming less lethargic and more socially engaged after coming off the drugs.  

Among other measures, staff at some homes work on making residents less lonely or bored. That can include using pet therapy or putting together personalized music playlists. 

'Let them feel like they're still alive'

Julie Mitchell said being able to take part in familiar activities is important to seniors in care.

"Let them feel like they're still alive," she said.

Mitchell remembers her father, who died four years ago, as a man who puttered all his life, and who liked doing things with his hands. 

She said Pidgeon was able to play his accordion just two weeks before his death, despite his dementia. 

While he was waiting for a long-term care bed to open up, he'd spend a few hours each evening restrained in a chair at the Burin Peninsula Health Centre. 

"That was really, really tough on him," said Mitchell, whose family members visited daily. 

She said the staff provided excellent care but were stretched so thin that it was impossible to keep an eye on her father every single minute of the day. 

Mitchell said she understands that the restraining chair was needed to keep him safe. 

He was not restrained overnight; an alarm on his bed alerted employees if he got up in the wee hours. 

Once a long-term care bed became available, there was no need for him to be restrained. The secure unit he stayed in meant Pidgeon could wander at will without compromising his safety.

Mitchell urged the province to reduce the use of antipsychotic drugs and physical restraints, noting that Newfoundland and Labrador, with its rapidly aging population, is facing a so-called "grey tsunami."