‘Why does the Manor physically restrain a third of its residents?’

To the Expositor:

Mr. Bud McConnell deserves hearty thanks for his November 14 Letter to the editor in The Expositor, where he assures us that he is well cared for as a resident at Manitoulin Centennial Manor (‘Manor resident responds to writer’s dismay, page 4). The next time I’m in Little Current, I hope to meet Mr. McConnell in person, if he is willing.

When the board refused to answer my concerns about the care they provide for the Manor’s residents, they suggested that I consult other public sources, rather than bothering the Manor’s Board of Management. Unfortunately, the answers I received from these other sources raise even more troubling issues at the Manor, in contrast to Mr. McConnell’s positive experiences.

For example, Health Quality Ontario reports that 32.5 percent of the Manor’s residents regularly have physical restraints used on them (ie. of the 60 or so residents at the Manor, 20 of those residents are kept in physical restraints). To me, it seems excessive for the Manor to use 2.3 times the physical restraints used by the average Ontario LTC (Long Term Care) facility. For all 639 LTC facilities in Ontario, 92 percent of these LTC homes have discovered how to use less physical restraints than the Manor. Manitoulin Lodge in Gore Bay (one of the three LTC facilities on Manitoulin Island) has only six percent of its residents in physical restraints; more than five times better than the Manor’s 32.5 percent. What can the Manor learn from Manitoulin Lodge? In addition, 17 LTC homes in Ontario use no physical restraints whatsoever.

A physical restraint is defined as anything that restricts the movement or activity of a resident, if that resident is unable to readily remove and disable the restraint by themselves. Some typical examples of a physical restraint are seatbelts in wheelchairs, tilting wheelchairs (recliners), locking lap trays, personal movement alarms, wall alarms, and full bed rails.

Applying physical restraints to a resident can cause a loss of freedom, frustration, depression, anxiety, loss of dignity, pressure sores, incontinence, constipation, loss of bone density, choking, loss of strength and muscle mass, a drastic drop in quality of life, and many other problems for that resident, up to and including death. In short, physical restraints are no fun. Does the Manor fully inform the resident (or the substitute decision maker) about all of these risks before seeking permission to apply the physical restraint?

I believe humans hate being physically restrained, as shown by the example of seatbelts in cars. For adults, a seatbelt can be readily removed by the wearer, is generally comfortable, has been mandatory in Ontario for 36 years now and yet four percent of people still don’t wear seatbelts in spite of the overwhelming benefits in case of an accident.

For front line health care workers, the use of physical restraints adds significantly to their workload in an already busy work day, requiring them to generate extensive documentation and regularly check on the safety and comfort of the residents who are under physical restraint. When we minimize the use of physical restraints, everybody wins.

Many LTC homes find that in providing a comprehensive activity program (ie. interesting activities during the morning, afternoon, and evening), the residents are distracted or dissuaded from dysfunctional or risky behaviours without resorting to the use of physical restraints. I understand that the Manor’s activity programs are currently limited in scope, and occur mainly during the day.

LTC homes often use physical restraints to prevent the residents from hurting themselves or others or to reduce the risk of residents accidentally falling and injuring themselves. Falls are a leading cause of injury and death among seniors. Unfortunately, recent research shows that physical restraints don’t decrease the risks of injuries and sometimes they cause a greater number and severity of injuries. For the 17 LTC homes that use no physical restraints whatsoever, they have resident fall rates similar to the Manor. Therefore, there is no simple explanation justifying why the Manor has excessive use of physical restraints.

The excessive use of physical restraints is not the fault of the Manor’s front-line health care workers. The health care staff must follow the Manor’s policies. Under Section 29(a) of the LTC Homes Act and Section 109(g) of the Regulations, each LTC facility must have a policy that minimizes the use of physical restraints. This is such a serious issue, MOHLTC wrote six pages of regulations that prohibit or limit the use of physical restraints in LTC homes. The Manor’s Board of Management sets and approves the Manor’s physical restraint policy, and therefore the board is responsible for its success or failure.

Generally, if an organization has excellent policies, the staff can practice the implementation of those policies, get better each day, and build towards excellence. If the organization’s policies are poor, incomplete or ambiguous, then the staff will be frustrated every day when they try to make them work and unfairly suffer the consequences when the faulty policy causes an incident. I suggest that this general rule is also true for the Manor.

A board member previously stated to me that the board doesn’t involve themselves in the daily care of the residents; they leave those details up to the Manor’s administrative staff. While ensuring confidentiality and respect for the residents, I believe the Manor’s Board of Management should know the reasons why their policy causes an excessive use of physical restraints. Unfortunately, the board has other priorities, and refuses to discuss anything about the Manor.

We have heard about able-bodied people riding in a wheelchair for a day to learn first-hand about the challenges faced by the disabled. Perhaps one or more of the Manor’s board members could volunteer to have physical restraints applied on them for 8 hours. If any of the board members are brave enough to volunteer, then I will volunteer too, for misery loves company. It should make for some interesting conversations, this captive audience of the board member(s) and I, assuming the Manor’s staff decides to park us in the same spot. After that eight-hour ordeal, perhaps the newly enlightened board member(s) would recommend re-considering the Manor’s policy on physical restraints.

I therefore ask the Manor’s board to immediately review their physical restraint policy, and seek suggestions from the Manor’s front-line health care workers on how to minimize the use of physical restraints.

Overall, I respectfully suggest that the Manor’s Board of Management needs to focus on doing their very best for the current residents and staff at the Manor before there can be any thought of renewing or increasing the board’s responsibility or workload. I believe that the health, safety, and happiness of the Manor’s current residents and staff are more important than (and come before) the further expansion of the Manor’s empire.

Glenn Black
Providence Bay