University at Buffalo (UB)
How would you feel if each time you moved or transferred from one area to another you heard a siren? How would you feel if at every attempt to move or transfer you were repeatedly told to “sit down”, “wait a minute”, or asked, “… what do you need? “or, “where are you going?” Elders who reside in communal living environments and pose a risk of falls or have fallen experience this lifestyle every day.
Under F 222, a federal regulation that is entitled Restraints, there are identifiers for what constitutes a restraint and what alternatives facilities might implement in place of this device. A restraint is defined as any device attached or adjacent to one’s body that an individual cannot remove easily which restricts movement or normal access to one’s body. Consequences of these devices are listed as: potential for decline in physical functioning (e.g. ability to ambulate) and muscle condition; contractures; increased incidence of infections and development of pressure ulcers due to limited mobility; delirium; agitation and incontinence. It is also outlined that residents may face loss of autonomy, dignity and self-respect, and may show symptoms of withdrawal, depression, or reduced social contact. In effect restraint use can reduce independence, functional capacity, and quality of life.
If we look at and evaluate what happens to individuals who wear personal alarms, you may readily identify the similarities between the consequences of restraint use and those of a motion detection device. Ironically, facilities frequently use these devices instead of restraints to prevent falls, but one might argue that these alarms actually epitomize the definition of a restraint by virtue of what they inhibit; independent movement. These devices restrict the mobility of the person that wears them in that to avoid hearing the loud siren of the sensor, they become statues. It is indeed modern day conditioning at its finest, but at what cost?
Why are we using these alarms then? If we cross-reference the federal tag F 323 Accidents, this regulation outlines that the facility has an obligation to balance protecting the resident’s right to make choices and the facility’s responsibility to comply with the regulation to maintain an environment free of hazards. The facility has an obligation to ensure that each resident receives adequate supervision and assistive devices to prevent accidents from occurring and or re-occurring. With that being said, we can clearly see why personal alarms have become a standard of practice in the plan to prevent falls and the re-occurrence of falls. There is much more to an unplanned change in planes however (my savvy definition of a fall).
When a fall occurs, a root cause analysis must always be conducted to determine the reason(s) for the incident and it’s best to start with basic human needs. Is the person experiencing pain/have they been in the same position for too long, do they need to use the bathroom, are they hungry/thirsty, cold/warm, tired or need to lie down, etc…? Next we assess spiritual needs: are they lonely, bored, desire comfort? What do we know about this person, their hobbies, interests, customary routines? What upsets them and conversely what calms them down? Does your facility have permanent team assignments creating an environment that fosters relationship building so staff can truly get to know those they care for? Is it too noisy and they are trying to retreat into a quieter environment? Are they new to your facility and everything/everyone is foreign? Do they have dementia and the way in which staff interacts with them is setting them off? Is it an isolated incident and merely what we all say when we fall, it was merely an accident?
How would you feel if folks came rushing to your side after you fell and assisted you up after making sure you were ok, dusted you off, sat you in a chair and then when they wouldn’t take the time to determine why you fell, they alarmed you creating a world of more noise, fear and immobility? Have we merely traded one type of restraint for another? Let’s be honest, we know that personal alarms do not prevent a fall, they alert us when a fall has already happened, or I have seen many residents who use the alarms as a personal call light, and so they set them off when they need something. This creates what I like to refer to as the “car alarm syndrome”, whereby people just begin to ignore the alarm.
In conclusion, personal alarms do not work for the purposes they are intended. They add to an already excessively noisy environment, they create the same consequences that restraints do and actually fit the definition of a restraint by forcing limited, at-will mobility.
Stay tuned, with the person-centered care movement, the eradication of personal alarms may very well be next on the list of regulatory modifications as it relates to autonomy, personhood, dignity, choice and home like environments.