Physical restraint to prevent falls is a controversial topic, and it’s not always clear what constitutes a restraining device. Learn more about fall prevention and assistive devices, including the Lap Buddy.
The idea of using restraints to help prevent falls in older adults who are wheelchair-bound is a controversial one. For one thing, restraints can cause a number of negative side effects: limited mobility, decreased feelings of dignity, and even increased risk of injury due to entrapment. Because of these dangers, professional organizations such as the American Geriatrics Society and the Centers for Medicare and Medicaid Services have advocated a reduction in use of restraining devices in nursing homes and elsewhere. Over the past few decades, the emphasis has moved away from restraint and towards less intrusive, more individualized options for fall and injury prevention.
For seniors in wheelchairs, falling out of the chair while trying to get up can present its own set of risks. Seat belts can help, but if they aren’t easily removable, they’re considered a restraint, and therefore many facilities won’t use them. Chair-exit alarms can also help, but they’re dependent on a quick response.
“They use the alarm on the chair, but by the time it goes off, it’s too late to get to her,” says A Place for Mom reader Darlene Eberhardt-Partain, whose mother resides in assisted living. This is an all-too-common story when it comes to using chair alarms; it’s not that they don’t work, but staff must be on alert and nearby for the alarm to be effective. Enter the Lap Buddy, an inflatable pillow that snugs into the frame of the wheelchair and is meant to gently remind the occupant to ask for help before getting up.
The Lap Buddy has a friendly, cheerful-sounding name, but fall prevention is a serious matter. According to the CDC, falls are the leading cause of injury death in adults aged 65 and older, and one in three seniors takes a fall each year. Falls can lead to moderate or even severe injuries, such as fractures or traumatic brain injury, and they can lead to debilitating fear that discourages potentially healthy activity. Common causes of falls and fall-related injuries in seniors include:
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Of course, falling out of a wheelchair presents a conundrum for caregivers: how is it possible to keep the person from falling and injuring themselves without limiting their movement through restraints? One possible solution is the Lap Buddy, an inflatable cushion that snugs into the wheelchair frame itself. The idea is that the presence of the cushion would serve as a reminder to the wheelchair occupant rather than an actual restraint. The problem is, some facilities still see the Lap Buddy and similar products as a restraint. The crux of the matter seems to be whether the product is removable. If the user can easily remove it, it is not a restraint, according to the Centers for Medicare and Medicaid Services. If it does qualify as a restraint, however, many nursing homes and assisted living facilities will not condone their use except under the advice of a physician.
“The Lap Buddy was perfect,” says Darlene Eberhardt-Partain. For Darlene’s mother, it was an accessory she didn’t mind using, and “it provided another layer of protection from falling.” Unfortunately, she reports, “the state came in and had them removed, saying they were a restraint. To me the risk of falling is the higher concern.”
So what can caregivers and family members to do to minimize the risk of falls, especially if restraint is not a possible or desirable option? First, you’ll want to pinpoint the most likely potential causes of falls in your loved one, whether it’s failing vision or physical impairment. And take heart—there are plenty of ways you can help prevent falls.
Does your loved one use a Lap Buddy or similar product? What has your experience been with fall-prevention devices for seniors in wheelchairs? We welcome your comments.