DoLS or Deprivation of Liberty Safeguards, in Health and Social Care settings means a whole raft of rules and regulations, tied up with Health and Safety surrounding how vulnerable people are kept safe without unwarranted restrictions. Deprivation of Liberty Safeguards (DoLS) – Alzheimer’s Society
The families of vulnerable people and the average Joe Bloggs who happens to observe incidents or gets involved by default, sometimes find it hard to reconcile keeping a person safe whilst allowing freedoms and choice. For the average lay person who finds it a difficult concept, the following may make the conundrum clearer.
An elderly person falls out of bed. Cot sides will address this issue. Problem sorted you may think. However, cot sides also prevent a person being able to get out of bed unaided. Is it right to prevent somebody getting in and out of bed as they wish. Would you like your bed to double up as a prison? Somebody determined to get out of bed anyway, may climb over the top of the rails and fall from a greater height than simply falling out of bed. So the solution to prevent somebody falling out of bed already creates other problems. By removing one risk, you may increase another. More importantly, is the removal of independence and freedom worth the reduction in risk of falling out of bed. These are questions which must be addressed before taking a decision to use cot sides.
People with memory issues, confusion and dementia can, and sometimes do wander off. Unless the care environment is a secure, lock up type of care provision, then it will happen unless the person is immobile. Care homes can and do take precautions, with alarms on exits and attempts to keep wandering souls meaningfully occupied. Some care homes are cleverly designed to enable people to wander at will, yet remain within the premises. Wander in a way which reduces the sense of being trapped. Or the sense of being in the wrong place which drives a lot of wandering. However, without one to one supervision which is generally cost prohibitive, it can not be guaranteed to keep someone contained. Not without locking people up, or taking other illegal measures to contain them in a less obvious way.
Illegal measures such as trapping a person in their chair with tray-tables wedged into place. Locking or blocking fire exits. Using door furniture which an elderly confused person is unable to manage. Removing or hiding walking aids. Turning off all the lights at night and closing up internal fire doors. Fire doors are heavy and difficult for frail, elderly to open and hold open in order to pass through. Inappropriate use of medication which sedates people. Tying people into chairs or beds with the use of safety belts or constrictive bedding. There is a very fine line between tucking someone in for the night, and using the same bedding in such as way as to pin them down in the bed.
Put in writing, it is obvious that such measures are wrong. Yet sometimes people believe them to be the lesser evil. Sometimes people suffer from tunnel vision, in that all that can be seen is the desire to keep a vulnerable person safe. To restrain a person in order to keep them safe may seem sensible. However, what if it causes greater harm to quality of life and emotional wellness? This is at the heart of the conflict of interests. Keeping someone safe and possibly thoroughly miserable, or accepting the consequences of being less controlling.
Unless a person is at serious risk of harm or may harm others, they actually have a right to the same freedoms and choices as everybody else. To take away those rights and choices involves going through all the correct channels and following DoLS guidelines. Just because it is inconvenient and may seem neglectful when viewed on a superficial level, is not good enough reason to restrain or lock up another person.