Category: Dementia Safety Topics™ Online Training Program

Minimizing and eliminating restraints in dementia care is not just a policy goal—it’s a compassionate approach that honors the dignity, comfort, and individuality of every person. By applying what you’ve learned about restraint-free care, you can help create a supportive environment where people with dementia feel safe, valued, and respected.

Here are some practical ways to put restraint-free principles into action.

1. Involve Families in Care

Family members play a vital role in helping caregivers understand the person behind the dementia diagnosis. Their insights can make all the difference in preventing distress and behaviors that might otherwise lead to restraint use.

Ways to Involve Families:

• Learn personal histories. Talk with families about their loved one’s daily routines, likes, dislikes, and comforting habits.

• Identify triggers. Ask about things that might upset the person and should be avoided.

• Find calming strategies. Discuss what brings comfort or reassurance—whether it’s music, touch, or conversation.

• Encourage companionship. Invite family and friends to sit with their loved one and offer support during quiet or stressful moments.

• Support transitions. Ask family members to spend extra time with the person during times of change, such as moving rooms or adjusting to new caregivers.

• Assist with personal care. Family members can often help with intimate tasks, like bathing or dressing, that might cause anxiety.

• Make it feel like home. Encourage families to bring familiar furniture, photos, or keepsakes to personalize the person’s space.

By actively including families, care teams gain valuable information and build trust—all while helping reduce the need for restraints.

2. Create a Supportive Environment

The physical and emotional environment greatly influences behavior. A well-designed space can prevent frustration, confusion, and the need for restraints.

Tips for a Restraint-Free Setting:

• Promote comfort and safety. Adjust wheelchairs to the right height so feet can touch the floor. Avoid unnecessary footrests when they make movement harder.

• Encourage rest. Help tired residents go to bed rather than sit uncomfortably or attempt to move without help.

• Engage through meaningful activity. Offer day and night programs that match individual interests and energy levels. This helps reduce agitation and wandering.

• Protect wounds gently. Keep dressings covered or secured to prevent interference.

• Anticipate needs. Respond quickly to calls for help, and offer snacks, toileting assistance, or repositioning before discomfort occurs.

• Provide supportive seating. Choose chairs with the right height, armrests, and cushions for each person. Individualize how long someone sits up, and vary where they sit throughout the day.

• Limit wheelchair use. Use wheelchairs primarily for transport and offer more comfortable seating whenever possible.

• Use visual cues. Add familiar signs or colors to help people find their way safely and avoid entering others’ rooms.

• Reduce exit stress. Make exits less visible to prevent unsafe wandering outside care areas.

These thoughtful adjustments create a calm, secure environment that naturally decreases the likelihood of restraint use.

The Takeaway

Creating a restraint-free environment is a shared responsibility—and a rewarding one. By involving families, adjusting the environment, and responding with empathy, caregivers can build a community where people with dementia live with dignity, comfort, and freedom.

CARES® Tip: Respond Appropriately

Meaningful engagement is one of the most powerful ways to reduce restraint use. Involve people with dementia in activities that reflect their interests, past experiences, and strengths. Whether it’s folding towels, listening to favorite songs, or watering plants, these small, familiar tasks can bring comfort and purpose.

Talk with your activity director or supervising nurse about ideas for personalized engagement. Together, you can design daily routines that promote independence, reduce agitation, and support a truly person-centered care environment.

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When caring for individuals living with dementia, minimizing and eliminating restraints is one of the most important steps toward providing compassionate, person-centered care. Restraints—whether physical, chemical, or environmental—can cause distress, confusion, and even physical harm. Instead of focusing on control, caregivers are encouraged to focus on connection and understanding.
The CARES® Approach offers a simple yet powerful five-step method that helps caregivers respond to challenging behaviors with empathy, insight, and respect.

C – Connect with the Person

Connection is the foundation of good dementia care. Before any behavior can be understood, caregivers must first know the person behind it. Taking time to connect—by speaking gently, maintaining eye contact, and showing genuine interest—helps build trust and understanding.

By connecting with the person, caregivers can better recognize the emotions and needs that might lead to behaviors often mistaken for “agitation” or “resistance.” This understanding is the first step in preventing situations that could lead to the use of restraints.

A – Assess Behavior

Every behavior communicates something. In dementia care, challenging behaviors often arise from unmet needs—pain, hunger, discomfort, fear, or confusion. The second step in the CARES® Approach, Assess Behavior, encourages caregivers to observe closely and think deeply about what each person’s actions might mean.
Learning a resident’s life story, daily habits, likes and dislikes, and what is considered “typical” behavior for them helps uncover the reasons behind their actions. This knowledge empowers caregivers to respond with empathy rather than restraint.

R – Respond Appropriately

Once caregivers understand the person and the behavior, the next step is to Respond Appropriately. This means using the insights gained from connection and assessment to meet the person’s needs in a calm and supportive way.

For example, if a resident is trying to stand up repeatedly, they might need to use the restroom or stretch their legs—not be restrained in a chair. Responding with patience, reassurance, and creativity helps reduce distress and promotes dignity and safety.

E – Evaluate What Works

Not every approach will work for every person. The fourth step, Evaluate What Works, encourages caregivers to reflect on which strategies are most effective in reducing challenging behaviors.

Caregivers should ask themselves:

• Did my approach calm the person?

• Did I identify the cause correctly?

• What can I do differently next time?

By continuously evaluating and adjusting care methods, caregivers can refine their approach and improve outcomes for each individual.

S – Share With Others

The final step, Share With Others, emphasizes teamwork. Dementia care is most effective when caregivers, nurses, family members, and support staff communicate openly about what strategies are working.

Sharing observations, successful techniques, and even small victories ensures consistent, compassionate care across the team. It also helps prevent misunderstandings or conflicting approaches that can lead to frustration or restraint use.

A Compassionate Path Forward- Caring Without Restraints

The CARES® Approach is more than a set of steps—it’s a mindset rooted in empathy and respect. By connecting, assessing, responding, evaluating, and sharing, caregivers can create a supportive environment where people living with dementia feel safe, understood, and valued.

Minimizing and eliminating restraints isn’t just about safety—it’s about honoring the person behind the diagnosis and helping them live with dignity and comfort every day.

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When a person living with dementia acts out or becomes restless, the first reaction may be to think about safety—sometimes even considering restraints. But before taking that step, it’s essential to pause and ask: Why is this happening?

The real key to preventing, reducing, or completely eliminating the use of physical or chemical restraints lies in understanding the person’s needs. Behavior is communication. When a person resists care, tries to get up, or becomes agitated, it’s often a signal that something deeper is going on.

Is the person in pain? Hungry? Cold? Lonely, sad, bored, or afraid?

These unmet needs can easily trigger distressing behaviors that may seem difficult to manage. But rather than reaching for medication or physical control, the most compassionate and effective approach is to identify and meet those needs.

After all, you wouldn’t give someone medication just because they’re cold—or restrain someone who’s simply frightened. It sounds simple, yet it’s a powerful truth: when we take the time to know each person, to observe and connect, we can often prevent the situations that lead to restraint use altogether.

This philosophy is at the heart of the CARES® Approach—a person-centered way of caring that emphasizes understanding, empathy, and meaningful connection. By constantly assessing behavior and responding to the underlying causes, caregivers can create safer, more dignified environments where restraints are rarely, if ever, needed.

Because true care isn’t about control—it’s about compassion, respect, and meeting each person exactly where they are.

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It’s natural to wonder, “Isn’t there some medication that could help this person?”
Specific medications can be helpful for people who truly need them. However, when we turn too quickly to antipsychotic medications to calm or control the behavior of a person living with dementia, there can be serious and unintended consequences.

Caution Against Quick Medication Use in Dementia Care

Many behaviors in dementia care—though challenging—are actually forms of communication. A person may be trying to express pain, discomfort, boredom, fear, or confusion. Turning immediately to medication may silence that communication without addressing the real cause.

Consider these examples:

• Getting up and down out of a chair

• Repeatedly trying to leave the building

• Screaming or crying

• Entering other people’s rooms

• Pacing the hallway

• Getting upset with caregivers

• Banging fists on the table

• Throwing things

Are these situations truly solved by medication—or are they signals that the person needs understanding, comfort, or reassurance?

Responding with Compassion, Not Control

If someone with dementia yells, hits, or even bites, it’s easy to feel frustrated or frightened. But remember: these actions are expressions of distress, not deliberate aggression. Before reacting, pause and take a moment to reset.

Here’s what to do instead:

• Slow down. Rushing or showing frustration can increase the person’s anxiety.

• Take a deep breath. Staying calm helps you think clearly and respond appropriately.

• Have compassion. Try to see the situation through their eyes—what might they be feeling or trying to say?

• Use the CARES® Approach. This person-centered method focuses on Connecting, Assessing, Responding, Evaluating, and Sharing—steps that help caregivers understand and support the person with empathy.

The Power of the CARES® Approach

These simple strategies can make a profound difference. They help caregivers connect with individuals, uncover what’s truly causing distress, and respond in ways that meet emotional and physical needs. Most importantly, they often eliminate the need for physical or chemical restraints altogether.
When we slow down, observe, and respond with compassion, we not only improve care—we protect dignity, safety, and trust.

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Although restraints are often used in care settings to prevent harm, research and experience show that they frequently cause harm instead. People who attempt to break free from restraints can suffer severe injuries—such as broken bones, concussions, or even death. Moreover, simply sitting or lying down for too long without movement can weaken the body and mind, leading to a wide range of health problems.

Below are some of the most common and serious complications caused by physical restraints:

1. Dehydration

People who are restrained are often unable to drink water independently. Without adequate hydration, they can quickly become dehydrated, which affects every system in the body.

2. Psychological Distress

Being restrained can be deeply traumatic. Individuals may feel anxious, stressed, frustrated, agitated, lonely, or ashamed. This distress can lead to depression, social withdrawal, or even increased aggression and restlessness—the very behaviors restraints aim to control.

3. Loss of Postural Tone

Remaining in the same position for extended periods causes a loss of “vascular tone”—the ability of blood vessels to constrict properly. When a person changes position, such as from lying to sitting, blood pressure may drop, leading to dizziness, confusion, or fainting.

4. Pneumonia

Prolonged bed rest increases the risk of pneumonia. When a person lies down for too long, fluid can accumulate in the chest, making it easier for infections to develop and spread to the lungs.

5. Decreased Appetite and Malnutrition

A lack of movement often leads to a reduced appetite. Someone who was previously active may lose interest in eating, resulting in malnutrition and weakened immunity.

6. Urinary Tract Infection (UTI)

Restraints can cause or worsen incontinence. Limited mobility, lack of fluids, and an inability to use the bathroom independently all contribute to the development of UTIs.

7. Constipation

Physical activity is crucial for healthy digestion. When someone cannot move freely, the bowels slow down, leading to constipation—made worse by poor hydration and reduced appetite.

8. Incontinence

Restraints can make it impossible for individuals to reach or use the toilet in time, resulting in incontinence. Over time, this can also lead to skin irritation and infection.

9. Decreased Bone and Muscle Strength

When people are confined and unable to move, their bones lose density and muscles lose mass. This physical decline can make walking or even sitting up difficult, increasing the risk of falls and fractures.

10. Swollen Feet

People restrained in a sitting position often develop swollen feet, as fluids accumulate in the lower limbs when movement is restricted.

11. Pressure Sores

Pressure sores, or bedsores, develop when the same part of the body bears weight for too long. Redness is an early warning sign; if ignored, these sores can progress to painful, infected wounds.

12. Contracted Muscles

Without stretching and movement, muscles and tendons can shorten and stiffen—a condition called contracture. This reduces flexibility and can permanently limit mobility.

13. Decreased Functional Skills

The combined effects of these physical and psychological issues lead to a significant decline in a person’s ability to perform daily tasks—such as eating, bathing, or using the bathroom—further reducing independence and quality of life.

Conclusion

Physical restraints may seem like a safety measure, but they often create new risks and diminish dignity. Understanding the consequences of restraint use helps caregivers seek safer, person-centered care alternatives that support both well-being and autonomy.

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For many years, physical restraints were used in dementia care with the belief that they kept people safe. But behind this idea lies a deeper truth — being restrained can be frightening, isolating, and deeply uncomfortable. To truly understand why restraint-free care matters, we first need to imagine what it feels like to lose the ability to move freely.

Imagine this:

1. You are seated in an uncomfortable chair.

2. You cannot stand up or move around.

3. Your arms are too weak to reposition yourself.

4. Your bottom aches from sitting too long.

5. You need to use the toilet, but no one is nearby to help.

6. You are cold from a draft, yet unable to shift or find a blanket.

You are thirsty but cannot reach for a drink.

Anyone would find this situation distressing and uncomfortable. Now, imagine being unable to communicate your needs clearly — this is often the reality for many people living with dementia.

For decades, physical restraints were commonly used in long-term care settings. Caregivers once believed that restraining a person was the best way to prevent falls, injuries, or wandering. In the early 1990s, studies revealed that nearly 6 out of every 10 nursing home residents were physically restrained.

Restraints came in many forms — tying a person to a chair, a wheelchair, or even a bed. Although these practices were often well-intentioned, they stripped individuals of their independence, dignity, and sense of control.

Today, we know better. Restraining someone doesn’t just limit movement; it affects emotional well-being, increases agitation, and can even lead to physical decline. Compassionate, person-centered care focuses on understanding the reasons behind behaviors and finding safe, respectful alternatives to restraint use.
By stepping into the shoes of those who are restrained, we can better appreciate the importance of preserving autonomy, dignity, and comfort in dementia care.

Restraint-Free Care

Restraint-free care focuses on supporting safety and dignity without restricting a person’s movement. Instead of using physical or chemical restraints, caregivers use observation, communication, and individualized care strategies to understand the person’s needs. By creating a calm, engaging environment and addressing the reasons behind behaviors, restraint-free care promotes comfort, trust, and well-being — helping people with dementia live with greater independence and respect.

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In the past, physical restraints were often seen as a necessary part of dementia care. Caregivers and healthcare staff believed that using restraints would help keep people safe—especially those at risk of falling, wandering, or becoming agitated. The intention behind their use was often good: to protect the person with dementia and those around them.

Why Restraints Were Commonly Used

Restraints were traditionally applied in situations where a person with dementia might:

• Be at risk of falling

• Strike out at others

• Wander or move unsafely

• Take food from other people’s plates

• Enter other residents’ rooms or take their belongings

• Get out of bed during the night

• Appear confused, restless, or agitated

• Require lifesaving medical treatment

These actions were often misunderstood as challenging behaviors that needed to be controlled. In reality, they were expressions of unmet needs, confusion, or distress.

The Hidden Harm of Restraints

Although restraints were meant to prevent harm, research has shown that they often do the opposite. Physical restraints can lead to serious injuries, emotional trauma, and, in some cases, even death. They may increase confusion, fear, and agitation in people with dementia, making behaviors more difficult to manage instead of improving them.

Simply put, the use of restraints causes more harm than good.

Knowing the Person Is Key

When caregivers and families take time to know the person behind the behavior, they can identify what might be causing distress or confusion. This person-centered approach allows for creative, compassionate solutions that keep everyone safe—without compromising dignity or freedom.

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In dementia care, our primary goal is always to promote safety without compromising dignity or independence. One area that continues to evolve is how we think about and manage restraints. While once considered protective, restraints—whether physical or chemical—can actually increase the risk of harm and distress. Understanding what constitutes a restraint and why minimizing their use is essential can help caregivers provide better, more person-centered care.

What Is a Restraint?

A restraint is anything that controls or limits a person’s movement, behavior, or access to their body. There are two main types of restraints: physical and chemical.

1. Physical Restraints

Physical restraints are objects or devices that restrict a person’s ability to move freely or access certain parts of their body. Examples include:

• Belts, vests, or wrist ties

• Lap trays or restrictive clothing that the person cannot remove easily

• Chairs designed to prevent standing or movement

• Bed or chair alarms that frighten people into staying still

While these restraints might appear to prevent falls or injuries, they often do more harm than good. They can cause fear, agitation, or even serious accidents when a person with dementia tries to escape them.

2. Chemical Restraints

A chemical restraint involves using medication—usually antipsychotics—to control dementia-related behavior or make care tasks easier for staff. These medications can sedate a person, reducing movement and responsiveness.

However, such medications should never be used simply to calm a person or manage behavior related to dementia unless absolutely necessary for safety reasons. The Centers for Medicare and Medicaid Services (CMS) has required nursing homes to reduce the use of antipsychotics for people with dementia since 2012.
There are times when these medications are appropriate—for example, when a person has a serious mental illness or poses a danger to themselves or others. In those cases, physicians must clearly document why the medication is being prescribed and for how long.

Misconceptions About Restraints

For many years, restraints were believed to promote safety, especially in preventing falls. However, evidence shows that they can actually increase the risk of injury or trauma.

For instance, bed rails were originally designed to keep people from falling out of bed. But for someone with dementia, a bed rail can become a source of danger. A person who doesn’t understand its purpose may try to climb over it, leading to a more severe fall or even entrapment. Without the bed rail, the fall might have been less harmful—or avoided altogether.

In short, restraints can create the illusion of safety while introducing new and serious risks.

Moving Towards a Restraint-Free Approach

The ultimate goal in dementia care is to eliminate the need for restraints by understanding each person as an individual. Compassion, observation, and communication are key. When we connect deeply with the person and respond to their needs—rather than control their behavior—we create a safer, more respectful care environment for everyone.

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When caring for individuals living with dementia, “wandering” is one of the most common behaviors caregivers encounter. But rather than seeing it as a problem to eliminate, it’s important to understand wandering as a meaningful activity that happens for a reason. By reframing our perspective, we can create safer, more positive experiences for both the individual and the care community.

Why Wandering Happens

Like all dementia-related behaviors, wandering doesn’t occur without cause. A person may walk around because they’re following a routine, searching for something familiar, or simply enjoying movement. Your role as a caregiver is to pay attention, recognize patterns, and learn what each person is trying to express through their actions.

When Wandering is Positive

Wandering isn’t always something to stop. In fact, when done safely, walking around can be a healthy practice that promotes exercise, reduces restlessness, and provides a sense of purpose. For many individuals with dementia, movement brings comfort and helps them feel engaged with their environment.

When Wandering Becomes Risky

Wandering can become harmful if it leads someone into unsafe areas, outside of the care setting, or into another person’s private space. These risks highlight why it’s so important to understand each person’s habits and to provide safe spaces where exploration can happen without harm.

The Importance of Knowing the Person

The best way to support safe and positive wandering is to know the individual well—his or her routines, habits, and preferences. This knowledge allows caregivers to anticipate needs, prevent unnecessary risks, and make wandering a safe and enriching activity.

Shifting the Language

Language matters. Instead of labeling someone as a “wanderer,” use positive, respectful terms such as “exploring” or “walking around.” This small shift reinforces dignity and helps everyone focus on the person, not the behavior.

Final Thoughts

Wandering is not a behavior to fear, but an opportunity to better understand and connect with people living with dementia. By recognizing the reasons behind it, ensuring safety, and using respectful language, caregivers can turn wandering into a positive part of daily life.

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Wandering is a common behavior among people living with dementia. While it can sometimes cause safety concerns, wandering also has positive aspects—it can help individuals stay active, reduce restlessness, and promote independence. The key is to support wandering in a safe and meaningful way.

That’s where the CARES® Approach comes in. CARES is a simple, person-centered framework that helps caregivers connect with individuals, understand their behaviors, and respond in ways that promote dignity, safety, and well-being.

Here’s how it works:

C – Connect with the Person

The first step in the CARES® Approach is to connect with the person. Taking time to build trust and establish a human connection helps encourage safe wandering and reduces feelings of confusion or distress.

A – Assess Behavior

Next, carefully assess behavior. Observe the person with dementia closely—when, where, and how often are they wandering? Are there specific triggers, such as time of day, routine changes, or environmental cues? Recognizing patterns helps you understand their needs and intentions, making it easier to guide them safely.

R – Respond Appropriately

The third step is to respond appropriately. Use what you know about the individual, combined with your observations, to address their needs in a supportive and respectful way. Your response should reduce risk while honoring their independence and dignity.

E – Evaluate What Works for Safe Wandering

The fourth step is to evaluate what works. Pay attention to which approaches are effective in supporting safe wandering and which are not. Continuous reflection helps improve care and ensures strategies remain person-centered.

S – Share with Others

Finally, share with others. Communicate your observations, successful strategies, and challenges with colleagues, family members, and the care team. Sharing ensures consistency, strengthens teamwork, and provides the best support for the person with dementia.

Conclusion

Wandering doesn’t always need to be prevented—it can often be supported in ways that bring comfort, activity, and purpose to people with dementia. By using the CARES® Approach, caregivers can create safe environments, reduce risks, and help individuals live with dignity and independence.
Safe wandering isn’t just about managing behavior—it’s about seeing the whole person, honoring their needs, and walking alongside them with compassion.

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