Are the use of stair gates acceptable and within the standards of restraint in a dementia care home?

Answered by Sheila Scott

Dear J,

Thank you for your question which like so many issues is complex and each case is different.

I have recently been working in a nursing home which did use a stair gate at ground floor level to prevent an individual who was prone to falling on the stairs from going upstairs. Her bedroom was on the ground floor and the home was large with several staircases but the lady in question only ever attempted to go up one particular staircase.

You identify in your email that you recognise that this is restraint so you must consider whether or not the lady is subject to a DoLS authorisation. If she isn’t if and when you have come to a conclusion to use a stair gate if she does not have mental capacity, you must apply for a DoLS authorisation.

I am sure that you realise that a stair gate should only be used as a last resort. Any decisions you make must be well and appropriately recorded within the care plan and you should continue to review any decision you make.
We asked our Health and Safety Expert Sally Beck for her opinion and this is what she said which I believe is very helpful.

“No person is to be restrained other than in exceptional circumstances. Staff should use restraint only if this is the only practicable means of securing the welfare and safety of the person or other individuals. Restraint must be safe and used only as a last resort.

Care managers must review whether restraint is needed and outline less restrictive alternatives such as supporting the person with moving in a safe manner or increasing safe activities and reviewing methods of therapeutic behaviour management and occupational therapy.

The use of stair gates is designed to be used in a domestic setting and is associated with child safety and could potentially detract from people’s dignity and independence.

Therefore, further guidance will be necessary as all situations and environments are different. Where it may be suitable to use in one area it equally may be unsuitable in another environment.

Any type of restraint used must be documented, have a time limit and permission sought from a medical practitioner or a relative.

Document the specific evidence of the decision-making process as to why restrictive stair gates were needed to be used and demonstrate how there are no alternatives. Using a stair gate must be risk assessed.

Review whether the presence of a stair gate brings additional hazards such as the individual attempting to climb over the stair gate.

Any restraint equipment used will need to be maintained and inspected regularly. Staff will require training in the use of all restraint equipment. The methods of restraint equipment used will need to be reviewed as the condition of the person changes. The use of restraint equipment should be used for short term rather than long term use.”

As part of your risk assessment you might wish to consult your insurers.

You might also want to consider whether you should notify the CQC within the context of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notification of other incidents.

Best wishes.

Sheila