The Hidden Restraint – Part 4

hidden-restraint-4This post by Dr. Al Power was published on

All-or-none thinking” and “surplus safety” make it difficult for organizations to visualize a pathway to unlocking doors.

At last, here is the final installment of this marathon blog post. First, a brief recap, for those who just came in the door:

Part 1 advanced the idea that a locked door meets the definition of a physical restraint, and showed how the things that we do to keep people physically safe may actually erode their sense of emotional security. Part 2 affirmed that walking—indoors and outdoors—is both a normal activity and a fundamental human right. It also outlined in detail many of the structural, operational, and relational factors in the living environment that might cause distress or an increased desire to leave, independent of any brain disorder.

Part 3 provided some insights into how we can start to unlock living areas and enable more freedom of movement, with some illustrative stories from various communities that have ventured down this path. And now, as promised, we will conclude by addressing concerns around safety and risk; and I will share a story that beautifully illustrates many of the concepts involved.

For this discussion, I will summarize many of the points I presented in the “Security” and “Autonomy” chapters of my second book, Dementia Beyond Disease (which will be released in a mildly revised edition in a few weeks, shortly after the second edition of Dementia Beyond Drugs comes out.

There are two common operational practices that make it difficult for organizations to visualize a pathway to unlocking doors (and many other activities as well): all-or-none thinking and surplus safety. Let’s look at each of these:

All-or-none thinking

All-or-none thinking is the tendency to see empowerment around dementia in very black-or-white terms, both individually (either he can do that, or he can’t) or as a group of people (either they can all do that, or no one can). This view is compounded by institutional processes that make it difficult to accommodate individual abilities, needs, and preferences.  The result of their inflexibility is that organizations default to policies that restrict everyone in order to prevent the rare bad outcome…

Read the entire blog at

1 Comment. Leave new

One of the worse nursing homes at which I worked had an outdoor area accessible for residents except in inclement weather. What a relief for people trapped upon occupancy.


Leave a Reply