Ethics of technology and restraints in residential care for elderly
with dementia and people with intellectual disabilities:
development of a multidisciplinary direction for safe care

In recent years various research * among which the second evaluation of the
Special Admission to Psychiatric Hospitals Act (BOPZ) * has endorsed that the
current judicial framework for freedom restriction in the care for elderly with
dementia and people with intellectual disabilities does not offer the necessary
legal protection to patients/clients that are faced with freedom restrictions.
The current judicial framework also fails to correspond with concepts of good
care as they have been developed from within the field. Moreover, traditional
institutionalised care is increasingly shifting towards small scale living
arrangements where new care supportive -and safety enhancing technology
(domotics) is becoming increasingly important.

Taking this in consideration, there is need for a clear normative framework for
the localization and application of freedom restricting measures in the care
for people with dementia and people with intellectual disabilities. This
framework should offer the necessary legal protection to those who are
subjected to freedom restrictions, but should also correspond with concepts of
good care as they have been developed from within the field, in particular when
it comes to alternatives for (traditional) freedom restrictions. Special
attention should be given to the place of new care supporting -and safety
enhancing technology (domotics) that is being increasingly applied in the
field. This technology has on the one hand as its aim to increase safety and
quality of life and serves on the other hand as an alternative to the more
traditional *hard* freedom restrictions.

The goal of this research project is to develop a multidisciplinary guideline
for the responsible and restrictive treatment of freedom restriction in the
care for elderly with dementia and people with intellectual disabilities. In
this guideline the emphasis will lie in the prevention of freedom restriction,
the application of alternatives for freedom restriction and the role of
electronic surveillance (domotica). The research project will combine a
normative approach with an empirical approach, whereby, on the basis of concept
mapping *best practices* will be selected for additional empirical research.
Next to all the developments in the field to decrease all applications of
freedom restriction, there is also a law proposal for freedom restriction in
preparation in order to replace the current Special Admission to Psychiatric
Hospitals Act (BOPZ). The results of this research project could contribute to
the further consolidation of the law proposal and a better implementation of
new regulation.

There will be chosen for a combination of literature research and empirical
research. The empirical research will combine qualitative and quantitative
methods. Firstly, use will be made of the methodology of concept mapping. This
is a structured conceptualization process developed by the sociologist Trochim,
whereby qualitative and quantitative methods are combined, bringing together
the views of the participants of the process in a conceptual framework (Trochim
& Kane, 2005; Trochim, 1989; Burke et al, 2005).
The findings of the concept mapping will form the basis for the development of
a questionnaire. Questions will be drawn on the institution's policy in
relation to freedom restrictions, the used definition of freedom restriction,
the specific measures that are being applied, the application of other freedom
restricting means, the use of domotics and nature of this use, the
decision-making and involvement of the clients and their representatives, the
manner in which awareness is being raised or not, etc. The present/used
directive or guideline(s) will also be requested.
On the basis of a comparison between the answers to the questionnaire and the
'normpolicy freedom restrictions' three instititutions will be selected of each
sector that will be subsequently be approached to participate in the second
qualitative part of the research project. If it emerges that per sector more
than 3 institutions satisfy the criteria, a decision will be made by the
projectgroup in correspondance with the assisting committee.
The researcher will subsequently perform ethnographic fieldstudy in the form of
participatory observation in two of the selected institutions, one of each
sector. For practical reasons only short observation will be done in the
remaining intitutions, with additional interviews that will take place chiefly
there. Besides the conversations held with care helpers and representatives of
the management these interviews will also entail conversations with clients.

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