How to Approach Locking Resident Doors

Today one of our Social Workers posed the question, "Can we install a lock on a bedroom door for a resident?" While the immediate answer was a resounding "NO!" from the interdisciplinary team, I felt the question was worth some research.

When a resident requests increased physical security, there are two questions:

1. Why does this resident not feel safe/trusting of the environment?
2. What limitations do we face when balancing safety and security?

Trust

A resident usually requests a lock box because they have already lost something. Looking back on past purchases, I realize that this "intervention" is 95% emotional and 5% physical security. Admit it, the lock boxes you are buying for your residents aren't exactly Fort Knox. A thorough investigation of a reported misappropriation is a more appropriate approach, in my opinion, than a physical device provided after the fact.

A resident that is consistently losing items will only be further confused at the lockbox concept. You will be searching for keys, items the resident insists did (or did not) make it into the box, or the box itself.

The confusion factor aside, one often overlooked reason that a resident does not feel safe in your facility (their own home) is uninvited guests. I'm not referencing wandering residents here, but rather staff that do not knock on doors, new staff that do not introduce themselves, and staff that enter the room in the middle of the night, provide care, and leave without verbal exchange. This is not about intention of the worker; it is about perception by the resident. Managers may want to personally introduce new staff to anxious residents, and even third-shifters with the best of intentions need that occasional remind to increase communication with sleeping residents.

Safety

At some point in my training, someone ingrained risk management in me so deeply that there aren't many situations where safety isn't my number one de facto consideration. And while that occasionally conflicts with my liberal views on resident rights, that what if question must be asked anytime you place a barrier, device, chemical, medication, or other thing between the worker and the resident.

In 1988 it was ruled that "Locked Units" could only use time release doors. Often you see utility rooms, beauty shops, clean linen rooms with keys dangling on fobs from door frames, for staff convenience and resident safety (I find this very insulting to the resident). It is required that any automatically closing door must have a call light inside the room it contains.

Back to the question at hand: Does a resident have a right to install a lock on their bedroom door?

I contacted the Director of Life Safety at our State Department of Health. Life Safety Code (which is not a free document) does not cover this specifically. His advice (with some mild hesitation) was this: Yes, the resident has the right, but the facility must take careful steps to ensure safety:

1. It must be a lock that opens automatically on the inside (push button type).
2. Staff must have a key. What staff? I eventually pin-pointed him down to the charge nurses. His point was that staff must be able to immediately get into the room when necessary.
3. A Life Safety Surveyor may very well debate you on this, not to mention a health surveyor.

This Director really gave me a soft nod to go ahead with the lock if I felt we could manage it properly. I know that we could manage it properly. I think it may give the resident a heightened sense of security, but I am afraid that this will be a short-term feeling for the resident. There is a distinguishable difference, when working in someone's home, between safety and security. Empower staff to help residents feel secure and you can circumvent silly mechanical solutions that may jeopardize safety. Can we install the lock? Yes. Will we install the lock?

Not this time.