Use of restraint beds rises in Dutch hospitals amid concerns over patient safety
Despite efforts to reduce the use of restrictive measures in hospitals, the deployment of so-called "tent beds," a form of confinement for patients, has increased across the Netherlands. This trend has raised questions about patient care practices as hospitals grapple with the challenges of managing older patients exhibiting agitation or cognitive issues.
The Dutch Health and Youth Care Inspectorate (IGJ) has called for a reduction in the use of all restraint measures, with the principle of "no, unless" guiding such interventions. However, findings from a survey conducted by the NOS Nieuwsuur show a rise in the use of tent beds, which fall into the second-most severe category of restrictive measures.
A tent bed is a mesh-enclosed bed that can only be opened from the outside, preventing patients from leaving it independently. It is often used to manage patients displaying agitated or confused behavior, frequently caused by delirium, dementia, or other cognitive impairments. While intended as a less severe alternative to physically restraining patients with wrist or ankle straps, its use remains controversial.
All 28 hospitals surveyed by Nieuwsuur reported using tent beds, with most acknowledging an increase in their deployment. The Diakonessenhuis hospital in Utrecht noted that tent beds could provide safety and calm in certain situations. “For patients in a confused state who may wander, the bed can prevent them from falling and breaking a hip,” said senior nurse Melanie van Essen.
However, some institutions, such as VieCuri Medical Center in Venlo, have moved away from using tent beds entirely. "As far as we’re concerned, the tent bed is outdated," said Bart Verheijen, team leader in geriatric medicine at VieCuri. Instead, the hospital employs alternative care strategies to manage patient behavior.
The survey revealed significant discrepancies in how often hospitals rely on tent beds. One hospital reported using tent beds only twice in 2023, while another used them for 195 patients. Most hospitals fell within a range of 13 to 79 uses annually. The IGJ has refrained from condemning the increased use of tent beds, emphasizing that they are less invasive than physical restraints but should be used only after careful consideration of alternatives. “Each decision must weigh whether the measure is absolutely necessary and whether less intrusive options are available,” an IGJ spokesperson stated.
The rise in the use of restrictive measures coincides with increasing challenges in managing hospital patients with memory-related issues. Nearly half of older patients experience cognitive impairments during hospital stays, a figure expected to grow as the population ages. Agitation and confusion often occur when patients struggle to understand their environment or treatment.
“Hospital care for older patients needs drastic reform,” said dementia care researcher Annette Plantinga, who collaborated with Alzheimer Nederland on a study of patient behavior. The study found that 74 percent of caregivers in 2024 reported restlessness among their loved ones during hospital stays, compared to 60 percent in 2019.
Plantinga highlighted that healthcare workers may inadvertently exacerbate patients’ distress. “Nurses often fail to recognize their role in provoking behavior. For example, walking into a room and starting to wash a patient without explaining can confuse and upset someone with memory problems,” she explained.
To manage agitation, hospitals have implemented various strategies, including hiring external staff such as security personnel or non-certified caregivers to assist with patient monitoring. In some cases, sedatives are administered to calm patients. However, experts warn that sedatives can lead to complications, including an increased risk of falls.
“I see medication as the invisible tent bed,” said geriatric professor Marcel Olde Rikkert, emphasizing the risks of over-reliance on pharmacological solutions.
Some hospitals have also experimented with creating a more reassuring environment for patients. This includes involving family members or volunteers, bringing familiar objects from home, and maintaining a structured daily routine with activities to reduce anxiety.
Unlike nursing homes and psychiatric facilities, Dutch hospitals are not required to report their use of restrictive measures to the IGJ. Plantinga criticized this lack of oversight, arguing that the Inspectorate should track these interventions in hospitals as well. “It’s unclear why there’s a difference. The IGJ should have at least minimal insight into how often and why restrictive measures are used in hospitals,” she said.
