u/VanFenix

Hey, hoping some PSWs/caregivers can help me out. I'm putting together a care plan for a client and I really want to know where YOUR limits are; what you're actually allowed to do, and what you'd never do. Honestly the "no, we can't do that" answers are the ones I need most.

Local: ONTARIO CANADA

Quick rundown on the client (keeping it general):

• High-functioning autistic adult. Fully capable, and they helped build this plan themselves while of sound mind. Nobody's forcing anything on anyone.
• After a few days without sleep, they lose the ability to regulate and have hurt themselves badly before (self-injurious behaviour). When sleep-deprived they normally stay home — going out that dysregulated is dangerous. Basically a broken circadian clock.
• They mask hard, so you can't trust what they say in the moment — you go off what you can actually see, not "I'm fine." Example: if I ask how they slept and they say "like crap," that's a risk and I treat them as unsafe. If they say "I slept good," I still make my own judgement call.
• They've gotten out of moving vehicles and, on occasion, seriously hurt themselves while highly dysregulated. The client rarely leaves the house because of this — and that's the whole point of this plan: I'm trying to safely get them out to parks, malls, etc.
• Incontinent, wears briefs.

What's being considered:

• A transport harness (prescribed EZ-On vest) with sewn-on wrist restraints, in the car, to stop them hurting themselves during an episode — it also stops them unclipping, reaching the driver, or getting a door open. Prescribed last year. I'm honestly not 100% sure whether the wrist restraints have to be used every time or just the vest; the prescription includes them (they're sewn to the vest) and says the setup is to be used and is non-negotiable, with the client's prior consent. (Meaning the client knows they get dysregulated, mask it, and are at serious self-injury risk — and consented to this ahead of time with their doctor, to protect themselves.) We have the doctors note as well confirming this as part of their care plan. Is this enough?
• Belt cutters in the car so they can be cut out fast in a crash or fire (manual shows a 2-cut release).
• In the community: when rested, totally free, no restraints. The client actually likes the EZ-On vest for the sensory input. Only during a bad stretch does the worker stay close, and a previous caregiver used a short tether for things like busy roads or outdoor outings.
• Taking restraints off: if they say they feel bad, believe it. If they say they feel good, you still have to actually see they're calm first, because of the masking.
• Briefs changed on a skin-safe schedule, not every time they ask — breaking routine is usually bad, but skin and health come first.

What I want to know from you:

1. What's actually IN your scope vs. not, with a harness or restraints?
2. The big one: does a prescription PLUS a care plan authorize you to keep restraints on if the client asks to be released mid-journey — when the prescriber has authorized them and documented that the client can't give or withdraw consent in the moment due to dysregulation and masking, and the client consented in advance with their provider? Or does a contemporaneous "let me out" always have to be honored, no matter what's on paper, even when it puts the client or others at risk?
3. What would your agency straight-up not allow? What training would you need first?
4. What consent/paperwork would you need to see before doing any of this?
5. If a restrained client needs out fast — what's your move?
6. What would make you say no, or leave the job? What are your red flags?
7. What do you wish clients and families actually got about what you can and can't do?

Basically I want this to respect what you're allowed and okay with doing — not just what the client wants, or what the OT/prescriber set up in the care plan. So be blunt. Tell me what's over the line. Thanks a ton.