More than 20 years after Congress passed the the 1987 nursing home regulatory law (OBRA) which granted nursing home residents the “right to be free” restraints for discipline or staff convenience–much progress needs to be made to accomplish that goal.
Once widely thought to prevent nursing home residents from falling and wandering off, the use of physical restraints is not nearly as common in most nursing homes. According to a recent USA Today article, the use of physical restraints amongst nursing home residents has been drastically reduced over the past 20 years. Medicare statistics verify 21.1% of residents were restrained on a daily basis in 1991 compared to just 5.5% in 2007, the most recent full-year set of statistics available.
‘Restraints’ are generally known as any device used to prevent a resident from wandering or falling, or residents who may be easily agitated (due to uncontrolled pain). The most commonly used restraints used in the nursing home setting are bed rails and geri-chairs. However, nursing homes have been be known to use make-shift ‘tie downs’ thereby securing residents to beds, benches, dining chairs and even toilets.
While the use of restraints may seem like a way of controlling a resident from harm themselves, studies have shown that restraint usage causes muscles to atrophy and result in residents actually becoming reliant upon the restraints for support when sitting or walking. The psychological consequences of restraints are also a problem encountered in nursing homes. According to Dianne Snyder, of Thornwald Home– a restraint-free nursing home in Pennsylvania, “They experience some anguish. You kind of break their spirit. They give up.”
Situations involving injury or death with the use of restraints are more common than most would like to believe. If a resident is left unattended with restraints in place, they can become tangled in straps resulting in strangulation or broken limb.
Is it possible to ban the use of restraints in nursing homes?
There will always be residents are some facilities who require the use of physical restraints to protect them from harming themselves. However, there is ample room for further reduction. For example, Pennsylvania a voluntary program to ban the use of restraints of which more than 90% of the state’s nursing homes participate, has reduced the use of restraints to just 2.8% of residents last year.
Like everything in the nursing home, the quality of care provided to residents is a reflection of the training provided to the staff. Staff intervention is essential to identify those who may be predisposed to falling or wandering from the facility. Fall prevention techniques such as: padded floors, non-slip chairs, adjustable beds and socks with traction may quickly reduce the number of residents who require the use of restraints. Nursing homes must “educate, educate, educate” according to Snyder. “Not only the staff, but also residents, families and physicians.”
Related Nursing Home Abuse Blog Posts On Restraints
Web Resources On Restraints
SAFETY WITHOUT RESTRAINTS, A New Practice Standard for Safe Care, Minnesota Department of Health