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Nursing Homes Curtail Use Of Physical Restraints With Residents

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,gerichair 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

Warnings Do Little To Prevent Bed Rail Entrapment

How Much Freedom Should Assisted Living Facilities Give The Mentally Disabled?

Web Resources On Restraints

Report: “Freedom from Unnecessary Physical Restraints: Two Decades of National Progress in Nursing Home Care”

 

SAFETY WITHOUT RESTRAINTS, A New Practice Standard for Safe Care, Minnesota Department of Health

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  • R W

    Our facilities have been without restraints for years. When we get new management or employees with experience that is normally thier first response to a fall, that or an alarm, which I assume will soon become considered a restraint due to the annoyance it causes to other residents and the resident using the alarm becomes apprehensive of the noise also, reacting as if they are restrained. How can this be allowed? My belief is it is taking an individuals freedom away without due process, so to speak. How is that legal?

  • Lynnlie

    I work in a nursing home facility which has recently been forced by the health dept. to become restraint free. We have one resident in particular who simply does not have the cognitive ability to understand that she no longer has the ability to walk and if she attempts she will fall. I cannot tell you how many times this women has fallen since the state required her laptray to be discontinued. It seems she is continually on neuro checks and has a bump, open area, or bruise on her face. One on one care was attempted at first, but with the 3% cut from medicaid,our nursing home has realized our luxury of overstaffing was a thing of the past. Charge nurses, such as myself, have attempted to bring her along in her wheel chair as medicines are passed and treatments are completed but obviously, to ensure privacy to the other residents, she can not go absolutely everywhere we go. When the family pleaded with state inspectors to allow the tray, one inspector stated “i don’t care if she stands up,falls to the floor, brakes a hip and dies, that is her right.” I strongly disagree. Most of you would agree, the majority of residents are placed in nursing home because they no longer have the ability to make good decisions for themselves. One senerio we hear often is “momma kept leaving to stove on..and almost burnt the house down once…” and this is a reason for family members to place their loved ones in a long term care facility. What it really comes down to is residents have a right to be protected from their own misjudgement, weather caused by alzheimers’, or other dementia.

  • Glenda

    My mother is in a nursing home and I was told, “she has a right to fall.” This is the craziest statement. These state inspectors certainly have their place, but I wonder how they would respond if it was their family member needing protection from their own misjudgement. Talk about “going overboard” !!

  • KaySue

    What about the right of the person who is legally responsible for their loved one having the right to protect them from falling and ending up with cuts or broken bones. I have witnessed my own family member falling and breaking her shoulder, her pelvis and receiving multiple lacerations on her head. She does not realize she cannot walk and often bends over to try to pick something up and then she falls forward on her head. Please tell me why a form of restraint is not a humane act in this situation. We are forced to wear seat belts in cars so we will not hurt ourselves but we deny their use for the persons in nursing homes who cannot keep themselves from injury. To me this is abuse.

  • Shirley

    My Mom has fell 2 times this week, once out of bed, once out of wheel chair. She just pops off to sleep and topples to floor. I know she is going to do it, the facility knows it is going to happen. But “right to fall” does not care. Stupid most ridulous thing I have ever heard.

  • Broden

    I think Lynnlie said it best. “What it really comes down to is residents have a right to be protected from their own misjudgement, weather caused by alzheimers’, or other dementia.” I am a nursing assistant at a nursing home and our facility gets into trouble by the state when people fall, even though they say it is there right. I have seen patients hit there heads and die. Ive seen more preventable broken hips, arms, necks, tailbones etc. I would never bring my cofused, non weight bearing parent to a home that says it is her right to die a painful death after breaking her hip or arm and not being able to take the pain. I have seen it before. This is a stupid law and needs to change. We cant say that we have the patients best interest in mind when we say “Yes we will watch them, Yes we will prevent them from burning themselves, hurting themselves, all except falling.It’s there right to fall.” I do understand about the restraints making them feel trapped. So did my seatbelt when my mother made me wear it. And I hated the life preserver on the boat. But I do understand that they knew better than I did what kind of dangers where out there if I didn’t have it on.

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