Can Physical or Chemical Restraints be Used on Patients?

A. These can be used to a limited extent only if the reason is fully documented and if their use is subject to a care plan.

There are two separate parts to this question that involve different regulations. The first question involves physical restraints and the second is chemical restraints.

When it comes to physical restraints, there is sometimes a need for them in the nursing home setting. Residents must be assessed for their risk of falls, and some residents have greater chances to injure themselves by falling out of bed or when they are transferring from their wheelchair to their bed and vice versa. Nursing homes must establish and follow a fall prevention plan. In some instances, the fall prevention plan may validly call for some form of a restraint to be used on a resident for their own protection.

There are several different kinds of physical restraints that are used on nursing home residents. When a resident is sitting in their wheelchair, a lap bar will keep them in place and will prevent them from getting out of their chair unless the lap bar is loosened. Bedrails are another form of restraint since they ensure that a resident will remain in their bed so long as the bedrail is in the up position.

Restraints are permissible so long as they are used pursuant to a plan and are not used any more than is absolutely necessary. In other words, they are an option but should not be the preferred or the first option. While there are some benefits to restraints, they still have negative effects on residents since they impair their mobility. This could cause both a physical reaction when the resident suffers from a lower level of activity or emotional responses when the resident feels that they are being restricted.

In actuality, many nursing home abuse restraints for their residents. Some of these low-performing nursing homes will put residents in restraints not because they need them, but because the nursing home does not have sufficient staff to care for their residents. In these instances, the residents will be secured behind lap bars in their wheelchair because staff cannot take the time to ensure their safety. This practice is a violation of state and federal regulations that govern the use of restraints. In other words, nursing home restraints may be used based on the need of patients and not the requirements of the nursing home based on their staffing situation.

The use of chemical restraints would imply some sort of pharmacological intervention to sedate a resident. Like the use of physical restraints, any type of pharmacological intervention must be based on the resident’s actual needs instead of the nursing home’s convenience. While a resident may present a challenge to the nursing home staff based on their agitated mental state, this does not mean that the nursing home may blindly drug them to keep them quiet. In fact, improper use of these chemical restraints contributes to thousands of deaths each year in nursing homes.

In 1987, Congress passed legislation that cut back on some of nursing homes’ usage of psychotropic drugs. Before these drugs can be given regularly, there must be documentation of necessity and periodic trials of medication while they are being used.

Chemical restraints may only be used in conjunction with psychiatric care and opinions. However, the drugs may only be used to help the resident when it is absolutely necessary as opposed to being used for a restraint. This requires the resident to be assessed and pharmacological interventions can only be used as a last resort after other interventions have been tried. Then, the nursing home must continuously assess the use of this medication and attempt gradual dose reductions as they are able.

These medications are not outright prohibited. In fact, there are some nursing home residents who are fitting candidates to receive these medications and may benefit from taking these drugs. A large percentage of nursing home residents do suffer from psychiatric ailments such as anxiety and depression, but drugs should not be used as a substitute for trying to address the root causes of these conditions.

Like physical restraints, nursing homes often fail to comply with the rules in this area. Numerous nursing homes are cited for their use of these medications without either exploring alternatives or attempting gradual dose reductions. Some of the worst nursing homes in the country actively try to drug seniors to make them more compliant with staff. This is a form of nursing home abuse, and can have negative ramifications for the resident in many different areas.