Under the Nursing Home Reform Act of 1987 (OBRA 87), certain rights and protections are assured for nursing home patients, including “[t]he right to be free from chemical and physical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms”.
The guidelines for these regulations specify that a nursing home’s responsibilities for preventing abuse also apply to practices and omissions which can lead to abuse if left unchecked.
The Department of Health and Human Services’ definition of the inappropriate use of restraints is “chemical or physical control beyond physician’s orders or not in accordance with accepted medical practice.”
When the Nursing Home Reform Act was passed, restraining nursing home residents to manage wandering, agitation, or at the discretion of staff, was a widely accepted practice. However, the use of restraints is not only unnecessary but dangerous as well.
The Centers for Medicare & Medicaid Services has determined that “the use of physical restraints can cause harm including strangulation, loss of muscle tone, decreased bone density (with greater susceptibility for fractures), pressure ulcers, decreased mobility, depression, agitation, loss of dignity, incontinence, constipation, and in some cases, resident death.”
The Food and Drug Administration estimates that there may be at least 100 deaths or injuries annually associated with the use of restraints, many deaths occurring when the patient is trying to get out of the restraint or while attempting purposeful behavior such as going to the bathroom.
Nursing homes, in recognition of the dangers of restraint use, are increasingly using alternatives to restraints, including:
- Personal strengthening and rehabilitation program
- Use of “personal assistance” devices such as hearing aids, visual aids, and mobility devices
- Use of positioning devices such as body and seat cushions, and padded furniture
- Efforts to design a safer physical environment, including the removal of obstacles that impede movement, placement of objects and furniture in familiar places, lower beds, and adequate lighting
- Regular attention to toileting and other physical and personal needs, including thirst, hunger, the need for socialization, and the need for activities adapted to current abilities and past interests
- Design of the physical environment to allow for close observation by staff
- Efforts to increase staff awareness of residents’ individual needs – possibly including assignment of staff to specific residents, in an effort to improve function and decrease difficult behaviors that might otherwise require the use of restraints
- Design of resident living environments that are relaxing and comfortable, minimize noise, offer soothing music and appropriate lighting, and include massage, art or movement activities
- Use of bed and chair alarms to alert staff when a resident needs assistance
- Use of door alarms for residents who may wander away
It important that nursing home residents and loved ones remain educated about the dangers caused by the use of restraints, as well as alternatives to restraints. The hazards, risks, and side effects of restraints most often outweigh the benefits of their use.