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Guidelines On Use Of Physical Restraints In Nursing Homes

2000 Nursing Home Ombudsman Agency of the Bluegrass, Inc.


What are Physical Restraints?

Physical restraints are items used to restrict, restrain or prevent movement of a person. Examples of restraints include belts, vest restraints, cuffs and sometimes special chairs or bed siderails. Whether or not a particular item is considered a physical restraint depends on the purpose and effect of its use. If an item is used to restrict movement, it is a restraint. The same item may not be considered a restraint if it used to enable a resident in some way. For example, a bed rail could be used to keep someone from getting out of bed or could be used to help a resident turn over in bed.

The most common reason given for using restraints is to prevent injuries to persons who are at risk of accidental falls due to physical or mental illness.


Why Should Use of Restraints be Limited?

Although restraints may help prevent some injuries, they often create other serious problems. These may include chronic constipation, incontinence, pressure sores, emotional problems, isolation, and loss of ability to walk or perform other activities. Residents may also be harmed trying to escape from restraints or from improperly applied restraints.


What are the Rights of Nursing Home Residents Regarding Use of Restraints?

Federal and state laws prohibit nursing homes from using restraints unless they are medically needed. Nursing home residents have the right to refuse treatment, including the use of restraints. Federal law only applies to Medicare and Medicaid certified facilities. Most nursing homes are Medicare and Medicaid certified.


What Are Good Nursing Guidelines?

Guidelines require all nursing homes to carefully assess the needs of each resident. Restraints should only be used as a last resort and only after less restrictive alternatives have been tried.

Restraints must never be used:

1. As a permanent means of control.

2. As a form of punishment;

3. For the convenience of the facility staff;

4. As a substitute for activities or treatment.

If restraints are used, they must be based on a physician's order for a specified and limited time. Restraints may only be applied by a qualified professional.


What Are the Federal Guidelines?

In addition to meeting good nursing standards, Medicare and Medicaid certified nursing homes cannot use physical restraints unless they are needed to treat the resident's medical symptoms. Federal law requires certified facilities to care for residents in a way that maintains or enhances quality of life. Restraint use does not enhance quality of life.

Medicare and Medicaid certified nursing homes must ensure that a resident's abilities do not decline unless the decline cannot be avoided due to the resident's medical condition. Residents often lose the ability to bathe, dress, walk, toilet, eat, and communicate when they are regularly restrained. If restraints are necessary, they must be used in a way that does not cause these losses. Residents must be released from restraints and exercised at least every two hours.

Nursing homes sometimes use restrains to help keep residents in proper body alignment or position. However, proper positioning can often be achieved by using pillows, pads, or comfortable chairs. A Medicare or Medicaid certified nursing home cannot use restraints to help position residents unless it has first consulted with therapists to determine whether less restrictive support devices could meet the resident's needs.


How Can I Help Prevent Unnecessary Restraint Use?

Make sure the nursing home conducts a careful assessment and considers all options before using restraints. The attached sheet gives information on alternatives and more details on your rights. If your nursing home knows you are well informed on this issue, they are more likely to respect your wishes regarding use of restraints. If you need further assistance, contact the Nursing Home Ombudsman Agency of the Bluegrass.

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