Physical Restraints

Both Federal and Florida law restrict the use of physical restraints for nursing home residents.  Under the Federal Nursing Home Reform Law, a physical restraint can be utilized only to treat a resident’s medical conditions or symptoms. Restraints never can be used for discipline or the nursing home’s convenience. (See Section 483.13(a) of Title 42 of the Code of Federal Regulations).  Florida law (Section 400.022(1)(o) restricts the use of restraints allowing only those restrains authorized in writing by a physician for a specified and limited period of time or as are necessitated by an emergency.  In the case of an emergency, restraint may be only applied by a qualified licensed nurse who shall set forth in writing the circumstances requiring the use of restraint, and, in the case of use of a chemical restraint, a physician shall be consulted immediately thereafter. Restraints may not be used in lieu of staff supervision or merely for staff convenience, for punishment, or for reasons other than resident protection or safety.
The law restricts the use of restraints because there is a large body of research showing that the use of restraints is harmful, both psychologically and physically.  Patients who are restrained typically become even weaker and less able to function independently because their movements are restricted.  Many patients also become ensnared in the restraints and fall when trying to extricate themselves.
Restraints include vests or belts tying the resident to a wheelchair or bed.  Placing a resident in a chair angled in such a way to prevent the resident from standing is also restraining the resident.  Bed rails are also a restraint.

The FDA has published risks associated with the use of bed rails as follows:
• Strangling, suffocating, bodily injury or death when patients or part of their body are caught between rails or between the bed rails and mattress.
• More serious injuries from falls when patients climb over rails.
• Skin bruising, cuts, and scrapes.
• Inducing agitated behavior when bed rails are used as a restraint.
• Feeling isolated or unnecessarily restricted.
• Preventing patients, who are able to get out of bed, from performing routine activities
such as going to the bathroom or retrieving something from a closet.

If a nursing home requests the ability to use restraints on your loved one, you should first ensure that other less restrictive measures have been explored.  Alternatives include having activities that redirect the resident, installing electronic monitoring devices or increasing staffing levels.  Nursing homes sometimes resist the idea of additional staffing and may respond that their staffing levels meet the state mandate.  However, keep in mind that the facility is required to provide the care that each resident needs to reach the highest practicable level of functioning.  (See Section 483.25 of Title 42 of the Code of Federal Regulations).

Nursing home residents need advocates to ensure that their safety and dignity are preserved.  Advocates should feel empowered to request a care plan meeting to discuss any issues, such as the use of restraints, as issues arise.

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