The Use of Physical Restraints in Nursing Homes

Dear Experts,

Can someone tell me about laws against restraints in nursing homes? I understand the need for regulation and proper assessment and documentation, but I can't understand why it is against someone's rights to be restrained for their own safety and the family's peace of mind when all other interventions have failed. I would like to know if these policies are those of the facilities themselves or if states actually ban the use of restraints under any circumstances. As a former nursing home employee, I was always told "the state will now allow it."

Rosalie Wolf, NCPEA President, responds:

The use of both physical and chemical restraints in nursing homes has been the subject of a lot of research over the past decade. Restraints are defined as mechanical devices, materials, or equipment, which restrict freedom of movement or normal access to one's body. Physical restraints have been found to decrease muscle tone and increase the likelihood of falls, incontinence, pressure ulcers, depression, confusion, and mental deterioration. If an accident occurs with the use of restraints, the results are usually more harmful than if the physical restraint was not used.

On the basis of empirical evidence, the federal government, under the Patient's Rights Act, made the use of physical and chemical restraints grounds for facility "deficiencies" except when ordered by doctors. Facilities cannot impose physical restraints as discipline or for their own convenience. Interestingly, a study conducted at the University of California, San Francisco has demonstrated a significant decrease in facilities receiving deficiencies for this requirement - from 21.2% in 1991 to 13.5% in 1997. (Harrington, C. et al. (1999.) Nursing facilities, staffing, residents, and facility deficiencies, 1991 through 1997. San Francisco, CA: University of California.)