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PHYSICAL RESTRAINTS 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 and cuffs. Special chairs and bed side rails can be used as restraints. 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 is 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. However, according to the "Journal of the American Medical Association" there is no evidence that restraints reduce the risk of falls or injuries. SHOULD USE OF RESRAINTS BE LIMITED? Yes. Although some believe restraints may help prevent some injuries, they often create other serious problems. These problems include chronic constipation, incontinence, pressure sores, emotional problems, isolation, and loss of ability to walk or perform other activities. Residents have also been harmed trying to escape from restraints or from improperly applied restrains. The use of restraints can be a humiliating experience for a resident. Restraints are typically seen by residents as the loss of the basic right to move around. WHAT ARE THE RIGHTS OF NURSING HOME RESIDENTS REGARDING USE OF RESTRAINTS? The Federal and Michigan Nursing Home Reform Acts 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. Although Michigan and Federal laws regarding use of physical restraints are similar, there are some differences. Michigan’s law applies to all Michigan nursing homes. Federal law only applies to Medicare and Medicaid certified facilities. Most nursing homes are Medicare and Medicaid certified. WHAT ARE THE MIGHIGAN GUIDELINES? Michigan Department Bureau of Health Systems (MDBHS) guidelines require all Michigan nursing homes to carefully assess the needs of each resident. Restraints may only be used as a last resort and only after less restrictive alternatives have been tried. Restraints must never be used:
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 Michigan 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. Rarely does restrain use enhance a resident’s quality of life. Residents have the right to make decisions about their care and treatment. Restraints should not be used without the consent of the resident or legal representative. Medicare and Medicaid certified nursing homes must ensure that a resident’s abilities do not decline unless it cannot be avoided due to a medical condition. Residents often lose the ability to bathe, dress, walk, toilet, eat, and communicate when 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 restraints to help residents maintain 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 a resident unless it has first consulted with appropriate health professionals to determine whether less restrictive support devices could meet the resident’s needs. GENERAL OPTIONS FOR REDUCING USE OF RESTRAINTS There are many actions nursing homes can take to reduce or eliminate the need for restraints. Some general actions include:
SPECIFIC PROGRAMS FOR REDUCING RESTRAINT USE Some specific programs which have been used to reduce the use of restraints in nursing homes include:
HOW CAN I HELP PREVENT UNNECESSARY RESTRAINT USE? Make sure the nursing home conducts a careful assessment and considers all options before using restraints. If your nursing home knows you are well informed on this issue, they are more likely to respect your wishes regarding use of restraints. The National Citizens Coalition for Nursing Home Reform has developed information on restraints and alternatives. The coalition can be reached at: National Citizens Coalition for Nursing Home Reform 1424 16th Street NW, Suite 202 Washington, DC 20036-2211 Telephone: (202)332-2275 ARE MICHIGAN NURSING HOMES REDUCING THE USE OF RESTRAINTS? Many Michigan nursing homes have dramatically reduced the use of restraints in the last few years. Statewide, restraint use dropped from about 45 percent in 1990 to 16 percent in 1995. However, some homes still use restraints inappropriately. Restraint use ranges from 0 percent in some of the better homes to almost 70 percent in others. It is best to look for a nursing home that provides safety without use of restraints.
Rev: 95, 96, 97, 98, 03, 03/04
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Site last updated 06/26/04