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Use of restraints in nursing homes

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Though the Nursing Home Reform Act of 1987 limited the use of physical and chemical restraints in nursing homes, their use continues to be an issue at facilities across the nation. The reforms did not prohibit all restraints, but only put limitations on their usage.

Federal law prohibits both physical and chemical restraints used with the intent to discipline, to make patient care easier, or in any situation where they are not required to treat the patient’s medical symptoms.

 

What is considered a restraint?

Physical restraints are anything attached to or near a resident’s body that they cannot easily control or remove, and that are intended to prevent them from moving freely. Examples of physical restraints include limb ties, wheelchair bars, vests, bedside rails, and tightly tucked bedsheets.

Chemical restraints include the use of sedatives, antipsychotics, and overmedicating residents as a form of punishment or so that they are easier to control.

Many facilities incorrectly operate on the assumption that they are keeping residents safe and preventing them from harming themselves with these types of interventions. However, resident behavior or understaffing are not excuses to impose restraints.

 

Why a nursing home may resort to restraints

Restraints are most commonly used among residents who have mobility and functional problems, behavioral issues, and cognitive deficiencies. Staff may use restraints in order to keep a patient from falling on the one hand, or to control someone with severe behavioral symptoms on the other. A severely understaffed facility may also use restraints as a way to remedy their inability to closely monitor each patient.

Though restraints are often used to prevent patients from suffering injuries, research shows these are not safe. They don’t actually decrease the risk of injury, but instead lead to increased emotional and physical suffering.

 

Restraints are dangerous

Because they prevent patients from moving, physical restraints increase the risk of bruises, skin breakdown, and strangulation, as well as other serious injuries such as fractures and head trauma. Additionally, residents forced to use physical restraints may suffer increased mobility problems, stiffness, and lower bone mass.

Antipsychotics are the most frequently used chemical restraint, and are often prescribed to residents with dementia. Though the risks of these dangerous drugs are well known, many facilities continue to prescribe them unnecessarily, along with a host of other medications, making them even more dangerous. Chemical restraints are known to cause damage to the heart and cardiovascular system, an increased risk of falls, loss of mobility, and memory loss.

 

Emotional suffering

Not only can restraints cause physical pain, they often lead to depression and emotional suffering. Being unable to move and control oneself makes residents feel powerless and causes social withdrawal. Many experience anxiety, increased agitation, and even terror with the implementation of physical restraints.

 

Stay involved in your loved one’s care

CMS guidelines indicate that when a physical restraint is used, the facility is required to use the specific restraint for the least amount of time necessary, and provide ongoing evaluation of the need for the physical restraint.

Like with chemical restraints, psychotropic drugs cannot be administered legally without a doctor’s order, who in turn must have the consent of the patient or their family. When a new drug is prescribed to your loved one, it’s important to understand the medical reason for the drug in addition to its dosage and any potential risks. Make sure to get as much information as you can from a medical professional before approving the use of a new drug.

As a family member, you are vital in creating a personalized care plan that meets the needs of your loved one. Confirm that the facility is frequently assessing your family member and updating their care plan in response to any new symptoms.

If you or a loved one has suffered injuries as a result of improper restraint usage, don’t hesitate to call Jehl Law Group today. With over 65 years of collective experience, our attorneys are ready and waiting to assist you with any questions or concerns.

 

References:

https://www.health.state.mn.us/facilities/regulation/safety.html

https://www.nursinghomeabuseguide.org/neglect/chemical-restraints

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

https://www.nursinghomeabuseguide.org/physical-restraints/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564468/