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Guidelines On the Use of Physical Restraints in Nursing Homes  

What are physical restraints?

Physical restraints are items used to restrict, restrain or prevent movement of a person. Examples of these include belts, vest restraints and wrist restraints. 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. For example, a bed rail could be used to keep someone from getting out of bed or it could be used to help a resident turn over in bed.

The most common reason given for using restraints is to prevent injuries to people who are at risk of accidental falls. 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 physical restraints 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 been harmed trying to escape from restraints or from improperly applied restraints. 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 the use of restraints?

Federal law and the Georgia Nursing Home Reform Act 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 Georgia and federal laws regarding use of physical restraints are similar, there are some differences. Georgia law applies to all Georgia nursing homes. Federal law only applies to Medicare/ Medicaid-certified facilities. Most nursing homes are Medicare and Medicaid certified.

What are the Georgia guidelines?

Georgia regulations require all 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:

  • As a permanent means of control;
  • As a form of punishment;
  • For the convenience of facility staff; or
  • 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 Georgia standards, Medicare/ 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 restraint 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 the legal representative.

Medicare/ Medicaid certified nursing homes must ensure that a resident's abilities do not decline unless it cannot be avoided due to their 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/ 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 residents needs.

General Options For Reducing the Use of Restraints

There are many actions nursing homes can take to reduce or eliminate the need for restraints. Some general actions include:

  • Meeting identified physical needs such as hunger, toileting, sleep, thirst, and exercise according to the resident's routine rather than the facility's needs;
  • Training staff members to meet individualized resident's needs;
  • Staffing at levels high enough to enable staff members to respond to individualized resident's needs;
  • Providing residents with companionship and supervision, including the use of volunteers, family and friends;
  • Offering physical and diversionary activities such as exercise, outdoor time, and other activities of interest to residents;
  • Adapting the environment through use of alarms, good lighting, individualized seating, mattresses on the floor, and so forth;
  • Removing hazards such as over-bed tables with wheels.

Specific Programs For Reducing Restraint Use

Some specific programs which have been used to reduce use of restraints in nursing homes include:

  • Restorative care, such as walking, bowel and bladder training, independent eating, dressing, and bathing programs.
  • Wandering program to provide residents safe areas to walk while preserving the rights of others.
  • Wheelchair management programs to assure the correct size chair is used and that it is kept in good condition.
  • Individualized seating program for those residents who do not need wheels for mobility. Chairs should be tailored, as are wheel chairs, to individual needs.
  • SERVE program (Self-Esteem, Relaxation, Vitality and Exercise), including fun, relaxation, stretching, range-of-motion and walking.
  • Video visits. The family can send video-taped visits when the family members live far away.
  • Outdoor program daily during good weather.
  • Rehabilitation dining room to help residents increase mealtime skills and independence.
  • Preventive program for calming aggressive behaviors; mental health services should be available for residents with behavior disorders.

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, staff members are more likely to respect your wishes regarding the use of restraints.

The National Consumer Voice for Quality Long-Term Care has developed a booklet on alternatives to restraints, "Restraints: The Exception, Not the Rule." See:

National Consumer Voice for Quality Long-Term Care
1001 Connecticut Avenue, NW Suite 425
Washington, D.C. 20036
(202) 332-2275


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