Restraint Abuse and Injury

Bed Rrestraints

The Nursing Home Reform Act of 1987 gives all nursing home residents the right to be free from physical and chemical restraints used for the purpose of discipline or for the convenience of the nursing home staff. Restraints may be used only to ensure the physical safety of the resident or other residents and, except in an emergency, only when a doctor writes an order that details the duration and circumstances under which restraints can be used.

Although the use of restraints in nursing homes has decreased since the Nursing Home Reform Act was passed, too many nursing home residents are still being restrained. The most recent data shows that in 1999, about 16 percent of nursing home residents were restrained at some point during their stay — that’s about 240,000 people. Also, approximately 200 nursing home residents die each year as a result of strangulation or suffocation caused by restraints, even in cases where the restraints were correctly applied.

Those most often restrained include residents limited in their ability to carry out three or more activities of daily living, those with low cognitive performance, those taking antipsychotic medications, and those with a history of falls. Often there are too many patients for too few employees. Unfortunately, this situation is too often remedied by the use of physical or chemical restraints. The unnecessary use of restraints in nursing homes is a form of nursing home abuse; and, in most case, restraints are not necessary.

Physical Restraints

A physical restraint is a manual method or a physical or mechanical device that is attached or placed next to a person’s body that restricts freedom of movement and can’t be controlled or easily removed by the patient. Examples of physical restraints include:

Hand mitts
Restrictive chairs, like Gerichairs with lap trays and small wheels that limit mobility
Vests that tie nursing home residents to their chairs or beds
Wrist restraints
Ankle restraints
Bedrails when used to keep a resident from getting out of bed when desired
Bed sheets tucked so tightly that a resident can’t move
The placement of a wheelchair-bound resident to a wall that prevents the resident from getting up

Bedrail Injuries

Remember also that the law requires a doctor to write an order for bedrails when they are used to restrain a nursing home resident. Oftentimes, the use of bedrails isn’t questioned and orders are not obtained because people mistakenly believe that the bedrails are either an effective safety device or that they pose no harm.

The most common injury suffered by those enclosed by bedrails occurs when a nursing home resident climbs over the rails and falls to the floor. This type of fall increases the risk of a more significant injury because when people climb over their bedrails and fall, the height of the fall is greater than had they fallen from a bed without rails.

Also, because the use of bedrails increases the likelihood that a nursing home resident will spend more time in bed and, therefore, lose muscle strength and develop gait and balance problems and disorientation and confusion, the chances of falling when attempting to get up after the rails are removed increases.

The combination of bedrail restraints and any other physical restraint attached to the body, like a vest or wrist restraint, can be deadly. The likelihood that a falling resident will become suspended in the restraint when attempting to climb over, under, around, through, or between the rails increases, and possible resulting injuries include:

Chest compression
Strangulation
Suffocation
Death

Chemical Restraints

Chemical restraints are psychoactive drugs given to control such things as pacing, restlessness, and uncooperative behavior. Although many psychoactive drugs can be useful to treat depression and dementia, they can be extremely harmful when used to restrain a nursing home resident.

Effects of Restraints

The use of physical and chemical restraints can result in a variety of emotional, mental, and physical problems, including:

Increased cognitive dysfunction, such as disorientation and confusion
Decreased activities of daily living
Increased agitation and loss of autonomy and dignity
Bedsores
Urinary incontinence or retention
Chronic constipation
Loss of muscle function
Increased bone fragility
Cardiopulmonary de-conditioning
Contractures
Lower extremity edema
Fractures that result from a fall caused by the use of a restraint
Death

Research supports the conclusion that restraints are not effective in preventing falls and resulting injuries. This makes sense because the use of restraints prohibits people from moving around and getting sufficient exercise. Therefore, muscles become weaker and gait and balance worsen. In addition, many restrained nursing home residents become disoriented and confused. When a person is physically deconditioned, has an unsteady gait and balance problems, and is disoriented and confused, the likelihood of falling increases.

Tips to prevent restraint injuries

Review the resident’s plan of care to determine the risk for using restraints. Risks factors include problems with falling, positioning, elopement and/or wandering.
Learn about the drugs your or your loved one is taking. Many books are available that contain easy-to-understand descriptions, adverse side effects, and what medical conditions certain drugs are used to treat.
If a restraint is used, remember that the law requires the doctor to write an order for the restraint that details the duration and circumstances under it can be used. Ask to see the order.
After reading the order, discuss the restraint use with the physician and ask how the restraint will help the resident’s function. If you are dissatisfied with the explanation and believe the restraint is unnecessary, contact authorities. Pennsylvania residents can click here for contact information.

Legal evaluation of physical restraint injury claims

A resident may not be restrained because he/she is difficult, or requires considerable attention. Except in an emergency, restraints may only be used with a physician order and documentation that supports the use of restraints. The use of proper restraints is appropriate to protect the resident from falling or wandering.