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Reduction of Restraints in Nursing Homes Begs Question is This a Good Thing

Reasons To Use Not Use RestraintsWhile some doctors providing care nursing homes order physical restraints for their patients, research shows that these devices tend to increase injury and cause other serious health issues. Physical restraints are known to cause weakened bones and muscles, incontinence, constipation, bedsores, poor circulation, infections and poor appetite. So why do facilities still use restraints and is this policy good practice?

Rosenfeld Injury Lawyers LLC represents nursing home residents who have suffered severe side effects caused by unauthorized use of restraints and other types of professional negligence. Our law firm has extensive experience in resolving cases for our clients who have developed preventable bedsores or were mistreated, abused or neglected. Our attorneys are available to answer any legal question on how to receive the monetary compensation you deserve because negligent actions caused your damages. Should you have additional questions, we invite you to contact our office for a free review of your legal rights.

Identifying Physical Restraints

Physical restraints involve both the practices and devices that are used to restrict a resident's movements. A physical restraint device could include a limb restraint, vest, soft tie, tray, or lap cushion used to constrain the resident's movements. However, this is far from a complete list of all known physical restraints used in nursing homes, hospitals and other caregiving facilities. The practices used to restrain a resident physically could include using Velcro to strap a patient in using their clothing, fabric, or a sheet that restricts their ability to move. Some caregivers use belts, bars, tables, and trays that are difficult for the resident to remove or used as an inappropriate tool to prevent them from standing or rising.

Restraint Policies and Procedures

According to the national campaign Advancing Excellence in Americans Nursing Homes, developing, implementing and enforcing specific policies and procedures on the use of restraints can help maintain the dignity and respect of every resident in the facility. These policies and procedures should encourage:

  • Following a philosophy that provides only rare use of restraints that are “reserved for extreme circumstances.”

  • Training that helps to identify the difference between an “enabler” and a “restraint.”

  • Developing a Care Plan that eliminates behavioral patterns that result in falls. The Care Plan might involve:

    • Keeping cups of water close to the resident and answering call lights to take the resident to the toilet as soon as assistance is needed.

    • Monitor the resident to identify pain, discomfort, agitation, and restless behavior that tends to cause unsafe wandering.

    • Monitor the resident for known physical or emotional behaviors associated with infections and pain.

    • Identify agitated behavior triggers and take steps to alter the resident's behavior immediately.

  • Developing a Care Plan that helps to identify “calming behavior” for each resident and include interventions that minimize or prevent any restless behavior. This part of the Care Plan might involve:

    • Having the resident participate in an enjoyable activity that keeps them engaged;

    • Taking a few minutes to sit with the resident and hold their hand;

    • Providing the resident with a beverage or snack; or

    • Distracting Alzheimer residents or redirecting their actions.

  • Identifying the resident's specific interventions as detailed in their care plans.

  • Remaining alert and attentive when a resident might be experiencing pain and discuss effective treatments with the Charge Nurse.

  • Maintaining an active restraint-free committee that meets on a regular basis to keep updated on changes in the law and monitoring staff to ensure policies and procedures are followed.

  • Following strict procedures, guidelines and protocols when restraints must be used and provide ongoing monitoring to identify specific problems associated with restraints. Routine monitoring could help identify restraint-associated issues like the development of urinary tract infections, bedsores, behavioral changes, and functional restrictions.

  • Following protocols for the use of restraints, even if the procedure contradicts the physician's orders.

  • Providing recommendations and suggestions to the Charge Nurse if you have any ideas on how to avoid using a restraining device on a resident.

Treating Every Resident With Dignity

The level of care doctors provide their patients today has improved significantly since just a few decades ago. Back then, a doctor's first choice for treating tonsillitis was to remove the child's tonsils. During that time, using restraints on residents was routine in nursing facilities, sanitariums, and hospitals. Ensuring the patient was happy and treated with dignity was not always the first consideration.

Now, the use of restraints in a nursing facility is implicitly regarded as an indicator of providing substandard quality of care. Because of that, the healthcare industry encourages caregivers to take a more proactive role in understanding that every resident and patient should be respected for their individuality and not merely managed at the convenience of the Nurse or Nurses' Aide. Following this procedure is especially crucial for dementia patients who are particularly affected by restricting their motion by restraints.

Government Interaction

A section of the Omnibus Budget Reconciliation Act of 1987 that Congress enacted laws was enacted to reduce the widespread use of physical restraints in nursing facilities. However, according to the National Institutes of Health (NIH), the Act received pushback from many nursing home operators who asserted that “reducing restraint use could be prohibitively expensive, causing payors perhaps as much as $1 billion annually.”

However, the extensive analysis performed by the NIH on the use of restraints versus the costs revealed that “residents who are physically restrained require more nursing care than other residents. Higher levels of a nursing assistant's time were consistently provided to restrained patients.” The investigation concluded that “Residents free of restraints are less costly to care for the restraint clients. The 1987 Federal requirements concerning restraint use, which is aimed at improving quality of care and quality of life, can be implemented without engendering major increasing care costs.”

The new law identified what restraint was as defined under the Federal Nursing Home Reform Act of 1987. Congress enacted the law to restrict the use of chemical and physical restraints on elderly residents when used to alleviate a staff's heavy workload, as a form of discipline, or as an alternative to identifying the underlying cause of a medical symptom to justify using the restraint.

In fact, the law only allows the nursing facility to use restraint devices when required to ensure the resident's physical safety and even then, only after a physician has provided a written order that specifies the circumstances and the duration of how the restraint will be used. Unfortunately, many caregivers in the nursing home industry have loosely interpreted the law and still use restraining devices needlessly and without appropriate authorization.

Liability Concerns

Many long-term care facilities and nursing homes are facing the expense of litigation after injuring a resident using restraints. Alternatively, none have been sued because they failed to use a restraint. Many plaintiffs have won lawsuits filed against nursing homes and hospitals because a victim or a loved one suffered serious harm. These lawsuits claim that the facility failed to address the resident's underlying cause of their fall and instead chose to use restraints to prevent recurring accidents.

Personal injury attorneys providing legal representation to plaintiffs have shown in court through expert witness testimony and clinical studies that the use of physical restraints is ineffective at preventing a fall. In fact, many lawyers have been able to prove the opposite, showing that the restraint caused the fall to occur. Some studies have revealed that restrained residents were three times more likely to suffer severe injuries in a fall-related accident compared to residents who were not restrained. No research study to date has shown beneficial consequences for a resident who is being restrained. In fact, the studies show the adverse effects among restrained elderly residents who were significantly more likely to suffer from increased morbidity and mortality rates.

Common Restraint Adverse Effects

Some studies have shown the adverse effects related to the use of a physical restraint that causes significant cognitive, physical, psychological, behavioral and physiological changes in the restrained resident. The most common adverse effects involve:

  • Physical Effects – Some studies show that restrained residents suffered horrific consequences including:

    • Skin trauma involving bruises, cuts and tears,
    • Decreased endurance, strength, tone and muscle mass,
    • Fall-associated injury
    • Increased falls with injuries
    • Accidental death caused by strangulation

  • Cognitive and Psychological Effects – Researchers have identified the negative aspects of restrained or residents that cause problematic cognitive and psychological effects including:

    • Humiliation
    • Depression
    • Anger
    • Emotional isolation
    • Fair
    • Increased dementia
    • Anxious or sad moods
    • Loss of self-determination

  • Physiological Effects – Some of the physiological effects of restraining residents in a nursing home involve:

    • Increased dementia
    • Reduced appetite
    • Incontinence
    • Constipation
    • Orthostatic hypotension – Decreased systolic blood pressure or decreased diastolic blood pressure when standing compared to sitting or when in a supine position.
    • Dehydration
    • Bone demineralization
    • Cardiac distress

  • Behavioral Effects – Some of the adverse behavioral effects of restraining a resident in a nursing facility involve:

    • Combativeness
    • Anger
    • Withdrawal

Alternatives to Using a Physical Restraint

Caregivers can improve resident safety using appropriate adaptive devices instead of unlawfully using physical restraints without authorization. The caregiver can lower the bed to reduce the potential risk of severe injury should the resident fall out. Chair alarms and bed alarms can be used as a useful tool for notifying staff members should the resident stand up or shift their weight significantly, which could cause them harm.

The caregiver can also increase resident safety by using alternative methods including making modifications to the resident's wheelchair or recliner and alleviating discomfort using wedge cushions. The nursing staff and doctors can also develop, implement and enforce the resident's Care Plan that would include toileting and napping schedules, occupational and physical therapy sessions, exercise programs, and positioning mobility-challenged residents near the nursing station. The most common alternatives to using a physical restraint on a resident include:

  • Utilizing psychosocial interventions that could include active listening, therapeutic touch, resident to staff conversations, and distractions including calendars, radios, and television.

  • Utilizing supervision and companionship interaction provided by family, friends, staff members and volunteers that minimizes the time the resident feels alone.

  • Eliminating or modifying treatments that cause distress including nasogastric tubes and intravenous lines that can create confusion or panic in some residents.

  • Modifying the nursing home's elements by utilizing a bedside commode, adding better lighting, or positioning the resident close to the nursing station. Other modifications can include leaving the resident's bed rails in the down position, placing an additional mattress on the resident's floor and keeping the room quiet while positioning the call light near the resident for easy access.

  • Utilize useful tools for minimizing the need to restrain the resident. These tools could include installing a pressure sensitive bed alarm and playing music that is tailored specifically to the resident's likes.

Recent studies have revealed that restraining a nursing home resident poses significantly more risks to injury compared to the benefits they provide. Even though the federal government has enacted laws to minimize the use of restraint through regulations, there is still a significant prevalence of restraint use without proper legal authorization.

As a result, many victims and family members have filed lawsuits against nursing facilities and medical professionals who have not follow the established procedures and protocols and misuse restraints.

Hiring a Restraint Injury Attorney

If your loved one was the victim of mistreatment, neglect or abuse by caregivers at the nursing home, you might be entitled to receive financial compensation. The nursing home injury attorneys at Rosenfeld Injury Lawyers successfully prosecute chemical and physical restraint injury cases to hold those at fault for injuries financially accountable. Our legal team believes that older adults should be respected and treated with dignity while receiving the highest level of care in an assisted living center, nursing home, or rehabilitation facility.

We urge you to contact our law offices today at (888) 424-5757 to schedule a no obligation, initial consultation at no charge to you. Let us review the facts of your case and provide numerous legal options on how to proceed. We accept all nursing home abuse, neglect, and mistreatment cases through contingency fee agreements. This arrangement postpones payment of all our legal services until after we have successfully resolved your situation through a jury trial or a negotiated settlement.

We provide every client a “No Win/No-Fee” Guarantee, meaning if we are unable to finalize your claim for compensation, you owe us nothing. All information you share with our law offices will remain confidential.


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