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Restraints

The Nursing Home Reform Act of 1987 gives 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. Physical and chemical restraints may be used only to ensure the safety of the resident or other residents and, except in an emergency, only when a doctor writes an order that details the length of time and circumstances under which restraints can be used. Because of the potential dangers involved, restraint use must be monitored, and its effectiveness must be continuously evaluated. An effort should always be made to use the least restrictive available method of restraint, and to restore each individual to his or her maximum possible level of independence.

There are two types of restraints used in nursing homes. Physical restraints include restrictive chairs, bedrails, hand mitts, vests that tie nursing home residents to chairs or beds, wrist restraints, and ankle restraints. Chemical restraints are psychoactive drugs given to control unwanted and uncooperative behaviors, such as pacing, restlessness, and extreme agitation. Applying physical or chemical restraints routinely or for prolonged periods should be avoided whenever possible.

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

• Humilation and depression
• Increased cognitive dysfunction, such as disorientation and confusion
• Decreased involvement in nursing home social activities
• Increased agitation and loss of autonomy
• Bedsores
• Loss of muscle function
• Increased bone fragility
• Cardiopulmonary de-conditioning
• Frozen joints
• Lower extremity edema