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Nursing Home Restraint Explained
Jan L. Warner & Jan Collins

Question: The hospital sent our father to a nursing home for rehabilitation after treating him for a broken hip. He tries to get out of bed by himself and has almost fallen several times. We have been asking the nursing home to restrain him in the bed, but they say they can't. How can we protect Dad from doing more damage to himself?

Question: My mother is severely demented. I finally talked my father into placing her in a nursing home because she wails and screams almost 24 hours a day. Although the nursing home told us that they could take care of her, on a recent visit I found that she had been drugged and placed in an isolated part of the facility. The administrator says Mother is disruptive to other residents. While I understand that she may be worrisome to others, I don't believe it is right to treat her like this.

Answer: Federal and state laws generally prohibit the use of physical and chemical restraints as discipline for the resident or as a convenience for the facility. Physical and mental abuse, corporal punishment, and involuntary seclusion are also prohibited.

Generally, however, restraints may be used to treat a resident's medical symptoms with appropriate consent and a written order from the attending physician that details the specific conditions under which restraints are to be used. Even though residents generally have the right to be free from physical restraints and seclusion, these measures may be appropriate if there is significant risk of the resident harming himself/herself or others, and if less restrictive alternatives would be insufficient. In either case, there must be a written doctor’s order that details the reasons for the restraint order. Should the physician’s order be given by telephone, the doctor must examine the resident and sign a written order within twelve (12) hours.

In an emergency, where imminent harm would result and the physician cannot be contacted, the facility may temporarily restrain a resident until a physician's authorization is received. In no case should a resident remain in physical restraints or seclusion for more than 24 hours without another order from the physician. During periods of restraint or seclusion, a health professional should see the resident at least every 12 hours to monitor the resident's condition, and other staff should check the resident at least once each hour. During restraint or seclusion, residents should be allowed to use the toilet according to their needs, bathe, and be fed and hydrated.

If chemical restraints (drugs that have mind-altering effects) are prescribed, they should be part of an overall plan ordered by the attending physician, who must review the resident's medication regimen at least every 30 days.

Taking the NextStep: Under federal law, families have a right to be involved with the facility and the physician in developing a care plan for the resident. Family involvement is especially important if the use of restraints is warranted. Using the above general principles as a guide, we suggest that families become proactive in the treatment plan of loved ones who reside in a facility.

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