Safety and Dignity: The Importance of Physical Restraint-Free Care in Nursing Homes

At Olsman MacKenzie Peacock, we believe every nursing home resident deserves care that respects their dignity, autonomy, and freedom. Unfortunately, in some facilities, physical restraints are still used, limiting a resident’s freedom and causing serious physical and psychological harm. It is crucial to understand your loved one’s rights and how the inappropriate use of physical restraints violates those rights. 

What Are Physical Restraints?

A physical restraint is any object or device that restricts a resident’s movement or access to their own body and cannot be easily removed by the resident. Common examples include:

  • Bed rails that prevent a resident from voluntarily getting out of bed due to their physical or cognitive inability to lower the rails independently.
  • Placing a chair or bed close enough to a wall to prevent the resident from rising or getting out of bed.
  • Placing a resident on a concave mattress so they cannot independently get out of bed.
  • Tucking in a sheet tightly or fastening fabric/clothing to restrict movement.
  • Placing a resident in a chair, such as a beanbag or recliner, that prevents independent rising.
  • Using devices in conjunction with a chair (trays, tables, cushions, bars, or belts) that the resident cannot remove and that prevent rising.
  • Applying leg or arm restraints, hand mitts, soft ties, or vests that the resident cannot remove.
  • Holding down a resident in response to a behavioral symptom or during care if the resident is resistive.
  • Placing a resident in an enclosed framed wheeled walker that they cannot open or has been altered to prevent exiting.
  • Using a position change alarm to monitor movement, causing the resident to fear moving to avoid setting off the alarm.

Under 42 CFR 483.12, nursing home residents have the right to be free from physical or chemical restraints that are used for convenience or discipline rather than for medical reasons. Restraints should only be used to treat a resident’s medical symptoms and must be the least restrictive option for the shortest possible time. Even when restraints are necessary, facilities must continually monitor and reassess their use. 

The Harm Caused by Physical Restraints

Physical restraints often lead to harmful outcomes, both physical and psychological. Physically, they can cause:

  • Serious Injuries: Bruises, cuts, entrapment, strangulation, and suffocation.
  • Health Issues: Pressure sores, infections, incontinence, poor circulation, weak muscles, bone deterioration, and respiratory complications.
  • Accidents: Falls and injuries can become more severe when a resident is restrained and tries to free themselves.

Psychologically, restraints can have devastating effects:

  • Agitation and Anxiety: The feeling of confinement can increase a resident’s distress and cause anxiety.
  • Loss of Autonomy: Being restrained strips residents of their independence, leading to depression, withdrawal, and reduced social interaction.
  • Dehumanization: Restraints can make residents feel imprisoned, causing them to lose dignity and self-respect. 

Why Are Physical Restraints Used?

Restraints are often used on elderly residents who may fall or on residents with dementia who wander unsafely. However, many nursing homes use restraints due to:

  • Misconceptions about Safety: Families or staff believe restraints prevent falls, though evidence shows they often lead to more injuries.
  • Liability Concerns: Some facilities use restraints to avoid being held responsible for accidents.
  • Staff Shortages: Inadequate staffing can result in facilities using restraints instead of providing individualized care. 

The Right to Restraint-Free Care Under Federal Law

The Nursing Home Reform Act of 1987 and 42 CFR 483.12 ensure that nursing home residents have the right to:

  • Freedom from Restraints: Restraints cannot be used for convenience or discipline and may only be used to treat medical symptoms.
  • Quality of Care: Nursing homes must provide care that prevents poor outcomes and promotes residents’ dignity.
  • Individualized Care Plans: Each resident must have a care plan that addresses their needs and helps them maintain their highest level of functioning. 

Restraint-Free Care is Possible

Many nursing homes have successfully adopted restraint-free care practices without an increase in serious injuries. In these environments, residents are able to move freely, maintain their strength, and live with dignity. While no facility can completely prevent all falls, restraint-free care focused on individualized, person-centered care is far more effective than using physical restraints. 

Strategies to Reduce and Eliminate Physical Restraints

Eliminating restraints requires a comprehensive approach involving the entire facility. Strategies include:

  • Comprehensive Assessments: Evaluating residents’ physical and emotional needs allows staff to provide appropriate care without restraints.
  • Individualized Care Plans: Developing care plans tailored to each resident’s unique needs and routines.
  • Staff Training: Educating caregivers on how to meet residents’ needs without resorting to restraints.
  • Consistent Staffing: Ensuring consistent caregivers to foster relationships and trust with residents.
  • Creative Solutions: Finding alternative ways to meet residents’ needs, such as creating safe environments with comfortable seating, good lighting, and clear walking paths.

When Are Restraints Appropriate?

Restraints should only be used when a medical symptom necessitates their use, and a physician’s order is required for any restraint to be applied. However, they must always be the least restrictive option and used for the shortest time possible. Examples of inappropriate restraint use include placing residents in chairs they cannot rise from or using bed rails to prevent movement when the resident cannot lower them independently.

If your loved one is being restrained, the facility must:

  • Obtain and document a physician’s order for the restraint, based on the identified medical symptom.
  • Document the medical reason for the restraint.
  • Use the least restrictive method for the shortest time.
  • Reassess the resident regularly to ensure the restraint is still necessary.
  • Provide continuous monitoring and care during the use of restraints. 

How Olsman MacKenzie Peacock Can Help

At Olsman MacKenzie Peacock, we are committed to protecting the rights of nursing home residents. If your loved one has been harmed by the use of physical restraints, we can help you seek justice. Our experienced team will investigate your case, hold the nursing home accountable, and fight to recover compensation for the harm caused. 

Contact us today if your loved one has suffered from the inappropriate use of physical restraints. We are here to ensure that every nursing home resident receives the respect, care, and dignity they deserve.