Many of us have heard stories of residents in a LTC (Long-term Care) or Assisted Living being restrained. What does that really mean? And if restraints are used are the residents’ rights being violated?
Per California regulations a resident has the right to be free from physical and chemical restraint. The patient has the right to decline their use. The nursing home must obtain informed consent from the patient, family, and/or POA prior to using any type of restraint to ensure that no resident’s rights are violated.
A physical restraint is anything that is attached to, placed next to, or restricts the patient’s movement or access to their body. Items such as hand mitts, vests, cloth ties, leg and/or arm restraints, wheelchair safety bars, or anything else that prevents the patient from moving around are considered physical restraints. For example, placing a patient’s bed against a wall or using a bedrail, limiting their ability to get out of bed alone is considered a restraint. Another example is moving the resident’s wheelchair against a wall so that they patient cannot move. Nursing homes are not permitted to restrain or do anything that limits the patient’s movement unless the patient or their representative gives permission prior to their use.
Note: A patient’s representative may be a family member, a court appointed conservator, a person that the patient has chosen through an Advanced Health Care Directive, or some other person chosen by the patient that complies with the law.
Chemical restraints are any drugs that are used for discipline or convenience. These medications are not necessary for the patient’s well being. For example, they are not used to treat high blood pressure or a heart problem.
When can a restraint be used?
Restraints can only be used to treat the patient’s medical symptoms and only if the restraint will assist the patient in reaching their highest functioning potential. The only exception to this is in a case of an emergency, where the patient is in danger of harming himself/herself or others. Before using any restraints the nursing home must try all other methods of care. This may include, but not limited to, therapy to improve the patient’s ability to stand or walk and lowering of the patient’s bed to decrease the likelihood of injury due to a fall. The nursing home may use other methods such as pillows, pads, or lap trays to help the patient maintain good body positioning and balance without the use of restraints.
If all methods of non-restraint have be exhausted the nursing home may suggest the use of restraints. Before any restraints can be used the primary care physician must be contacted and the options discussed. The doctor must then write an order for the use of restraints. The written order must contain the duration of use (i.e. a week, a month, etc.) and how often it is to be used (i.e. while in wheelchair).The doctor must also explain the symptoms that the restraint is being used for. The patient and/or their representative have to have enough information to make an informed decision. The side effects must also be discussed with the patient or their representative. Side effects vary and could include incontinence, reduced ability to walk or move your limbs, and an increase in depression.
Bottom line is the patient and/or representative must be given complete information and must understand the information before the use of any restraint. There is only one exception, in the case of an emergency where the patient poses a risk to himself/herself or others. The nursing home must ensure that the resident’s rights are protected at all times. The resident and/or representative have the right to refuse the use of restraints. The facility must ensure that they are using the least restrictive measures. Help protect our elder population by being fully informed.
Below are some questions that patient and/or representative should ask the doctor and facility prior to the use of restraints:
- What is the reason that the doctor believes the restraint is necessary?
- Can the problem be treated without a restraint and has the facility used other alternatives which are not restraints to treat the problem? (Has the patient received any therapy such as Physical Therapy, Occupational Therapy, or Speech?)
- What measures are being use and for how long? How often is the restraint going to be used? How restrictive is the restraint?
- What are the benefits and risks in using the restraint?
- Are there any side effects? If so, how long will they last and what are they?
The patient and their family/or representative are encouraged to write other questions they may have. Please do not be afraid to ask questions. Asking questions only helps the patient get better care.