$Unique_ID{BRK02461}
$Pretitle{}
$Title{What are the Laws Concerning Elderly Care in Nursing Homes?}
$Subject{nursing home homes reform act omnibus budget reconciliation physical
restraints restraining age aging aged old older elderly geriatric geriatrics
behavior behaviors nurse restrain restrained restraint care taking}
$Volume{T-23}
$Log{}

Copyright (c) 1992,1993   Tribune Media Services, Inc.


What are the Laws Concerning Elderly Care in Nursing Homes?


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QUESTION:  I was visiting my father in his new nursing home, when I noticed
that another patient on his floor was sitting in a wheelchair, with straps
around her, tying her to the chair.  I am worrying that they might treat my
father in this same fashion.  Do you know of any rules that govern the use of
these measures in nursing homes?

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ANSWER:  While such restraints were pretty common in nursing homes in the
past, today they are considered a major "no-no".  Yes there is legislation
that deals with this contained in the Nursing Home Reform Act (contained in
the Omnibus Budget Reconciliation Act) that was passed in Congress in 1987.
The use of physical restraints (and medications as well) was limited to
treating medical symptoms, and specifically prohibits their use for the
purposes of discipline or convenience.  This Act forms the basis for the
guidelines used by state nursing home inspectors and is used by the Health
Care Financing Administration which regulates Medicare and Medicaid certified
facilities.  Since these regulations went into effect, the use of both
restraints and sedating drugs is being closely watched.
     While there are restrictions in the use of these methods of controlling
patient behavior.  And the patterns of behavior in some patients may tax the
ingenuity of nursing home staffs.  However, in many cases restraining an
agitated patient just makes the situation worse, and can also cause injury in
the form of skin abrasions and ulcers when improperly applied.
     There are times, however, when a restraint such as you noticed may have a
proper place in caring for these patients.  That is when there is a question
of safety.  The situation that comes to mind first is safety during sleep.
When bed rails are judged insufficient to prevent a patient from falling out
of bed, restraints may be indicated.  They are usually placed in such a manner
as to allow the patient to move about with some freedom.  In fact, all use of
restraints must be governed by concern for the patient's freedom, dignity and
safety, and applied in a manner that is comfortable and improves the quality
of their lives.

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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician.  Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.