Legal Ramifications Nursing Home Restraints

Legal Ramifications of the Restraint of Nursing Home Residents

What is nursing home restraint?

The restraint of nursing home residents is a very serious issue and is strictly monitored and prohibited except in extreme circumstances. A restraint is defined as:

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“any device, material or equipment attached to or near a person's body and which cannot be controlled or easily removed by the person and which deliberately prevents or is deliberately intended to prevent a person's free body movement to a position of choice and/or a person's normal access to their body.” ¹

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Examples of restraints in nursing home residents can include:

• Wrist restraints
• Lap buddies that prevent a resident from rising from a wheelchair
• Gerry chairs or recliners that tip backward, when a resident is incapable of moving the chair to an upright position (this includes wedging items such as trashcans under the footrest of a recliner)
• Locked wheelchair wheels when the resident is unable to unlock such devices without assistance
• Vest restraints that tie to bed frames
• Side rails on beds
• Hand mitts
• Sheets tucked into the mattress so tightly that a resident is unable to move
• Solitary confinement to a room
• Chemical restraints, such as Thorazine, Ativan, Haldol, or Versed

Why Restraints Should Not Be Used on Nursing Home Residents

The laws that govern the care of nursing home residents differ from those that govern the care of hospital patients. Nursing home residents require assisted care, but the nursing home facility is their permanent home. As such, basic human rights such as privacy, and safety are of utmost concern. Nursing home residents should not be confined for safety reasons unless all other measures have been exhausted.

Alternatives to Restraints in Nursing Home Residents

When a resident is identified as being at risk for injury, the first intervention should never be a restraint of any form, and even when restraints are deemed necessary, the resident should be prescribed the least restrictive form of restraint possible.

Alternative measures to ensure a resident’s safety may include:

• Lowered mattresses or bed frames
• Mattresses placed on the floor
• Nonrestrictive alarms that alert staff of a resident’s attempt to rise from a bed or chair
• Redirection, or frequent activities
• Spending limited time in a common room or at the nursing station where supervision is more intense during times of the day when staffing is thinnest
• Incontinence training to help with attempts to ambulate to the bathroom unassisted
• Pain management

All physical and chemical restraints require a doctor’s approval. “Standing orders” for any type of restraint are illegal, and whenever a restraint is placed, the resident’s family representative must be notified of the application of the restraint and the interventions that were attempted prior to restraining the resident.

Wrongful Use of Restraints in Nursing Home Residents

When a restraint is wrongly used in the nursing home, the resident or the resident’s family may have legal recourse against the nursing home. Sometimes, restraints that are intended to prevent injury actually cause the injury or death of a nursing home resident. All restraints are dangerous to a resident and must be used with careful supervision and monitoring. Possible injuries from restraints can include:

• Falls
• Broken bones
• Pressure sores
• Skin tears
• Psychological effects such as depression, fear, or agitation
• A reduction in the ability to enjoy life or perform self-care activities
• Death

When a restraint is used, the resident is then at the complete mercy of others for his or her safety. This puts the resident at a greater risk for elder abuse, sexual abuse, psychological abuse, or violence perpetrated by other nursing home residents.

Nursing homes that are experiencing a staffing shortage may be tempted to increase the number of restraints in use to “make up” for the lack of supervision. Residents are especially at risk for the application of illegal restraints during the nighttime hours, when staffing may be at its lowest. If your loved one has not previously been prescribed a restraint, and you suspect an illegal restraint is being used, you may notice symptoms such as:

• Bruising on bilateral wrists
• Repetitive forward rocking motion when in the wheelchair, as if to force previously locked wheels free
• Changes in mental condition such as grogginess following the administration of a chemical restraint
• Ties hanging from the bed frame, or the presence of other unusual devices in the room that look as if they may be used to restrain a person
• Extra trashcans in the room when your loved one prefers to sit in a recliner

If you suspect your loved one is being illegally restrained in the nursing home, take action. Contact your loved one’s physician immediately to report your suspicions and question the nursing home administrator regarding the care of your loved one. If you find evidence of illegal restraint, don’t hesitate to notify your State Ombudsman, local police department, and a nursing home abuse attorney. The safety of your loved one and other residents of the nursing home depends on your actions.

If you suspect the improper use of restraints at a nursing home, call the lawyers at Sweeney Law Firm. In addition to the criminal charges which may be brought against the perpetrators, you and your loved one may be entitled to financial compensation for the damages incurred. The lawyers at Sweeney Law Firm specialize in elder care law and will help ensure that the improper restraint does not continue and that your loved one receives adequate care. There is no cost or obligation for us to evaluate your case. The Sweeney Law Firm works on a contingency fee basis. There is never a fee unless a recovery is made for you.

¹ Use of physical restraint in nursing homes: clinical ethical considerations