Restraints in California Nursing Homes: Potentially Harmful, Yet Still Used

According to the Nursing Home Reform Act (NHRA), of ORBA 1987 a nursing home resident has right to be free from physical, mechanical, or chemical restraint that restricts movement or normal access to one’s own body for purposes of discipline or convenience, or that is not required to treat the resident’s medical symptoms. Inappropriate use of restraints makes elderly nursing home residents vulnerable to nursing home abuse, neglect, abandonment, and isolation.

In the past, the perceived primary justification for restraining elderly nursing home residents was to prevent falls and injuries. Despite the restraint reduction mandates of the Nursing Home Reform Act (NHRA), the use of restraints on elderly nursing home patients continues to be accepted as inevitable; by the medical staff, the families of patients and no doubt, by nursing home residents, themselves.

Contrary to those perceptions of nursing home restraints, extensive research has shown a number of adverse events associated with a high-usage rate of restraints on nursing home patients and long-term care residents. These include:

• More Severe Fall-Related Injuries
• Decreased Mobility Abilities
• Pressure Sores or Ulcers
• Depression
• Aggression
• Impaired Cognitive Performance
• Impaired Social Engagement
• Death

Between 1999-2004, a cross-cultural study, published in Z  Gerontol Geriatrics 2005, estimated the use of physical restraints on the elderly in nursing homes ranged from 41-64%. The most frequently used restraints in nursing homes are bed rails, bed belts and table-chairs with belts. Medications have also been used as a means of restraining a nursing home resident. (See: Medication Errors in Nursing Homes)

A study published in Gerontologist, 2004 concluded that elderly residents of nursing homes with a high rate of restraint usage stayed in bed, during the day, 10% more than nursing homes with a low rate of restraint usage.  The restrained nursing home residents in the study were also more frequently observed with bed rails in use and they received less feeding assistance during meals.

Some predictors of high restraint usage in a nursing home or long-term care facility include:

• Membership in an Organized Health Care Chain
• High Medicaid Census
• Low staffing levels
• High Ratio of Certified Nursing Assistants (CNAs) to Registered Nurses (RNs)

The California Healthcare Foundation released a report last year, Snapshot: California’s Fragile Nursing Home Industry , which estimated that physical restraints are used on twice as many of the 110,000 California nursing homes residents, than are used nationally. Also, more California nursing home residents remain in bed all or most of the time, than residents do across the nation. The report also concluded that:

• Nursing assistants (CNAs), with about four weeks of on-the-job training, provided 64% of care to nursing home residents.

• Ninety-five percent California nursing homes did not meet the recommended daily standard of 4.1 hours of nursing per resident, per day.

• Nearly 25 % did not meet the state mandate of 3.2 hours of daily nursing care.

If you or a loved one has suffered due to the inappropriate use of restraints in a California nursing home or long-term care facility, contact a California Nursing Home Neglect Lawyer or California Elder Abuse Attorney for legal help, advice and assistance.

Young & Wallin handle California elder abuse and nursing home abuse and neglect cases throughout the state of California including Southern California elder abuse and nursing home abuse and neglect cases in Bakersfield, Barstow, Fresno, Los Angeles, Orange County, Riverside, Roseville, Santa Barbara, San Bernardino, San Diego, San Jose, San Francisco, Sacramento, and Ventura, California. As elder abuse attorneys and nursing home abuse attorneys, we also handle elder abuse and nursing home abuse cases out of state on a case-by-case basis.

If you or a loved one thinks you may have been a victim of elder abuse, nursing home abuse or neglect, contact us immediately.

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