Federal Law Regarding
The Use of Restraints in Nursing Homes
The following is an exact quote from Briefings on Long-Term Care Regulations, Vol.10, No. 3, March 2002, page 9 (published by Opus Communications, a Division of HC Pro). It is an excellent concise summary of the federal law regarding restraints. On the state level, there can be even stricter laws, but they cannot override or conflict with those on the federal level.
"OBRA Unrestrained About Restraints"
"The Nursing Home Reform Amendments of the Omnibus Reconciliation Act of 1987 (OBRA) detail the rights of residents to be free of physical and chemical restraints that are used by facilities for discipline and convenience. According to OBRA, residents have the following rights regarding restraints:
- Facilities should only use physical restraints as they are prescribed by written physician orders to treat a resident's medical symptoms and to ensure the safety of the resident and others.
- Facilities should only administer chemical restraints when they are ordered by a physician as part of a written plan of care for a specific medical symptom. An independent, external expert needs to review the use of chemical restraints for appropriateness at least annually."
Okay, that's the law.
How do I control problem residents?
Nursing home caregivers face a special challenge. Up to that stage of care, the place someone calls home all her life is almost assuredly of her own choosing. In nursing homes, there are invariably some residents who don't want to be there, and may have been "placed" by a close relative. What was intended as an act of kindness may be perceived by the resident as a "sentence," resulting in a depressed or even rebellious attitude. Add the possibility of varying degrees and types of dementia and physical limitations, and the caregiver has a very difficult task indeed.
How do you control problem residents? Legally, you can't restrain them, unless a physician has deemed restraints necessary. Remember, restraints work against the will of the resident by controlling him/her, either physically or mentally. That is not allowed except as described in the OBRA 1987 laws cited above. But there are ways to manage residents, and that means working with them instead of against them.
One of best ways to manage fall risk residents is the use of bed, chair, wheelchair and toilet electronic monitoring systems. Such systems can serve two purposes. One, of course, is to alert staff when a fall risk resident attempts to get up unassisted. But secondarily, a system that can also provide an alarm history can help staff establish fall risk resident behavior patterns. If, for example, it becomes apparent that every morning between 3:30 and 4:00 Fred Jones in room 303 gets up for a bathroom trip, a caregiver can pre-empt his bed exit by getting him up at 3:30 to go. Patterns are difficult to establish if only relying on the memory of already overloaded caregivers. Reliable electronic systems like Bed-Check's Model Vr can do much of the work for you.
Regardless, monitoring of fall risk residents is a safety issue. Reliability is imperative.
|
