Physical and Chemical Restraints in Nursing Homes
In 1987, Congress passed the Omnibus Budget Reconciliation Act, which contained the Nursing Home Reform Act. The act is designed to ensure nursing home residents receive a high quality of service. The act also includes a Residents’ Bill of Rights that states residents must be free of physical or chemical restraints that aren’t being used to treat their medical symptoms. However, nursing homes continue to use physical or chemical restraints, and some of them abuse the tools.
- What are physical restraints?
- When do nursing homes use physical restraints?
- What are the possible adverse effects of physical restraints?
- What are chemical restraints?
- What are the adverse effects of chemical restraints?
- Are there any times when the use of restraints makes sense?
- How can caregivers help ensure their loved ones are safe from restraints?
What are physical restraints?
According to a Journal of Medical Ethics article, physical restraints are “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.” Examples of restraints are vests, wheelchair bars or brakes, and sides on beds.
When do nursing homes use physical restraints?
Nursing home use of physical restraints worldwide varies from 5 percent to 85 percent, according to an article in the Journal of Medical Ethics. The range varies depending upon the country, the level of cognitive or physical function of the patients, and the local culture. Sometimes, nursing homes use physical restraints because they or the family believe they keep the patient safe from falls or wandering away, especially in short-staffing situations. However, the decision to use restraints should take more than the residents’ physical well-being into account. It also should consider their social and psychological well-being, the article says.
What are the possible adverse effects of physical restraints?
Physical restraints often have significant adverse effects on the health of nursing home residents. According to the Journal of Medical Ethics and a Health and Human Services Office of Inspector General study, physical effects can include the following:
- Respiratory complications
- Incontinence and constipation
- Requiring more help to conduct the activities of daily living
- The loss of bone mass and impaired muscle strength and balance
- Increased agitation
- Decreased cardiovascular endurance
- Increased risk of death because of strangulation or serious injuries
Although some residents report that some restraints, such as sides on the bed, make them feel safer, many residents express that the restraints negatively affect their dignity and cause them to feel ashamed. Some say they feel like caged birds, according to the article. They are frustrated, the HHS study says.
What are chemical restraints?
Chemical restraints are “any form of psychoactive medication used not to treat illness, but to intentionally inhibit a particular behavior or movement,” according to the College of Nurses of Ontario. Marquette Elder’s Advisor’s definition of chemical restraints does not limit the description to psychoactive drugs but instead includes any drugs that institutions use primarily for discipline or convenience. Chemical restraints, under this definition, can consist of prescribed and useful drugs that medical professionals dispense in overdose quantities.
Nursing homes sometimes use chemical restraints on residents who suffer from mental disabilities, according to the Marquette Elder’s Advisor article.
What are the adverse effects of chemical restraints?
Chemical restraints can also adversely affect nursing home residents. According to the Marquette Elder’s Advisor, examples of these effects are:
- An increase in instability, which can result in more falls
- Memory impairment and confusion
- Hypotension, especially a drop in blood pressure when the patient tries to stand
- Movement disorders, such as eye spasms, rigidity, or tremors
- Functional decline in the activities of daily living
- Agitation, insomnia, hallucinations, or nightmares
Are there any times when the use of restraints makes sense?
The Nursing Home Reform Act wants to end the use of restraints merely as a convenience and to find alternatives to the use of restraints whenever possible. However, sometimes restraints make sense. The key is that the restraint’s benefits must outweigh any physical, psychological, and social risks. Even then, health-care practitioners should choose the least restrictive restraint possible.
Specifically, the Journal of Medical Ethics says that physical restraints are justified only in certain situations:
- Health care professionals, family, and the patient envision specific benefits
- The healthcare team expects physical restraints to make the benefits attainable
- No practical alternatives exist
- Physical restraints hinder the person as little as possible
If health-care workers use physical restraints, they should continually monitor the individual’s health status to ensure the restraints are still providing more benefits than adverse effects. They also should ensure the patient is as comfortable psychosocially as possible. They should periodically offer breaks from the restraints and continually reevaluate the need for them.
Marquette Elder’s Advisor says that a nursing home patient’s care team should only use chemical restraints under certain conditions. These conditions include:
- The patient, or their legal representative, gives their informed consent
- The health-care team thoroughly explains the risks and benefits in the context of the individual’s circumstances
- A physician prescribed them
The resident also should have the right to refuse chemical restraints even if their doctor or the institution strongly recommends them. If the resident cannot decide for themselves, their health-care proxy should not give consent for the drugs to be used for convenience.
How can caregivers help ensure their loved ones are safe from restraints?
The most important way you can ensure your loved ones aren’t restrained for convenience is to be active in their care plan. Those who make decisions for their loved ones should regularly review their clinical charts and speak with all health-care team members. If you notice changes in medication or that your loved one is more sluggish and sedated than usual, speak up. Asking questions about your loved one’s mobility, digestive issues, falls, and possible interactions with other residents is also important.
An article in Aging Care suggests questioning specific diagnoses and seeking second opinions if these diagnoses appear in the chart. Doctors can prescribe psychotropic drugs legally for specific diagnoses, such as schizophrenia, Tourette’s syndrome, or Huntington’s disease. A New York Times analysis of Medicare data found that one in nine patients had been diagnosed with schizophrenia, even though the rate of schizophrenia in the general population is one in 150 people. Schizophrenia diagnoses generally occur before age 40. The Times concluded that doctors were falsely diagnosing patients with schizophrenia to be able to prescribe drugs for convenience.
If you believe your loved one is being restrained without a good medical reason, contact us today. We believe everyone who abuses senior citizens in nursing homes should be held accountable. Contact us to receive a free review of your case.
Dr. Patricia Shelton, MD
Dr. Patricia Shelton, MD, is a medical content creator. She holds a Doctor of Medicine degree and a Bachelors degree in neuroscience, both from the University of Washington in Seattle. Her career is now focused around medical communications. She primarily writes content for health-related websites, but has also written test prep materials, white papers, court documents, and more. She also teaches anatomy and physiology at the college level for the National Institutes of Health, as well as at the general public level in yoga teacher training programs. Her book, The Yoga Doctor, was published in 2015.