Archive for Thursday, March 27, 2008

Nursing homes loosen restraints

March 27, 2008


The use of physical restraints on nursing home patients declined nearly 40 percent nationally in recent years as the federal government, states and the nursing home industry placed greater emphasis on eliminating what once was a common practice.

Overall, about 5.9 percent of 1.5 million long-term patients were physically restrained repeatedly in 2006. That's a drop from 9.7 percent in 2002.

Physical restraints, such as bed rails or wheelchair belts, were once regarded as necessary to improve safety, to keep patients from falling or wandering off, but that mindset has changed during the past two decades.

"There's a whole movement away from a hospital-like environment in nursing homes to a much more homelike environment in nursing homes," said Mitzi McFatrich, executive director of Kansas Advocates for Better Care.

Kansas, at 2 percent, was among the states where restraints were least frequently used in 2006, according to an Agency for Healthcare Research and Quality report. Others were Nebraska, 1.3 percent; and Iowa and Maine, 2 percent. States that most frequently used restraints were California, 13.4 percent; Arkansas, 13.2 percent; and Oklahoma, 11.5 percent.

Kim Milner, project manager for Kansas' Nursing Home Quality Initiative, said the state began working with nursing homes to reduce the use of restraints in 2004 when the rate was 3.6 percent. In the third quarter of 2007, the rate was 1.5 percent.

"They've done an outstanding job. It's very rare that we have nursing homes in the state that are even using physical restraints," Milner said. "I would imagine that probably one-third of the nursing homes - if I had to guess - are restraint-free nursing homes."

Milner credits not only agencies and health advocates but also the nursing homes' staffs, residents and families for the success. When she was director of a nursing home in the 1980s, it was common practice to "tie everybody up to protect them from falling."

"Families were telling me, 'Don't untie them. I don't want them to fall.' So, it has really been a mindset change," she said.


Janis Pool 9 years, 12 months ago

I may be of old "mindset" but the newest Kansas interpretation on the regulation -reversal on the need for personal alarms- was overkill to me. The alarms were and are not binding or restrictive. Certain dementias take away impulse control from adults. Those same adults may still have reason. The alarms became an adaptive way to help those who can help themselves, and or, help those who would not otherwise call for help. But restraining? No.

dragonwagon2 9 years, 12 months ago

My family has just had experience with a restraint free nursing home. The result was.......numerous falls. My Dad, the resident, wasn't safer at all. I do understand and applaud the efforts to avoid "tieing everyone up", but I think we're leaning a little to much away from restriction just to meet the requirements of state agencies. There needs to be a little more concentration on intervention opportunities. It's not that anyone wasn't doing their job, it's just that their options were so restricted by the current reviewing agency guidelines.

I've worked in healthcare for 35 years now. It seems that rather than approach any new initiative with common sense, we lean very far one way then react and lean even farther the opposite way in reaction.

This is a great example of a State (responding, I understand to a National) initiative where common sense regulation would have been to the benefit of everyone involved - the resident (my Dad), the nurses, and the care facility.

HootyWho 9 years, 12 months ago

I agree with dragonwagon, i worked in Nursing Homes for 20 yrs as an aide, State regs play the tettertotter game all the time, one extreme to other, restraint free does work,,,IF you have the staff. It has been my expirience that most of the time there isn't enough staff to do retraint free and have no falls. Back in the day there was always somebody waiting to fill empty positions, its not the case anymore, nobody wants to work as an aide anymore, for lots of reasons, mostly because of ridiculous state regs, and don't get me wrong, some are very good, and some things have changed for the better, but some haven't, and nobody is listening as to why. I hope and pray i don't ever have to place anybody in a nursing home, I've been out of nursing homes for 5 yrs now, making less money, but i have piece of mind, no fear, and my sanity has returned.

aginglady 9 years, 12 months ago

And what about those restraints, belts, harnesses meant to provide torso support and keep a truly balance disabled person upright in their wheelchair? Not tipping over headfirst onto the tile floor? Not sliding down out of their seat, weighing too much for two people to lift easily back up? We gripe about the cost of Medicare, and yet we encourage fall injuries?

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