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.