Federal Definition of Restraint in Nursing Homes

Nursing homes that are certified by Medicare and Medicaid must follow federal guidelines when it comes to restraining their patients. Under federal law, restraint can only be used to treat the medical symptoms of a patient, and requires consent from either the resident or their legal representation. Restraint cannot be used for the purposes of convenience or as a substitute for other forms of medical treatment. Nursing home residents have the right to refuse restraint of any kind.

Purpose

• Drugs and sedatives can be used as restraining devices.

  The purpose of using restraint in nursing homes is to prevent the movement of a nursing home resident to protect them from themselves, or from harming others. Devices that can be used to restrain a nursing home resident include wrist restraints, belts and vest restraints. Other devices, such as bed rails, can be used to aid or restrain a nursing home member. For example, bed rails can be used to help patients in and out of bed, or they can be used to keep a patient from leaving her bed. Other restraining devices include drugs and sedatives.

Law

• Under certain circumstances, restraints can be used to help the patient, although this is not always the case. The Nursing Home Reform Act of 1987, also known as the Omnibus Budget Reconciliation Act of 1987 (OBRA 1987), protects nursing home patients from any form of abuse, including the use of restraints when they are not needed. The Nursing Home Patients Bill of Rights (NHPBR) allows residents of nursing homes to reject any chemical treatment, or any other form of restraint, without fear of discipline. Staff members who violate restraint laws are subject to criminal charges.

Guidelines

• Staff members of a nursing home must exercise restraint with restraints.

  Under federal law, all Medicare/Medicaid nursing home facilities must follow federal guidelines when using restraints on their patients. Restraints can never be used as a form of punishment, or to permanently keep a patient under control who otherwise does not need restraint. Restraints can also not be used as a substitute for other treatments, unless all other treatments have failed. Even then, a resident has the right to deny the use of restraining devices. Lastly, restraints cannot be used simply to make things more convenient for the staff.

Exercise

• Residents of nursing homes must be allowed to exercise.

  Under federal law, nursing homes that are Medicare/Medicaid certified can only use restraints to treat a resident’s medical symptoms. Federal law also mandates that nursing homes enhance or maintain a resident's quality of life, and that restraints should only be used to achieve that. If a resident is under restraint, they must be released for at least two hours of exercise a day.

Consent

• Only physicians can order drugs and sedatives for nursing home residents.

  To use any form of restraining device on a resident of a Medicare/Medicaid-certified nursing home, consent must first be given by the actual resident. In the event that the resident is not in a condition to determine whether restraints are necessary, the resident’s legal representative must give consent. Any medication used, including sedatives, for the purpose of restraint is prohibited unless a physician allows it. If a physician does allow it, the order must be in writing and must express how long the drugs should be taken for.