Restraint Injuries in Pennsylvania Nursing Homes

The rule

Restraint is permitted only to treat a resident’s medical symptom, with a physician order, informed consent, monitoring and a plan to reduce and remove it. Restraint for discipline or for staff convenience is prohibited.

In practice, restraint used because there are not enough staff to supervise safely is restraint for convenience, whatever the paperwork says.

What counts as a restraint

More than people expect:

• Bed rails that a resident cannot lower.
• Lap belts, trays and tables that prevent rising.
• Chairs a resident cannot get out of, including deeply reclined ones.
• Tucking sheets tightly enough to restrict movement.
• Placing a walker or wheelchair out of reach.
• Medication used to sedate rather than to treat a diagnosed condition.

The harms are physical, not just dignitary

Immobility from restraint produces pressure sores, muscle wasting and contracture, incontinence, constipation, pneumonia and rapid functional decline. Restrained residents frequently become more agitated rather than calmer.

Entrapment and strangulation in bed rails and lap belts remain a recognized cause of death, particularly where a resident attempts to climb over or slide under a restraint.

The paradox families should know

Restraints are often justified as falls prevention, and the evidence does not support that. Restrained residents lose strength and balance, and injuries frequently increase. A facility explaining a restraint as being for the resident’s safety is making a claim that can be tested.

What to ask and request

What is being used, who ordered it, what medical symptom it treats, what consent was obtained, how often the resident is monitored and released, and what the plan is to reduce it.

Then request the physician orders, the care plan and revisions, restraint monitoring records, consent documentation and the medication administration record.