I found an article about nursing homes and restraint use.

WASHINGTON (AP) – 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.

This is great news! Many who work in nursing homes- nurses, aides and others- are not pleased with the rules about restraint use. There is a real fear of resident safety.

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

When I first began working as an aide, restraints were common. We used them all the time: bed rails, seat belts, recliners, lap trays…not to mention posey vests and mitts and even leg and arm shackles. The use of such devices was justified in the name of safety. Staff couldn’t be with the residents all the time and we had to have some way to keep them safe.

States where physical restraints for nursing home patients were most frequently used in 2006 were: California, 13.4 percent; Arkansas, 13.2 percent; and Oklahoma, 11.5 percent.

States where restraints were least frequently used were Nebraska, 1.3 percent; and Iowa, Kansas and Maine, 2 percent. The nursing home data was part of an Agency for Healthcare Research and Quality report that compares states on numerous health issues.

As a side note to these numbers, only Oklahoma and Maine have mandated CNA/Resident ratios. The other states listed do not. That tells us a lot.

We all know the effects of restraint use:

Those effects typically include depression, pressure sores and dehydration, she said. Research has also shown that restraints even increased the likelihood of injury as the restrained residents lost strength due to inactivity, making it harder for them to walk once they were allowed to move around.

…Yet many aides and nurses still complain about the restrictions placed upon nursing homes with the use of these devices. The fear is still there. And it comes with good reason: Residents do fall; they trip, they slide, they get hurt. We’ve heard the saying that it’s the resident’s right to fall…and that bothers us. Falls come with their own set of problems: Broken hips, legs, arms, head injury and similar ailments. Consider the fear residents have once they have fallen too- this alone causes them to stay immobile.

Heather Thompson, director of nursing at Oakview Terrace, a nursing home in Freeman, S.D., said that about 21 percent of the home’s residents were physically restrained in the fourth quarter of 2003. However, since May 2006, the home’s policy has been that no restraints can be used on residents.

“It was kind of a scary deal for staff and for family,” Thompson said. “In the past, restraints were always seen as something that was keeping the person safe. We thought that by restraining the frail, elderly person, they wouldn’t fall and that we were helping them.”

I think it would help to see numbers and stats of resident falls and harm without restraint use. Certainly many residents were restrained who didn’t need to be. Abuses occurred. Restraints were used as a convenience for staff. We can’t deny this.

Much of our anxiety over restraints has passed onto resident families.

Family members have even reported the nursing home to South Dakota authorities because staff refused to allow any restraints, Thompson said.

“It’s gotten to be quite heated at times,” she said.

Just because a family member or guardian requests or demands restraints doesn’t mean they will be used. There has to be a real medical reason. I have seen state Ombudsmen come in to educate families on this.

Thompson said that technology and greater anticipation of a patient’s needs are good substitutes for restraints. For example, the unit for patients with Alzheimer’s disease has doors that require a code before they will open. That way patients can’t wander away. Beds can be lowered all the way to the ground, eliminating the need for rails for those patients susceptible to rolling out of bed.

Thompson said the nursing home also emphasizes increasing the patients’ physical activities to improve their strength. Most importantly, she said, staff members are trained to work exclusively with certain patients.

“They have to have the same staff working with the same group of residents, to get to know their habits, their routines, their behavior,” she said.

They should just ask the aides what would stop this problem.
I think the bottom line is more harm is caused by the use of restraints, then harm is prevented by their use. With the proper equipment and staffing ratios, this wouldn’t be an issue. Expensive and undignified alarms and low beds wouldn’t be needed. But we’re not going to see safe ratios in nursing homes. We do see consistent staffing now, more and more. The problem with this is turnover: Aides come and go faster than any other group of employees in any industry. Just when a resident gets used to an aide, they leave and new staff come along. We all know this is related to pay, benefits, and poor working conditions. It’s sad how all negative things in nursing homes start and end with the same problems.