Not so long ago, the use of restraints on nursing home patients was a common practice. The long-term care industry and even the family members of some patients rationalized that restraints enhanced patient safety. They prevented patients from falls or from wandering off.
More and more, the use of the restraints has fallen from favor as researchers and practitioners better understand the physical and psychological impacts of restraining patients. As one tragic incident in Utah illustrated, the use of restraints also poses safety risks. In 1998, a 45-year-old woman strangled on waist and chest restraints the staff at Rosewood Terrace had used to confine her to her bed. Officials believe Sandra K. Gordon slipped out of bed, the restraints caught on a rail and she strangled. A medical examiner ruled Gordon's death a homicide after an investigation determined she hadn't been checked for eight consecutive hours.
According to the latest Agency for Healthcare Research and Quality report, the use of restraints has dropped nearly 40 percent in recent years. Nearly 6 percent of 1.5 million long-term patients were restrained repeatedly in 2006. This trend is positive and represents significant improvement in patient care. Federal law limits the use of restraints for medical reasons, such as to prevent a resident from tearing out an IV.
But there is room for improvement, particularly in states, such as Utah, with above-average use of restraints, according to the AHRQ report.
Oftentimes it is difficult to parse state-to-state comparisons because the quality of reporting can vary. That is because these indicators are reported directly to the federal government by nursing home operators. The data are not verified by the Utah Department of Health, which licenses and regulates nursing homes in Utah.
Most Utah nursing homes do an admirable job caring for people who are ill and infirm. There has been a vast improvement in the use of restraints nationwide, which in the past were used for the convenience of caregivers or to discipline difficult-to-manage patients.
Fortunately, those practices have improved due to better regulation and monitoring by state agencies and independent monitors from nonprofit disability-rights agencies. This positive trend must continue.