Physical and Chemical Restraints
Physical and chemical restraints are often used in nursing home facilities. In certain situations, careful use of restraints is legally allowable. However, when restraints are used as a substitute for less extreme methods or one-on-one attention, the use of restraints may rise to the level of illegal abuse.
Both state and federal laws may regulate physical and/or chemical restraints. This overview focuses on regulations that are enforced if the facility receives federal aid, as most do. Please review your specific state's laws, or contact local legal counsel for additional information regarding your state's legal standards.
Physical restraints
A physical restraint is defined as any manual method or physical or mechanical device, material, or equipment attached to the resident's body that the individual cannot easily remove. The restraint restricts freedom of movement or normal access to one's body. Examples of physical restraints may be hand mitts or wrist restraints, vests that tie residents to their chairs or beds, wheelchair safety bars, bed rails, ankle restraints, or even bed sheets that are tucked so tightly that a resident cannot move.
Under the federal Nursing Home Reform Act (NHRA), residents have the right to be free from physical restraints "imposed for the purpose of discipline or convenience, and not required to treat the resident's medical symptoms." See 42 U.S.C. §§ 1395i-3(c)(1)(A)(ii), 1396r(c)(1)(A)(ii), 42 C.F.R. § 483.13(a).
When are physical restraints allowed?
Under the federal laws and regulations, there are limited and specific situation when a resident can be physically restrained. Federal law and agency guidelines state that a resident can be physically restrained only under the following circumstances:
- To ensure the physical safety of the resident or other residents
- There has been a written order from a physician that specified the duration and circumstances for the restraint use (there are exceptions for certain emergency situations)
- To promote greater functional independence
- The facility has explored and used less restrictive means and the less restrictive means were unsuccessful
- The resident is released, exercised, and allowed to use a washroom every two hours
- The use of the restraint is re-evaluated periodically
Additional detail is available under 42 U.S.C. §§ 1395i-3(c)(1)(A)(ii), 1396r(c)(1)(A)(ii), 42 C.F.R. § 483.13(a) and Interpretive Guidelines for Surveyors by the Center for Medicare & Medicaid Services (June 1995).
Chemical Restraints
Chemical restraints are psychoactive drugs designed to control a resident's activities. A psychoactive drug is a chemical substance that is capable of altering mood, perception, or thought. Psychoactive drugs are often effective when used to treat psychological disorders such as depression or dementia. However, the use of these drugs as restraints is often harmful and/or against the law.
When are chemical restraints allowed?
Under federal law, chemical restraints are only allowable at a nursing home facility if they are (1) supported by a physician's order, and (2) are necessary for a clinically justifiable and documented reason. Chemical restraints are considered unnecessary when they are:
- Given in excessive doses;
- Given for excessive periods of time;
- Monitoring data or adverse consequences indicate that the drug use should be discontinued; or
- Are prescribed only in anticipation of an adverse consequence of another prescribed drug.
Please see 42 C.F.R. § 483.25(I) and Interpretive Guidelines for Surveyors by the Center for Medicare & Medicaid Services (June 1995) for additional information.
Conclusion
The use of unnecessary physical and chemical restraints may cause emotional, mental, and physical problems. If you feel that you or a loved one has been injured as the result of illegal physical or chemical restraints, contact an experienced elder law attorney to discuss your options.
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