The law says NH must allow patients to be free from restraints, do they comply?

Under Federal law, patients have the right to be free from:
any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms. Restraints may only be imposed—
(I) to ensure the physical safety of the resident or other residents, and
(II) only upon the written order of a physician that specifies the duration and circumstances under which the restraints are to be used.”
42 U.S.C. § 1395i-3(c)(1)(A)(ii) and 42 U.S.C. § 1396r(c)(1)(A)(ii).

Guidance issued to Surveyors for Long Term Care Facilities by the Centers for Medicare & Medicaid Services lists the serious conditions that justify antipsychotic use, and the inadequate indications for administering antipsychotic medications. They should not be used if the only indication is one or more of the following:
1) wandering;
2) poor self-care;
3) restlessness;
4) impaired memory;
5) mild anxiety;
6) insomnia;
7) unsociability;
8) inattention or indifference to surroundings;
9) fidgeting;
10) nervousness;
11) uncooperativeness; or
12) verbal expressions or behavior that are not due to the conditions listed under “Indications” and do not represent a danger to the resident or others. Guidance issued by the Centers for Medicare & Medicaid Services, State Operations Manual, Appendix PP at 387 [PDF document page 434]. When antipsychotics are used without monitoring they may be considered unnecessary medications because of inadequate monitoring. Id. at 389.

In my state, Massachusetts, the legislature has enacted a law that requires all nursing homes to get consent from a resident, or a Health Care Agent or Guardian, before administering any psychotropic medication. This informed consent law requires the nursing home to give notice to the resident that includes (i) the purpose for administering a psychotropic drug, (ii) the prescribed dosage, and (iii) any known effect or side effect of the psychotropic medication. This law is codified as Mass. Gen. Laws ch. 111, §72BBB, but it is up to family members to be aware of the needs of the dementia patient, and the alternatives to antipsychotic medications.

Sources:
www.law.cornell.edu/uscode/text/42/1395i-3

www.law.cornell.edu/uscode/text/42/1396r

www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

www.malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111/Section72BB

I agree with both comments. The NH facilities are scared to death they will be sued so they overboard in not using restraints. When my mom went into rehab we told them we wanted an alarm on her because she was confused and would try to get up on her own. The administrator told me we cannot do that unless we see her trying to get up on her own, she said the law says my mom has the right to fall.....WHAT ??? So they did not alarm her and SHE FELL...only then did they alarm her chair and bed. So they try everything they can to not restrict patients. The law is good but sometimes it goes to far in the wrong direction. However they had to put something in place to keep these homes from using things just to make their job easier and neglecting residents.

My late mother's NH has alarms on the beds but they don't do any good as by the time the alarm goes off and staff come running the person is on the floor.

I also hate to think of my Mom falling at the rehab/long term care, but unless someone is glued to her hip, she will continue to keep falling as she forgets she cannot walk.

Anytime the facility calls me about a fall I take it stride because Mom could just as easily be falling at home. And these falls can happen in a split second even with you in the room.

At the facility, the bed is lowered, there are bumpers along side her bed, and thick fall mats on the floor next to the bed. The facility is trying out different sleeping pills for night but so far nothing is working as of yet... [sigh].

My mother's NH in Connecticut certainly does. When mom's wheelchair was delivered, it had a seat belt that was required to be removed before they would allow it to be used.

forgive me, but I thought that instead of physical restraints they use
"chemical restraints" ie: medications that sedate.

My daughter has worked rehab/nursing facilities for 19yrs. When you are in a nursing facility the state considers it your home. As such, you cannot be restained. Side rails aren't used because someone did a study that there are more accidents with residents trying to climb over the rails than just falling out of bed. My daughter doesn't agree. At her facility they put the bed down as far as it will go. Then the person doesn't have as far to fall. This is done mainly to protect the resident from abuse. My Mom is a fall risk and I hate the thought of Mom falling. My daughter says, its going to happen. Not much I can do about it.

I understand falls cannot be prevented 100%. Of time. I would never want my mom or anyone else for that matter tied down, but an alarm to at least lessen the chance only seems reasonable. Why wait till she falls to use it. Her bones are like chalk the dr told us so a fall can mean the end for some.

Nursing home reform act was passed in 1987 by President Reagan. Revisions have been made but that is the origin of the federal law

Yes they do comply, and in a way that is a serious problem for me. My Dad has fallen over two dozen times since April despite the fact that he is in an alarmed bed at night and an alarmed chair during the day. If he was able to be restrained, he wouldn't be falling out. They just can't get to him fast enough (he's still pretty spry) so he has had stitches and bruises constantly but they cannot restrain him either through tie-downs or chemically despite my requests.