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

My mother's NH does to a certain extent. They give her calming meds and have an alarm at her door.

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 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].

No, that is incorrect. NH's are allowed to use restraints, such as bed rails and and wheelchair seatbelts, else the NH is going to have a lot of falls on their hands!

I think the only time they maybe medicated is if they are a danger to themselves or others. Ex: an Alzhiemer resident who gets violent and then only by a doctors order. If u feel a person is being over medicated than talk to the doctor. Just because someone is being cared forin a nursing facility doesn't mean they can't see their doctors. And ur question about compliance, in the state of DE its yes.

Re:chemical restraint: the same outlaws chemical restraints.

As far as I can see, that part of the is respected as well in mom's facility as well. No zombie - looking folks. Several very impaired patients are in their wheelchairs near the nursing station and/or in the day room where staff can keep an eye on them.

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.

my father is in a NH and he has a small clip with alarm that is attached to the back of his wheelchair. Only because when he was first admitted he fell 2 times out of the chair. At least when the alarm goes off the aide,etc know that someone is trying to get up. Plus the patient then stops cause they hear the alarm. I have seen some patients with small seat belts on the wheel chair because they try to lean too much forward or they are constantly trying to get up even though they can't walk. this prevents them from falling and getting hurt. The side rails on the bed are only at the head level, but for my father, they put the bed the whole way down and put down padded mats just in case he does fall out (which he has also done in the past). But each time he fell, the would call me and let me know that they were checking him all over for any cuts/abrasions. So I guess it depends on where your loved one is placed. I think they just don't want the patients to feel "restrained" because some patients can get very violent if they don't feel free.

Mom [95] fell out of bed in RI. Required hospitalization for 10 days. Returned to SNF where she died 3 weeks later. No alarm or bed restraint.

Yes old people fall, but how do you balance their "right to fall" with your responsibility to keep them safe. You can be held negligent if they are injured. You are damned if you do and damned if you don't.

As for chemical restraints, the rules against their use are even more restrictive.

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.

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

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.

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

Yes, "she has a right to fall" is the prevailing philosophy. And, to an extent, I agree with it. I know that I would not want to be left sitting or lying around just so I wouldn't fall. Throughout our lives, living fully entails risks and, when you're old, that risk is the possibility of falling. I'd rather be up and about, no matter how wobbly, than sitting cautiously in a chair all day or waiting for assistance (no matter how responsive) every time I wanted to get from one place to another. A gerontologist once told me "Old people fall, that's what they do." Sounds elementary, but it's true. It's hard for adult children to understand that being restricted enough to be truly safe from falling would be no life at all.

That said, once the staff figures out your loved one's patterns and habits, they should be proactive in avoiding situations where they're engaging in really risky behavior and for some, that can mean chair and bed alarms.

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.

Anybody know the origin of this law. Federal mandate?

I was a supervisor in a Virginia Nursing Home when that law came into effect. It was a nightmare. We had to remove all the bed rails, the chair restraint belts and the chairs eating trays. Then we found out a few days later that the bed could have 1 side rail it could only be in the up position with a doctors order. We put alarms in the chairs and in the beds of the residents that were prone to getting up and wondering at night. Each state may be different, and yes the nursing homes must comply with their state laws. If not they will be fine each day they have not resolved the situation.

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 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.

In MA side rails can be used with PT recommendation for legit reasons such as transfers, mobility and safety issues.

Anything (i.e. a recliner or click on tray table) that a person cannot get themselves out independently can be considered a restraint.

Most homes in the northeast are so worried they will be cited they go in the opposite direction!