When an older parent or family member can no longer care for themselves at their own home, they may need to be placed in a residential facility. It can be a difficult decision for family members when they have to displace an older person from their home and belongings. However, it may be the best option to provide for their needs.
Nursing home residents have rights to quality care and humane treatment. Unfortunately, some nursing home facilities are poorly run, with understaffing problems, lack of staff training and supervision, and cost-saving members that put residents at risk of injury or death.
It can be difficult to identify nursing home neglect when many residents don’t speak out because they fear retaliation. Family members and friends may be able to look for signs of possible abuse or neglect, including restraint injuries. There are limited situations where the use of restraints is appropriate. Unfortunately, restraints may be overused, causing injury and harm to residents.
If you have questions about an elderly family member who may be mistreated in a nursing home, talk to your experienced medical malpractice team for legal advice.
What Are Restraints in a Nursing Home?
Restraints are ways to restrict individuals in a nursing home. Restraints can include medical restraints and physical restraints. Physical restraints in a nursing home facility may include wrist straps and ankle restraints to keep them immobilized in an emergency if they are considered a danger to themselves or others. Medical restraints can include medication or drugs to minimize pain or discomfort or immobilize a patient during a medical procedure.
Physical restraints for medical use include:
- Four-point restraints, like straightjackets
- Restraint masks to prevent biting
- Lap belts on wheelchairs to prevent falls
- Bed rails
- Safety vests or jackets tied to a chair or bed to prevent falls
- Limb restraints around the ankles or wrists to prevent harm or self-harm
- Mittens to prevent patients from undoing limb restraints
In many cases, the use of restraints in a nursing home is not appropriate. Restraints, including physical and chemical restraints, can be dangerous. Too much or the wrong type of drug can cause serious injury or death for nursing home patients, including when they cause a dangerous drug interaction with other medications. Physical restraints can cause serious injury, including developing infections and sores, or inability to move around for basic needs, including hygiene and food.
Chemical Restraints for Nursing Home Residents
Improper nursing home restraints include chemical restraints, which can be used to restrict a resident’s movement and expression. These can include sedatives or other medications to sedate a resident, making them easier to control for nursing home workers. Types of chemical restraints used for nursing home residents include:
- Benzodiazepines/anti-anxiety medication: also classified as anti-anxiety tranquilizers, or “minor tranquilizers,” for the treatment of anxiety and panic disorders.
- Antipsychotics: for treatment of schizophrenia, psychotic disorders, and other conditions.
- Dissocotiatives: treatment during surgery or other procedures, causes people to feel detached from their body or environment. Dissociative anesthetics include ketamine and dextromethorphan (DXM).
Why are restraints still being used so often in nursing homes? There is not a lot of oversight or patient protections in many nursing homes. Many residents do not have regular visitors and there is no one to advocate for the residents. Nursing home administrators are often more focused on profit than maximizing quality of care. Employees are often overworked and underpaid and restraints can be a way to make their workload less difficult.
However, nursing home restraints may be less common now than they were a few decades ago. According to the Department of Health and Human Services, in the early 1990s, nearly 20% of nursing home residents were in daily physical restraints in the U.S. By 2007, the percentage of nursing home residents in daily physical restraints was down to about 5%.
The Rights of Nursing Home Residents to Be Free From Unnecessary Restraints
The quality of nursing home care may vary between facilities. However, all nursing home residents have certain basic rights under the Nursing Home Resident Bill of Rights. Established by the Nursing Home Reform Act (NHRA) of 1987, nursing home residents have rights, including the right to:
- Be free from restraints
- Be free from abuse and neglect
- Get proper health care
- Be treated with respect
Many states also have nursing home rights laws, which may go further than the federal protections, including Maryland, Pennsylvania, and Illinois.
Baltimore Nursing Home Rights
Nursing home residents in Baltimore and Maryland have resident’s rights and services, where residents or their representatives have the right to be free from:
- Physical abuse
- Mental abuse
- Involuntary seclusion
- Physical or chemical restraints imposed for purposes of discipline or convenience
Nursing home residents should also receive treatment, care, and services in an environment that promotes or enhances quality of life. Residents are to be informed in advance about care and treatment, and if there are any proposed changes in treatment.
Nursing Home Resident Rights in Philadelphia
Nursing homes in Philadelphia and throughout Pennsylvania have to make sure the rights of residents are protected. According to the Pennsylvania Department of Aging, among the nursing home residents’ rights are the right to be free from restraints. “Chemical restraints (drugs) and physical restraints may be used only if ordered by a physician for a limited time in order to protect you or others from injury. Less restrictive solutions must be attempted prior to using restraints.”
Chicago Nursing Home Rights
According to the Illinois Long-Term Care Ombudsman Program, nursing home residents have the right to be free from physical or chemical restraints. In most cases, restraints should only be used as a last resort after trying other, less restrictive measures. When a doctor determines restraints should be used, the least restrictive intervention is to be used. The patient should be continually assessed for signs that the resident no longer represents a danger to themselves or others, at which point, the restraint measures should be stopped.
When Are Restraints Appropriate
There are limited situations where restraints are medically appropriate for nursing home residents. The main reason for the appropriate use of restraints is for fall prevention. Belts, bed rails, and other mechanical devices can help reduce the risk of fall injuries in a nursing home.
According to the Joint Commission, to put an individual in restraints or seclusion in response to violent or self-destructive behavior, there must be an in-person evaluation, face-to-face, completed by a physician, clinical psychologist, or other licensed practitioner. This needs to be done within one hour of the initiation of the restraint or seclusion.
Under the Joint Commission Standard of Patient Care PC.03.05.01, an organization can use restraint or seclusion, “only when it can be clinically justified or when warranted by patient behavior that threatens the physical safety of the patient, staff, or others.” The elements of performance include:
- The hospital uses restraint or seclusion only to protect the immediate physical safety of the patient, staff, or others.
- The hospital does not use restraint or seclusion as a means of coercion, discipline, convenience, or staff retaliation.
- The hospital uses restraint or seclusion only when less restrictive interventions are ineffective.
- The hospital uses the least restrictive form of restraint or seclusion that protects the physical safety of the patient, staff, or others.
- The hospital discontinues restraint or seclusion at the earliest possible time, regardless of the scheduled expiration of the order.
When restraints are used, it does not give nursing homes free rein to use them in any way they want. Standards still require nursing homes to use restraints safely. This includes having proper procedures and policies in place, and in accordance with the patient’s plan of care.
What Is Not Considered a Restraint?
When a nursing home resident is tied down to bed and cannot get up, that is a clear physical restraint. However, other commonly used measures may be more difficult to know if they are restraints, including enclosure beds with side rails or hand mitts. Whether these are restraints may be based on several factors, including the method of use and how it reduces the ability of the person to move about freely.
In some cases, if side rails prevent a patient from getting out of bed, it could be considered a restraint. This is similar to an exposure bed that prevents a patient from freely attempting to exit the bed. However, if the patient is unable to exit the bed with or without the side rails, the use of the side rails may not be considered a restraint. If a patient has a fall-risk order, the side rails that would prevent the patient from accidentally falling out of bed would not be considered a restraint.
How Do Restraints Cause Injury?
The use of restraints is not only limited because it is inhumane and abusive but it can also cause serious injury. Nursing home residents have suffered serious injury or death because of the negligent use of physical or chemical restraints. When a nursing home resident is injured because of the improper use of physical restraints, the resident may be able to recover compensation for their injuries.
Physical restraints can cause direct physical injury. For example, pulling against a restraint can cause sprains, edema, contractures, cut-off circulation, or broken bones. If these injuries are not addressed, they can cause other complications, including infection. Some restraints may cut off other medical interventions, like feeding tubes, catheters, or IV tubes.
The use of restraints around the wrist or ankles can cause chaffing or open wounds. Open wounds in a hospital or nursing home setting are an invitation for bacteria or viruses to enter the body, causing the resident to suffer an infection. Many hospital-acquired infections (HAIs) can cause serious injury in patients who are already suffering other medical conditions or have compromised immune systems.
Some of the most common HAIs in nursing homes include Group A Streptococcus (GAS) and Methicillin-resistant Staphylococcus aureus (MRSA). These infections can be difficult to treat in elderly patients. According to some estimates, a majority of nursing home residents carry MRSA, often through infections from ulcers, abrasions, or other sources of infection.
Restraints and Asphyxia
There are serious risks of asphyxia, or suffocation, involving physical or mechanical restraints. Restraints around the wrists, waist, or chest can risk strangulation if the resident is able to struggle loose but the restraints end up around the head or neck, or the patient is strangled after falling from the bed while restraints are in place. Restraining a patient on the floor can also make it difficult for a patient to breathe and prolonged pressure can result in asphyxia.
Unnecessary drug use to chemically restrain a patient can cause dangerous drug interactions or overdose. Some nursing home patients are given medication to sedate the resident but if the reaction is too slow or the patient continues to need additional attention, the nursing home staff may continue increasing the dose, risking overdose or other serious injuries.
In many situations, nursing home staff, nurses, and even doctors can become frustrated with a resident. This includes patients with physical restrictions, complex medical needs, and mental impairment. Using restraints as a convenience or way to punish a resident is wrong and may be considered malpractice. It can also cause serious mental distress to a patient. When restraints are appropriate, the response should be to help calm the individual.
Wrongful Death Lawsuits for Nursing Home Restraint Death
If a family member died in a nursing home, you may have questions about what really happened. The nursing home may not be open about what was behind the death. Many family members just expect the death was due to old age. However, when nursing home deaths are caused by medical malpractice, the family may be able to hold the facility responsible by filing a wrongful death lawsuit.
A wrongful death lawsuit can help the family recover compensation, including burial costs, funeral expenses, and other losses. A lawsuit can also make sure the nursing home facility is held accountable, to help other families avoid a similar fate.
Contact experienced trial attorneys who have successfully represented nursing home injury victims and their families to recover financial compensation from dangerous nursing homes. Call a malpractice lawyer to find out more about your case and what kind of damages you can recover. For a free consultation, contact Gilman & Bedigian online or at 800-529-6162.