In 1987, the Nursing Home Reform Act of 1987 provided the right for all nursing home residents to be free from physical and chemical restraints, used for the convenience of the nursing home staff or the purpose of discipline. This is a great law that many nursing homes violate with impunity. Sure, the use of restraints in limited circumstances is necessary to ensure the safety of a nursing home resident or other residents under a doctor's orders. But these nursing home all too often take it too far for two reasons: convenience and money.
In Maryland, COMAR 10.07.09.14 outlines the specific conditions under which physical and chemical restraints may be used in a nursing home. The regulation requires these constraints only under a doctor's orders. It requires two-hour rules on monitoring and exercise and also requires the doctor's plan to include a plan for getting off the restraints. Maryland law does not allow an indefinite plan for restraints.Background
A study published some years ago found that restraints in nursing homes accounted for approximately 1 in 1,000 deaths in nursing homes. Doesn't sound like a lot? It is. People in nursing homes are at significant risk for death in so many ways. Most people that go to nursing homes die there. Reports have indicated that this rate of incidence has remained consistent over the past decade in spite of statistics suggesting their use has been diminishing. The immediate cause of the majority of these deaths is strangulation, chest compression or dangling in the head-down position.
Policies vary between nursing home regarding the use of restraints. In recent years, reports have indicated that the use of restraints has been declining. A report from the Agency for Quality Improvement and Patient Safety (AHRQ) reported that usage dropped by more than 50% in recent years.
So many Maryland nursing homes are seeing the light in part because the evidence is growing stronger that the use of physical restraints has not been proven to be associated with beneficial effects.
Others nursing homes, driven by the desire to keep cost down but making patients easier to manage, have doubled down on their use of restraints to make their lives easier, often ignoring Maryland laws that set forth restrictions on chemical and physical restraints. These are the nursing homes that are frequently in the scopes of our nursing home attorneys pursuing these lawsuits in Maryland.Types of Restraints and Factors Leading to Injuries
Physical restraints in nursing homes and assisted living facilities include restrictive chairs, hand mitts, wrist and ankle restraints, vests (tied to chairs or beds), bed sheets tucked so that the resident can't move, belts, sleep suits, and full-enclosure bed rails among a host of similarly depressing types of restraints.
It what can be even more crippling, nursing homes often have doctors (and I think that is fair in too many cases: "have doctors") provide chemical restraints.
Clearly, this awful decision can be necessary and helpful in some instances where the patients are destructive to themselves and others, and psychoactive drugs can be useful to some - repeat some - patients who are restless, depressed or have uncooperative behavior. But many nursing homes read "some patients" as "any patient who requires any effort to manage." For many nursing home patients, this deprives them of the opportunity to enjoy their lives with energy and a clear head.
Medical research has provided us powerful evidence that restraints infrequently prevent injury, and may cause a great risk to patient safety.
A study published this year found that the number of staff and qualifications of staff had no bearing on the use of physical restraints. This is surprising on some level but, then again, the use of restraints is not a training issue. It is a "do you care about the patients?" issue. If you stick a patient on four-point restraints without psychiatric problem and without a doctor's orders, it is not lack of education about proper patient care. It is lack of caring problem and without a doctor's orders, it is not lack of education about proper patient care. It is a lack of caring about patient care.
This study bears out this logic finding that the biggest problem with restraints is the lack of proper monitoring of restrained residents.Injuries Resulting from Various Restraints
The most common injury our lawyers see from nursing home restraints is bed rail injuries. Typically, bed rail injuries occur when a nursing home resident falls to the floor while climbing over the rails. These falls increase risk of severe injury due to the height of the fall, as opposed to falls from a bed without rails.
In a study published in 2011 in the American Journal of Alzheimer's Disease & Other Dementias, the use of trunk restraints was found to be associated with an increased risk of falls and fractures in residents with Alzheimer's disease or dementia.
Another study has reported that 86% of cases reviewed were due to incorrect fastening of restraints, with another 9% due to the use of improvised non-standard restrictions. These authors also cite one case where a patient was properly restrained with a lap restraint, but slipped through the restraint and was unable to extricate herself when it compressed her neck, and in turn, she died of strangulation. All cases had one factor in common: the patient was not continuously monitored.
Other adverse effects associated with use of restraints include:
- Increased cognitive dysfunction, such as disorientation and confusion
- Loss of autonomy and dignity (usually does not result in a nursing home lawsuit, but that does not make it any less awful)
- Urinary incontinence or retention
- Chronic constipation
- Increased bone fragility and fractures
- Cardiopulmonary and musculoskeletal muscle wasting (again, not the subject of many lawsuits but devastating to good mental and physical health)
Several studies have been undertaken to study new devices and alternates to restraints. These studies have demonstrated that reduced use of restraints increases the quality of life, and the residents' functional status improves without any increase in serious falls or injuries. Moving toward such alternatives and increased monitoring of residents that must be restrained is crucial to decreasing injuries and mortalities associated with restraint.
[Miller & Zois] quite literally worked as hard as if not harder than the doctors to save our lives.
Still, this problem is not going anywhere because it is a matter of the heart. Too many Maryland nursing homes have had their hearts removed and replaced with a dollar sign. Restraints are easier and cheaper. One big way to prevent nursing home restraint injuries is for Maryland nursing home attorneys to bring lawsuits to give heartless nursing homes a financial incentive to provide good care.Talking to a Nursing Home Lawyer
If your parent, spouse, or someone you love has suffered serious injuries or death and you suspect nursing home negligence or worse, a lawsuit may be filed on their behalf. We are here to help figure out what you should do. Call our nursing home attorneys at 800-553-8082 for a free Internet consultation to discuss what happened. There are no fees or expenses; we provide a free consultation.More Maryland Nursing Home Lawsuit Information
- How much are nursing home settlements in Maryland?
- Bed Sore Injuries in Nursing Homes: another crime of neglect
- Decubitus ulcers (background and Maryland law)
- Two Common Defendants in Maryland Nursing Home Cases
- Sample Nursing Home Complaint (sample lawsuit against Manor Care in death case)
- Expert Report (sample certificate of merit and expert report defending Manor Care in a nursing home case)
- Plaintiff's Expert Report (expert report used by our nursing home lawyers in a lawsuit against Manor Care)
- Sample Mediation Statement in a Nursing Home Case (example mediation statement to settle a nursing home case)
- Picking a Maryland Nursing Home
- Maryland Nursing Home Law Update (new Maryland high court opinion dealing with a nursing home arbitration clause)