Sorry everyone but I have been very tied up lately and need your help. During the last 3 weeks, I have been to the er 7 times with various family members- including once for me. I have been there twice in the last 10 days for dh. He is in a nursing home in a low bed with a mat on either side. He fell out of the bed and his head hit the floor and he got a 2" gash. His head hit the floor because the aide was readying him for a shower and had to move the mat to bring the hoya lift in. In that instant, he rolled off and hit the floor. With this, the reaction of the nh was to order him a special bed with bolsters. The very next night, he fell out again and hit the very same spot but this did not reopen the wound. Yesterdasy, I got a call at 7:15 am indicating he fell out again and reopened the original cut and was on his way to the er. In each case, I had meetings with the admin and have been told that there are federal and state regulations that prohibit them from putting up guardrails on his bed because they consider these a restraint. I am upset that I cannot get him secured unless something happens. It is a step up practice. Now they have added a new pad and a rail to the side of the bed that he falls out of. If he falls from the other side then they will be allowed to add the second bedrail as long as I am willing to sign a document. This seems bizarre to me that the approach is reactive and not proactive and requires that my dh be hurt before they can secure him. I am trying to research this on the internet but keep ending up with web sites that don't apply. Does anyone out there know the correct website to search ( I tried the State of Ct Dept of Health). Help!!!
((Kathryn)) I don't live in CT, so I don't know their rules... but that seems crazy! I am all FOR no restraints, and the rules are followed adamantly where Lynn is. But, standard bedrails/guardrails ARE allowed. They are NOT restraints, they are precautions! I did have to sign a paper saying I wanted them up.
I tried a google search and came up with all kinds of laws, but none pertaining to your particular problem. I would ask the NH administration who you can contact about this law. They should be able to direct you to the proper place.
kathryn, i found a bit of info for you with regards to restraints laws in connecticut. connecticut statutes section 46a-150 and 46a-154 refer to the application and regulations of physical restraints on a person who is at risk. there are specific rules the must follow after reading what i could of the info i do believe it can be ordered by a licensed physician and or phychiatrist in connecticut who would attest to the necessity to use the restraints due to injury risk. even in texas here these same type rules for the use of restraints both chemical and physical are in force but can be used if ordered by his dr. and monitored with specific frequency. we used soft restraints and bedrails to keep DH safe and not pulling out IV during his hospital stay. wasnt an issue at all in the hospital. i think your issues are more specific to nursing home regulations. check with his personal dr and ask him to intervene on you and DH behalf for safety issues at this point. hope this helps! divvi if you have an atty you can call them and ask them about the statues listed above and get more info maybe. or just tell his dr you have this info and need his help - kathryn, check your email i am sendingpage of nfo w/regards to restraints you may find something to help you.
my dh was always falling while walking and in bed, the nh is not alowed to use restrants and no bed rails, all they can do is use the alzhemiers bed and pads on the floor, i complained on this matter to, he has fallen out of the bed but did not get hurt due to the pads and he no longer can walk by himself, he sits in his wheelchair, has tried to get out of it and fell, they now have him in one that they can tip back a little and he can no longer get out of it.
CMS has gotten very tough on nursing homes about bedrails- especially if considered a restraint. They can be used if it helps with mobility, etc. I'd call the number below for information and clarification. That many falls, not a good thing. Especially since it's resulted in repeated injury.
Health Care Facilities
If your complaint is in regard to care provided by institutions or agencies (i.e. hospitals, nursing homes, home health care, laboratories) you may send written documents to:
Facility Licensing and Investigations Section
Connecticut Department of Public Health 410 Capitol Ave., MS# 12 HSR Hartford, CT 06134-0308
Phone: (860) 509-7400
Fax: (860) 509-7538
The Connecticut Department of Public Health also maintains the Medicare Home Health Hotline to receive complaints specifically about home health services. The toll free number is: (800) 828-9769.
Zibby-my daughter works for a large nursing home chain. She flies somewhere every day. She had just got home tonight and not even unpacked. I e-mailed her for the above info, and after greeting her three kitties fired off the needed info. She is one great woman!
I do live in Connecticut and have run into some of the weird nuances that go along with this law. Restraining versus not restraining is a very tricky fine line to walk. Seat belting them in a wheelchair can be considered restraining, Tying them down to the bed in the hospital can be considered restraining. Hospitals and nursing facilities follow this but there are varying degrees depending on who and where.
When he was in the hospital last year for pneumonia (twice) there were different responses both times. The first time he was a bit more with it but I still told the staff if they needed to restrain him in anyway for safety (his and other patients), do it. The second time they did not restrain him and I was very upset as he was feeling better and wanting to get up but with an IV and catheter it wasn't safe. The hospital halls were not a safe place for a person in his condition to be. I complained to the nurse on this and all she said was that state regulations were that he could not be restrained for 24 hours before being released - no exceptions.
Honestly, I have no problem with restraining my husband for his safety. I would have a problem with it if I felt it was for the convenience of the facility. I have learned to be very careful in my choice of words - restrain and all its variations cannot be part of the vocabulary when talking with them.
Interestingly enough, talking with one of the nurses, he told me that 15 years ago, restraining was automatic - they always restrained someone. Times have changed and the pendulum has swung the other way. I am hoping that at some point that it kind of stops in the middle and restraining for safety reasons is okay again.
As I read therrja's post I realized that there is one type of restraint not only allowed, but required by law in all 50 states - seat belts in cars. Sometimes (no, most times) I think no 2 government agencies talk to each other.
Marsh, I think it's worse than that. I think that no two people within a single agency talk to one another. That applies to government agencies and insurance companies.
New Hampshire doesn't require adults to wear seat belts, I think its the only state left that doesn't.
I was thinking about this today while visiting Lynn. In another NH I had looked at they had the mats on the floor with no bedrails... it was state run. I wonder if that makes a difference? Where he is now is an independent NH and though they use no forms of restraints, they do use bedrails at the families request for precautionary safety. Seems like a no brainer to me.
If it was my LO, I'd be calling those numbers to find out what I needed to do to get the bed rails raised for the patient's safety.
About 10 years ago they brought me into the hospital unconscious with pneumonia. And they used the bed rails on me because for the first couple of days they didn't want to take a chance that I'd fall out of bed or even try to get out without someone there. And they were right.
when I worked in hospitals in 71-72 in NH and early 80s in WA, we put the bedrails up on probably 75% of the patients at night (I worked the night shift). It was for their safety - didn't want them to wake up, be disoriented and fall off the bed. Of course this was a hospital where people were in there for surgery or illness. Bedrails up was the norm, not the rarity.
I remember when I had my tonsils out in 1971 the first night they had the rails up. When I had my infertility surgeries in 76, 77 & 78, each time until the IV and catheter were removed, they had the rails up. For me, always having slept in a full to king size bed, I feared rolling out of the twin anyway.
Call nursing home administrator (if you have not) or department of health numbers above, for clarification. The intent of the CMS ruling was to decrease and in most cases eliminate the use of restraints in hospitals as well as nursing homes. Restraints were overused and often caused ill effects including death.
Restraints are still needed in many instances. The rulings were written to ensure safety, restraints may be used without an MD order in the case of an emergency. The regulations want patients assessed frequently by nursing, and with MD order, to ensure that the restraints are still needed.
Given the number of falls it appears that an assessment for a restraint is justified.
KATHRYN: Stay overnight, and then during the night, ring the bell and tell them that you caught him rolling out of the side of lthe bed without rails. Little white lies can come in handy! THE KISS PRINCIPLE = Keep It Simple for the STUPID!