curiously after some discussions about the use of restraints i looked up a few laws and this is what i found. ^^^ note i am not an atty but an interested caregiver.:)
Title 42 of US Code passed by US govt by Congress and current as of Feb 1, 2010... ( this pertains to ALL SKilled Nursing Homes)
Title 42 chapter 7 subchapter XVIII section 1395i-3 "Requirements for and assuring quality of care, in Skilled Nursing Facilities...."
1395i-3
C. 1) General Rights of Patients (A) Specified Rights (ii)restraints - the right to be free from restraints -^^^^^^ AND MAY ONLY BE IMPOSED IF--
(I) to ensure the physical safety of the resident or other residents, and
(II only upon written orders of physician specifying duration and circumstances under which the restraints are to be used.-except in emergencies and circumstances specified by the Secretary- until said orders could be reasonably obtained.-
per this US code, if it were my spouse who had been placed in a NH and has issues with regards to safety and a NEED for a form of restraint i would definately be bringing this US code to the attention of the NH and dr and asking why my spouse IS NOT being protected -, pertinent to his safety issues, with a WRITTEN doctors order specifying the need for a restraint-
hope this may be of benefit to someone who has their loved one with security issues and being told restraints arent allowed! divvi
i wouldnt care about the ratings or evaluations at all. Not meeting the care needs of an individual who is in jeopardy of getting hurt is a violation of HIS rights as a patient. its just as serious for a facility to not provide the adequate care and protection for a patient as breaking a rule or violation from the state or govt. as a matter of fact they could be held for negligence or worse if the patient got hurt and they DIDNT implement protective measures. at least i see it that way.and of course we arent talking about restraints for normal residents but those who are in need of protection to themselves and under a drs orders only divvi
Sometimes it's a matter of the paperwork. Our hospice requires a doctor's order for each day restraints as innocuous as a lap belt are used. Makes no sense to me.
As with any rule of law it started with good intent but has been pushed too far. Patients were being restrained without cause, expecially in under staffed facilities. There was no informed consent staff just tied them up! Patients were harmed and even died due to restraints being applied improperly and not being monitored while restrained. There were many instances documented where the restraint killed the patient. It is appropriate for the doctor to assess and write the order for restraints when necessary. It is also in good judgement for staff to restrain a patient who is in jeapordy of harming himself or others until the physician can evaluate patient. The need for writing the order each day is to ensure that the patient is being evaluated and closely monitored. All this being said....this law has created so much documentation....lots of rediculous red tape!! While I hated to implement this standard in a 719 bed hospital, a huge nightmare, I must admit that the outcomes were worth it. Now on the board of a nursing home, I see that staff has to be more attentive and closely monitor patients who are acting out. As a family member, if you think your LO should be restrained for safety purposes do not hesitate to talk to nurse about your feelings. Divvi is right on.
Thank you all for your help and opinions and searches on this topic. I am still in the middle of gathering information.
After a meeting with the director of nursing, she explained that the facility has chosen, as of two years ago, to be a restraint-free facility. They will not not not use restraints. The facility including the medical director do not beleive in them. They say that statistics bear out that a resident in any type of restraint, have much higher incidences of getting seriously hurt. They agree that my DH is attempting to stand numerous times throughout the day, and results in falls. All of his falls have caused him no physical harm, as they are occuring without restraints, and with aides nearby to help control the fall. They also say that the behavior of standing/sitting/standing/sitting will not stop with a restraint, just puts him at hihjer risk of harming himself. I guess this makes sense. There are two meetings this week..yesterday and today, that include all staff and medical director, to get input on how to help my DH with this behavior. One idea they are considering is using an aide and walker to walk up/down the hall 2x day to see if that may help. I have to say that I am impressed with their answers and attitudes. They want to address the underlying cause.
On the positive side, my DH was struggling to eat a mechanical chopped diet. He would take in only 25-50% of any meal. He is in a special DR to get extra help during meals. BTW, he has no teeth or dentures and high risk for choking due to neuro issues. Well..they changed him to pureed diet (gross...really gross) and he is scarfing it up and eating 100% with accepting an aide to feed him. Go figure.
sheltifan thats good to hear your update. if they have the extended staff to ensure your DH will not get hurt without a form of restraint that is wonderful. its what we all strive for. that said i would ask to have documented in his file that you requested a drs order for a restraint and they refused. just to CYA. that way they know if they dont do as they are suggesting and watching him the burden is on them. you did what you could to ensure his safety and they refused and offered a counter measure. now its up to them to follow thru. i guess my mind always works with doubts, but if he would get hurt at some point you may have some recourse later. just a thought, its what i would do if it were me. on the other hand the pureed diet sounds like its a much better plan for him. no teeth would make any meal hard to get down. if they know you have done your homework i find things tend to be more productive as they know you are informed and prepared.. good luck!! divvi
This topic is especially interesting to me, for personal reasons. For years I did not know what my grandmother died of. Nobody in the family could tell me. Finally I found a copy of her death certificate. (It was included in the information on her in the cemetery she is buried in. I had no idea they kept that kind of information, until a cousin told me.) She went into the hospital for something else, but her death was caused by a severe head injury from a really bad fall—after her admission to the hospital. I guess the hospital didn't want to share that kind of information with the family. But it gives the topic of restraints a special importance for me.
Divvi – Thank you for the excellent information. I'm printing it out and putting it in my "nursing home" file for future reference.
Jan that is indeed very sad to hear. its also not surprising that the facility wouldnt offer that kind of info to the family about the event that could be responsible. especially if its listed on the death certificate. you would most likely have had grounds for negligence which contributed to wrongful death lawsuit if you had known. there usually runs a 2 yr statute of limitation on wrongful death suits but it can vary by state. if it is listed on the death certifcate its a real shame a family member didnt notice and question that. it happens alot in facilities and they of course would like it to go away and not be held accountable. this is exactly why we are wanting our loved ones to be safe and secure on their premises and if a restraint per drs orders is needed to protect them so be it. divvi
Thursday night Lynn decided he could walk. He got out of his reclining chair and fell! Of course I am delighted he is improving....he couldn't even shift his weight laying down before! ....but now I am very concerned for his safety!
He is ok, thank God! But he did get a cut on his head and his arm is pretty beat up. He is on Coumadin, so this makes it all the more frightening....acccck
I spoke with the head nurse Friday and told her I wanted a safety belt for Lynn. She then quoted the restraint free poilicy. Yeah yeah I know the rules.....she listened patiently as I went on my rant.....I then asked for a care plan meeting.