Rehab facility won’t restrain LO for safety; legal?

Donnajoy

LO in rehab after breaking hip.  Won’t sleep in bed, sleeps I. Chair and fell out.  Facility says they cannot “ safety belt” her in the chair or restrain her in any way.  Just got a call back… she is unresponsive and going back to ER.  I live 3 hours away.  Why can’t she be secured for safety purposes?  This seems like negligence

harshedbuzz

Donnajoy-

I am so sorry you and your mom are living this nightmare. 

The facility is correct that they are prohibited by law from using physical or chemical restraints. We had a similar situation with my aunt who broke her hip and wrist while in an ALF. She was transferred to a SNF/rehab for aftercare and could not remember she couldn't walk. The family was required to provide a sitter or family member 24/7 as restraints could not be used. Even rails were considered "restraints".

Wishing you the best .

HB

easy23

Sorry for your problems. I hope everything is ok.

When my husband was in rehab two years ago for a fractured femur they put him in a Posey enclosure bed to prevent him from trying to get up and walk. It worked.

King Boo

Back when safety restraints were used, (including bedrails and cloth restraints)  patients with no safety awareness had further injury and death due to them.  Strangulations, spiral fractures, etc.

Unhappily, when safety awareness is gone in our LOWD, some things put them at greater risk.

Floor mat alarms can sometimes be used for short periods of time depending on rules (i.e. short term after surgery) but these really do not increase safety for our LO - rather, by the time they alarm, they are already fallen.

Supervision in the interim may be an option by hiring a 1:1 aide or family rotation.

I hope the ER outcome is ok

May flowers

Yes, that’s the law as I understand it. My FIL is rehabbing here after hip surgery a month ago (from a fall) and he cannot walk without assistance but he doesn’t understand that. I asked the PTs what kinds of things we could do to keep him from falling, and they said for them by law, no restraints. They did not look down on us for the restraints we are considering- one is an extra set of railing on the foot of the bed, and two is a seatbelt on his wheelchair. For recliners, propping the feet up keeps him from getting up as well. Ottomans with chairs do not work.

 Obviously, I don’t use these all the time but I do try to get him into a safe position when I have to take a bathroom break or at night.

Jo C.

This is a very significant issue with so many sides to it.   In the past, restraints were horribly overused without precautions.  Patients actually died or came to significant physical harm.  Yet; we worry about our LO who is not competent to know what is happening and is a huge fall risk, and NHs refuse to restrain.

This comes about because of the stringency of the law regarding restraints which makes it almost impossible for NHs to follow the mandates.  Often, a NH will demand family hire a 24 hour sitter to be next to the patient to ensure patient safety.  They do not address how the family is supposed to afford this and certainly, Medicare does not cover sitters.  Sometimes, if the patient is a fall risk from the bed, the patient is place in a hospital type bed that can be lowered very close to the floor by only a few inches and a mat is placed on the floor next to the bed - the patient then must be placed back upon the bed and again, and again . . .

Here is the actual Medicare law regarding restraints.  Scroll down a bit, the criteria is written in red and actually goes on for several pages:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R20SOM.pdf

For some reason, it seems to me in recall that there is also a mandate that the licensed nurses must assess the patient every so often (can't remember the timeline, but it was really frequent), and must document the full assessment and findings in the record and in some instances (may be a state law), the order for such restraints must be re-ordered every day with all the documentation as to who, how, where, why, what so to speak.   NOTE:  Even if a physician orders restraints, the NH staff can reject the order based on the legal mandates as set forth by CMS (Medicare.)

While CMS (federal) mandates are at the top of the requirements, there may be some states that have further requirements.  NOTE:   physical restraint may NOT be replaced with chemical restraints.

J.

JJAz

 My husband was in a medically licensed small group home owned by an RN.  This RN had been in the dementia care business for 20+ years.  He and I discussed this issue because my DH had LBD and was an extreme fall risk.  He typically fell 2-3 times per week because of extremely low blood pressure that would cause him to pass out while walking. 

 The RN explained that while there were ways to restrain patients who were a danger to themselves and still meet the Medicare and state licensing requirements, it basically wasn't worth it to the facilities to take the risk.  There were many hoops that they needed to jump through and if they just slipped up once, they could lose their license or be found liable in a lawsuit. 

 On the other hand, the facility was never found to be at fault if the patient hurt themselves when they were unrestrained.  It's really inhumane.  He explained that there are two types of restraints that have become "acceptable" that people don't question, even though they meet the Medicare description of restraint.  They are elevator locks/door alarms in memory care facilities and wheel locks on wheelchairs.  I had never thought about this, but it falls in a similar category as bed alarms, which are restricted. 

 Ultimately, the RN/owner agreed to use a restraint with my DH, for which I was very grateful.  This compassionate RN couldn't stand to see my DH fall all of the time and suffer all of the injuries that he did (everything from broken wrist to concussion).

Petra2024

good to read all this — my DH is in hospital as he had sudden decline and had wrist restraints used (I’d left to get rest with specific instructions for no restraints because he wouldn’t tolerate it and wouldn’t understand it — they were to call me and I’d return immediately if he was trying to get out of bed. No call and I returned to him hysterical and in wrist restraints.) I’m not leaving him again unless o can have another sitter here - we’re now in a room I can stay in. But he will be going to rehab at some point and this thread is helping me understand the difference between kinds of restraints and rehab vs hospital rules, etc. I have a feeling you’re helping me avoid another disaster down the road…

H1235

So sorry you have to go through this. I learn so much here. I hope this is never a problem for my mom, but feel more prepared having read these posts. I had no idea.

ronda b

https://alzconnected.org/discussion/59856/rehab-facility-won-t-restrain-lo-for-safety-legal

It's against the law to restrain a pt In a facility. The can in the hospital for safety.