Physical Restraints in Nursing Homes

Restraints should only be used when they are necessary as part of the treatment of a nursing home resident’s medical condition. Only a doctor can order a restraint. Restraints should never be used to punish a resident or to make things easier for the staff. Facilities are not allowed to use restraints based solely on a family’s request, unless there is a documented medical need and a doctor’s order. A resident who is restrained daily can become weak, lose his or her ability to go to the bathroom by themselves, and develop pressure sores or other medical complications.

Research and standards of practice show that the belief that restraints ensure safety is often unfounded. In practice, restraints have many negative side effects and risks that, in some cases, far outweigh any possible benefit that can be derived from their use. Physical restraints not only may not prevent falls, but can cause greater harm including strangulation, loss of muscle tone, decreased bone density (with greater susceptibility for fractures), pressure sores, decreased mobility, depression, agitation, loss of dignity, incontinence, constipation, and in some cases, resident death.

Benefits of refraining from the use of physical restraints have been well documented in long-term care literature; they include improvement in residents’ quality of life, greater independence and functional capacity, use of fewer antipsychotic medications, less skin break down, and fewer serious injuries due to falls.

The experience of many health care providers suggests that facility goals can often be met without the use of physical restraints. In part, this involves identifying and treating health, functional, or psychosocial problems. This may be accomplished through resident care management alternatives, such as modifying the environment to make it safer; maintaining an individual’s customary routine; using less intrusive methods of administering medications and nourishment; and recognizing and responding to residents’ needs for psychosocial support, responsive health care, meaningful activities and regular exercise. In evaluating and reconsidering the use of restraints for a resident, nursing homes should consider needs, problems, conditions, or risk factors that, if addressed, could eliminate the need for using restraints.

The New Mexico Medical Review Association (NMMRA) partners with New Mexico's nursing homes to improve the publicly reported quality measures posted on Nursing Home Compare, including measures related to reducing the use of physical restraints, as part of the National Patient Safety Initiative (NPSI). NPSI projects are part of NMMRA’s New Mexico Quality Improvement Organization (QIO) contract with the Centers for Medicare & Medicaid Services (CMS). 

Breaking the Ties That Bind

In May 2009, NMMRA launched Breaking the Ties that Bind: How to Keep Your Residents Safe Without Restraints, a collaborative of New Mexico long-term care facilities focused on reducing or eliminating restraints. Participants are working together to test and apply system changes to address restraint use. The collaborative aligns with the goals of the national Advancing Excellence in America's Nursing Homes Campaign and is supported by an advisory committee that includes representatives from the New Mexico Health Care Association; the New Mexico Department of Health, Health Facility Licensing and Certification bureau and the Innovation Network.

Find out more about how NMMRA is helping to Improve Nursing Home Quality of Care and access physical restraint (falls management) resources for providers.