Are nursing homes allowed to restrain patients? A comprehensive guide to regulations

Oct 15, 2025 3 min read •

Patient Rights elder care Legal

According to the Centers for Medicare & Medicaid Services (CMS), federal regulations prohibit nursing homes from using restraints for discipline or staff convenience. This means nursing homes are legally limited in their ability to restrain patients and must follow a strict set of rules to protect residents' rights and safety. Understanding these regulations is crucial for ensuring proper care and dignity for patients in long-term care facilities.

Quick Summary

Nursing homes are not allowed to restrain patients for convenience or punishment. Restraints are legally permissible only when medically necessary to treat a specific medical symptom, after less restrictive alternatives have been exhausted, and with informed consent. Federal and state laws strictly regulate their use.

Key Points

Restraints are Prohibited for Convenience: Federal regulations forbid nursing homes from using physical or chemical restraints for staff convenience or disciplinary purposes.
Medical Symptoms Required for Justification: Restraints can only be used to treat a resident's specific medical symptoms, never for general behavior management or fall prevention alone.
Alternatives Must Be Exhausted: A nursing home must try less restrictive alternatives, such as environmental changes or behavioral interventions, before resorting to restraints.
Informed Consent is Necessary: The resident or their legal representative must provide informed consent before a restraint can be used, except in immediate emergencies to prevent harm.
Advocates Can Help: If you suspect improper restraint, you can contact the Long-Term Care Ombudsman program to advocate for the resident's rights and resolve issues.
Improper Use is Abuse: Unnecessary or improper restraint is considered a form of neglect or abuse and can result in severe physical and psychological harm to the resident.
Physician's Order is Not Enough: A physician's order alone is not sufficient justification for a restraint; it must be backed by a comprehensive assessment and care plan.

Federal regulations on restraints

Federal law, specifically the Nursing Home Reform Act of 1987, guarantees residents the right to be free from physical or chemical restraints imposed for discipline or staff convenience. The Centers for Medicare & Medicaid Services (CMS) enforces these regulations, requiring facilities to create and maintain a restraint-free environment wherever possible. Any use of restraints must be documented and justified by a resident's medical symptoms, not for the ease of staff. This includes both physical devices and chemical restraints, which are psychopharmacologic drugs used to control behavior inappropriately.

Legitimate medical reasons for restraint use

While highly restricted, there are specific, documented circumstances where restraints may be used for a medical purpose. These are considered a last resort after other interventions have failed. Legitimate reasons include ensuring physical safety when a resident poses an immediate threat, medical necessity for procedures, and orthopedic needs for positioning. Even in these justified scenarios, a physician's order and a comprehensive assessment are mandatory to ensure no less restrictive alternatives exist.

Alternatives to physical and chemical restraints

Nursing homes are required to explore and implement less restrictive methods before using restraints. These alternatives include environmental changes, increased supervision, restorative care, behavioral interventions, and addressing underlying causes of behavior like pain or anxiety.

Improper use and potential consequences

The misuse of restraints for convenience, punishment, or due to understaffing is serious and can constitute neglect or abuse. This can lead to severe physical harm like injuries, pressure ulcers, and muscle atrophy, as well as psychological distress such as trauma, depression, and loss of dignity. Facilities misusing restraints can face legal action, fines, and penalties.

How patients and families can advocate for change

Family members and residents can challenge the use of restraints. Options include speaking with staff or administrators, requesting a care conference, contacting the Long-Term Care Ombudsman Program, filing a complaint with the state licensing agency, or consulting a legal professional.


Advocacy Method	Pros	Cons
Speak directly with staff/administrator	Can lead to a swift resolution, establishes direct communication.	Staff may be defensive or dismissive; may not resolve systemic issues.
Request a care conference	Involves the entire interdisciplinary team in discussing alternatives; creates a formal record.	Can be a slower process; requires preparation and firm advocacy.
Contact the Long-Term Care Ombudsman Program	An independent, free resource specifically trained to resolve resident issues.	May not have enforcement power, but can help mediate or refer complaints.
File a complaint with the state licensing agency	Triggers an official investigation; can result in fines or sanctions against the facility.	Can be a lengthy process; requires gathering evidence and filing a formal report.
Consult a legal professional	Can lead to a lawsuit for abuse or neglect, potentially resulting in compensation.	Expensive and time-consuming; may be emotionally taxing.

Conclusion

Nursing homes are significantly restricted in their ability to use restraints, which are prohibited for discipline or convenience. Restraints are only permissible as a last resort for documented medical symptoms, requiring a physician's order and a comprehensive assessment after less restrictive alternatives have failed. Residents and families have rights and resources to advocate against improper restraint use and ensure dignified care. For more detailed information on residents' rights regarding restraints and how to advocate, refer to {Link: VDH Virginia https://www.vdh.virginia.gov/content/uploads/sites/96/2016/07/Restraint-Guide.pdf}.

Definitions

Physical Restraint: A manual method or physical/mechanical device attached or adjacent to the body that restricts freedom of movement or access to one's body, which the resident cannot easily remove.
Chemical Restraint: A psychopharmacologic drug used for convenience or discipline that is not medically necessary to treat a resident's symptoms.
CMS: The Centers for Medicare & Medicaid Services, which administers federal regulations for nursing homes that accept Medicare or Medicaid.

Frequently Asked Questions

No, a nursing home cannot restrain a resident solely to prevent falls. Federal regulations specify that restraints cannot be used for staff convenience or discipline. While fall prevention is a safety goal, facilities must use less restrictive methods and address underlying causes of falls instead of resorting to restraints.

A physical restraint is any manual, mechanical, or physical method that restricts a resident's freedom of movement and cannot be easily removed by them. This can include items like vest restraints, lap trays, and bed rails if they prevent voluntary movement.

A chemical restraint is a psychopharmacologic drug used to control a resident's behavior for the convenience of staff or for disciplinary purposes, rather than to treat a specific medical or mental health symptom. This is also prohibited under federal law.

If you suspect improper use of restraints, you should first document your concerns and then speak directly with the nursing home administrator. If the issue is not resolved, contact your local Long-Term Care Ombudsman Program or file a complaint with your state's Department of Health or a similar regulatory agency.

No. Even if a family member or legal representative requests it, a nursing home cannot use restraints if they are not medically necessary to treat a resident's symptoms.

Bed rails can be considered a physical restraint if they are used to prevent a resident from getting out of bed voluntarily, especially if the resident is unable to lower the rails independently due to physical or cognitive limitations. Their use is restricted and requires careful assessment.

Alternatives to restraints include increasing staff supervision, modifying the environment to reduce fall risks, using low beds with floor padding, providing physical and occupational therapy, and using person-centered behavioral interventions to address underlying needs.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.