What Defines a Restraint in Healthcare?
In regulated care environments, a device is considered a restraint if it is attached or adjacent to the resident's body, cannot be easily removed, and restricts freedom of movement. The intent and the individual's ability to remove the device are key.
Types of Restraints
Restraints can be physical, chemical, or environmental.
- Physical Restraints: These include devices like full or partial bed rails that prevent voluntary exit from bed, vests, belts, ties that fasten a person to furniture, hand mitts that limit movement, and lap trays or tables that prevent getting up from a chair. Even tightly tucked sheets can be considered a restraint if they restrict leg movement.
- Chemical Restraints: These involve psychopharmacologic drugs used to control behavior for staff convenience rather than a medical need, including antipsychotics, sedatives, and hypnotics.
- Environmental Restraints: These are actions or setups that limit mobility, such as placing furniture to restrict movement or using alarms in a way that instills fear of moving.
The Difference: Restraints vs. Supportive Devices
A supportive or assistive device aids positioning or mobility and can be removed or controlled independently by the user. A restraint restricts movement and cannot be easily removed. A bed rail can be either, depending on the resident's ability to operate it.
Comparison of Restraints vs. Supportive Devices
| Feature | Restraint | Supportive Device |
|---|---|---|
| Primary Intent | To restrict movement | To aid function, positioning, or mobility |
| Individual Removal | Not easily removed by the person | Can be easily removed or controlled voluntarily |
| Effect | Can cause agitation, injury, and functional decline | Enhances safety, independence, and comfort |
| Examples | Lap tray that traps a person in a chair | A bed rail used as a handle to assist with repositioning |
| Legal Status | Heavily regulated; requires specific medical justification | Standard of care to assist with independence |
The Dangers and Consequences of Using Restraints
Restraints are associated with significant negative outcomes, leading to strict federal regulations. Physical risks include suffocation, falls, pressure ulcers, muscle atrophy, and reduced mobility. Psychologically, they can cause indignity, fear, anger, anxiety, agitation, and withdrawal. Restraints have not been shown to prevent falls effectively and may increase injury risk.
Alternatives to Restraint Use
Person-centered alternatives prioritize safety and respect by addressing the root cause of behaviors.
Effective alternatives include:
- Environmental Modifications: Using low beds, floor mats, improved lighting, and reducing clutter.
- Person-Centered Care: Tailoring care to individual needs, establishing routines, and providing meaningful activities.
- Increased Supervision: More staff monitoring or positioning residents closer to a nursing station.
- Mobility Aids: Providing appropriate devices like walkers and transfer poles (used correctly).
- Behavioral Interventions: Using de-escalation techniques, tactile stimulation, and comfort measures.
For detailed guidance on restraint-free environments in long-term care, consult the {Link: CMS regulations https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationgeninfo/downloads/scletter09-11.pdf}.
Conclusion: Prioritizing Dignity and Safety
Understanding what devices are considered restraints is vital for ethical care. Prioritizing person-centered strategies and alternatives over restraints enhances safety and dignity, preventing physical and psychological harm and creating a more compassionate environment for older adults.
