Steve Gold, The Disability Odyssey continues
July 30, 2007
People do not enter nursing homes pursuant to a court order requiring them
to stay involuntarily in these facilities. Unlike mental institutions and
hospitals, people in nursing facilities, thus, can legally walk out and
leave a nursing facility whenever they wish, including against medical
advice.
Nevertheless, physical devices and restraints are used throughout the
nursing home industry. In 2005, 92,303 people in nursing facilities were
kept in some kind of physical restraints, presumably against their will
and without any judicial or other independent authority's approval. In
fact, 6.9% of all the residents in nursing facilities were either tied
down or had equipment restraints which restricted their freedom of
movement.
In 2007, it has been reported that in a seven day period, every day, 9.3%
or 129,148 people with disabilities in nursing facilities were physically
restrained from leaving their beds.
The variation from state to state is quite amazing. In six states, more
than 20% of the disabled residents were restrained in bed on a daily
basis. On the other hand, fourteen states had 1% or less of their
residents so restrained. We list each state below.
In addition to physical restraints in a bed, disabled residents face
several other types of physical restraints in nursing facilities.
Nationally, during the same time period of the last seven days in 2007,
there were 1.8 % or another 24,000 people with disabilities restrained in
chairs who were prevented from rising from them, and 2% or 27,000
residents who had limb restraints. We do not know if the people
restrained in the chairs were also the same people who had their limbs
physically restrained.
Federal regulations clearly state that nursing facility residents have the
right to be free from physical restraints that are "not required to treat
the resident's medical symptoms." The federal Centers for Medicare and
Medicaid Services note that "restraints may not be used for staff
convenience." If they are used, they must be only "for brief periods to
permit medical treatment to proceed."
Disabled Advocates:
Have you asked your State Medicaid officials for nursing facilities by
percentages that use these physical restraints? This information is
known.
When you go into nursing facilities, have you discussed these restraints
with the residents?
What "medical symptoms" justify bed restraints on a daily basis for seven
days?
Do the disabled residents know their rights? Have you and the residents
reviewed their "plan of care" to determine what possible medical
justification could conceivably warrant such restraints?
Do the residents know they can refuse the "medical treatment?"
Below are percentages, by state, of nursing home residents who were
physically restrained in their beds on a daily basis for seven day in 2007:
| Alabama |
17.20% |
| Alaska |
1.30% |
| Arizona |
2.10% |
| Arkansas |
20.70% |
| California |
29.50% |
| Colorado |
0.90% |
| Connecticut |
4.00% |
| Delaware |
1.5 |
| D. C. |
7.7 |
| Florida |
6.9 |
| Georgia |
20.2 |
| Hawaii |
6.3 |
| Idaho |
2.6 |
| Illinois |
6 |
| Indiana |
3.2 |
| Iowa |
10.5 |
| Kansas |
4.8 |
| Kentucky |
3.4 |
| Louisiana |
21.2 |
| Maine |
0.8 |
| Maryland |
4.9 |
| Massachusetts |
1 |
| Michigan |
1.4 |
| Minnesota |
0.2 |
| Mississippi |
8.5 |
| Missouri |
21.6 |
| Montana |
0.6 |
| Nebraska |
0.8 |
| Nevada |
4.4 |
| New Hampshire |
0.7 |
| New Jersey |
17.2 |
| New Mexico |
4.2 |
| New York |
2.4 |
| North Carolina |
13.8 |
| North Dakota |
0.4 |
| Ohio |
1.7 |
| Oklahoma |
14.9 |
| Oregon |
1.9 |
| Pennsylvania |
2.1 |
| Rhode Island |
0.3 |
| South Carolina |
15.9 |
| South Dakota |
0.9 |
| Tennessee |
18.5 |
| Texas |
20.6 |
| Utah |
4.4 |
| Vermont |
0.9 |
| Virginia |
1.6 |
| Washington |
0.4 |
| West Virginia |
1 |
| Wisconsin |
0.3 |
| Wyoming |
0.9 |
|
|
| National |
9.30% |
Special thanks to Charlene Harrington and her colleagues at University of
California San Francisco.
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