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Physical Restraint Of Nursing Home Patients Limited By Law

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The Nursing Home Reform Act of 1987 mandated changes in American nursing care. Chief among those changes: patients may not be restrained (either physically or chemically) unless it is medically necessary. How has that mandate fared in practice?

Frail (usually elderly) nursing home patients may be unable to walk, or even to support their own weight. Among those patients who are able to stand, gait and balance may be so compromised that there is a constant risk of falls.

The purpose behind most restraints, particularly so-called “soft” restraints like vests that tie patients to their chairs, or tables that make it impossible to stand (and that can not be easily removed by a confused, weakened elderly patient) is to prevent the patient from getting out of a chair or bed, and thereby to avoid falls and resultant injuries. The problem with those restraint devices, according to a growing portion of the elder care community, is that they actually endanger rather than protect patients.

Restraints have been cited as the causative factor in numerous deaths and injuries of patients. A frail elderly patient who is constantly trying to escape from restraints may be in danger of slipping part way out of the restraint system, and patients have even been strangled by the “protective” device.

Furthermore, according to advocates for the elderly, the mere fact of being restrained can lead to increased anxiety and confusion, and may itself be the cause of future increases in the use of restraints, including tranquilizers for the resulting agitation. The frail patient’s adverse reaction to restraints can become the cause of further loss of mobility, strength, dignity and self-control, accelerating the patient’s decline and resulting in an earlier death.

One powerful force behind the use of physical restraints is the demand by families for what is perceived as protection of elderly patients. Legitimately concerned and well-meaning family members often demand that facilities tie up elders to prevent the possibility of falls. Because the danger of restraints may not be apparent to family members, the facility has a special duty to not only resist the use of restraints but also to help educate patients’ families.

Does the 1987 law prevent the use of restraints? No, but it does call for restraints to be used only for legitimate medical needs of the patient, and not for the convenience of the facility or the comfort of family members.

A small but growing number of American nursing homes have moved toward elimination of restraints altogether. One leader in this movement is the Kendal Corporation of Pennsylvania, which has operated restraint-free nursing homes in four states beginning in 1973. The Kendal Corporation, in fact, operates a nationwide educational and advocacy program, called “Untie the Elderly,” in which it promotes the elimination of restraints in other nursing facilities as well. The program offers a videotape on the use of restraints in nursing homes and a compelling and practical handbook for use by nursing homes considering eliminating the use of restraints. The “Untie the Elderly” program also operates a website, with more information about its program and training materials.

Another excellent resource on the use of restraints in nursing homes is the National Citizen’s Coalition for Nursing Home Reform (NCCNHR), which has long advocated for reduced use of restraints and increased emphasis on patient’s rights. NCCNHR has published a short Fact Sheet on the use (and overuse) of restraints. More details (including NCCNHR’s excellent books Avoiding Physical Restraint Use: New Standards in Care and Nursing Homes: Getting Good Care There) can be ordered from the organization’s site.

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Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

Elizabeth N.R. Friman


Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

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Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.