Residents of nursing homes and assisted living facilities have the right to be free from physical and chemical restraints. Not only are restraints contributors to serious falls, restraints reduce functioning and increase incontinence. Residents who are restrained have more bedsores, infections, and circulatory and respiratory problems. Residents already confused become more so when restrained. When restrained, residents become more agitated and stressed contributing to possible cardiac problems. Depression and withdrawal can occur with restraint use.

According to Maryland regulations, a physical restraint is any physical or mechanical device, material or equipment, attached or adjacent to a resident's body, that (1) cannot be easily removed by a resident, (2) restricts freedom of movement or access to a resident's body, (3) is used for discipline or staff convenience, and (4) is not ordered by a physician to treat a resident's symptoms or medical conditions.

Geri-chairs and full bedrails are restraints. So are waist belts and lap pillows. Waist and vest devices often used to tie residents in bed, or in a wheelchair, are also physical restraints.

Chemical restraints are mind-altering drugs used for discipline or for staff convenience that were not ordered by a physician to treat a resident's medical symptoms and (1) used in excessive doses (including duplicate drug therapy), (2) used for excessive duration, without sufficient monitoring, (3) used without adequate indication for use, or (4) used in the presence of adverse consequences which indicate the dose should be reduced or discontinued.

Drugs such as Haloperidol (Haldol) or Lorazepam (Ativan) are frequently used to chemically restrain residents. Some drugs, such as Phenergan and Compazine, not routinely considered mind altering, are chemical restraints when used to control behavioral or mental disorders.

Unfortunately, restraints give people a false sense of security. Frequently families will demand restraints be used. Maybe they fear their loved one will fall and break a hip. There is no evidence restraints prevent falls. In fact, studies have shown there are fewer falls with serious injuries when restraints are not used. Only 1 to 2 percent of unrestrained residents who fall fracture a hip; 80 percent have no injury. The worst falls with the greatest injuries have occurred when a resident has struggled to get out of a restraint or tried to climb over a bedrail.

Residents' needs must be assessed individually. Providers need to learn about a resident's life experiences and routines. The facility's environment needs to be adaptable to each resident. Providers need to look at alternatives to restraints to enable a resident to "maintain or attain his or her highest practical level of functioning." Restraints rob an individual of his dignity and personal identity.

For information about restraint alternatives, contact the Carroll County Long Term Care Ombudsman Program, 410-386-3800. The program can also be accessed through the Carroll County Government's toll-free number, 1-888-302-8978.