Share Your Story

Share

Share your stories with us! It could be a story about the care you received (or didn’t receive) in a healthcare facility. If you are a surveyor, share your surveying stories; the things you have seen, both good and bad. You can send then to me at jl [at] nursinghomesurveyor [dot] com, or leave them in a comment. Share with the world, and with those who are researching, what you have run into, what you have experienced, and help others to know what to watch out for.

 

This blog is to help you and others to learn about how to keep yourself safe in a nursing home or hospital.

 

Here is a question from AW:

 My name is AW and I’m writing you out of concern, and praying for understanding about what defines “restraint”.

I just got a call from a facility where my mom is being cared for.  She is only there temporarily until she regains the use of her legs.  My concern is that she fell from her bed.  I was told that the only protection or railing allowed on their beds are those located at the upper segment of the bed.  This doesn’t cover even half way down the length of the bed.
At any rate, when I questioned whether a family member could bring in a rail to offer more protection from her falling from the bed, I was told that the state considers this to be a restraint. Herein lies my question and concern.
If the patient is lucid and doesn’t have issue with the “extra” railing, why is it an issue or considered a restraint? My mother fell from the bed because she doesn’t have use of her legs, but was trying to maneuver herself off of the pan. Considering the fact that she has a sore spot on her backside, understanding that the timeliness of the techs are often lengthy because of the patient load, she didn’t want to aggravate the area by setting in wetness or whatever may have been present till help arrived.
Can you offer any response to our State’s regulations and whether we can offer her some sort of protection?  I can’t see where a hospital bed would be any different.  To this, may I add that while she was at the hospital (not the rehab), she had railings there that were used for pulling herself up for support or maneuvering. Are the cases of restraint a per case issue?
Any information or direction you could provide, would be appreciated.
And I answered AW with the following:
Give me a bit to find and look at your state’s regs, and see where they differ from Federal regs. But I think they will be pertty much the same as the Federal regulations. Here is a link to a document with the federal regulations, and some guidance  – you will want to read this. It is a pdf, and if you notice at the top it is 635 pages – you want to start reading at page 55 of 365 (towards the bottom of the page) – starting at 483.13(a) Restraints – and reading through to the end of that section (is it quite a number of pages). It will help you understand about restraints in Nursing Homes – many nursing homes think they can’t have restraints – and that is not true – they must do comprehensive assessments and try less restrictive methods, but they can use siderails if the resident requests it – and they care plan appropriately for monitoring, maybe they could use 1/2 or 3/4 length rails; or just put them up at certain times, or get a kind that your mother can put up and down electically herself…. all sorts of things they can do. If she is alert and oriented and able to make her own decisons, then she can request them, and they just need to be care planning that and documenting that she wants them – and they may even have her sign something saying this is at her request. They HAVE TO MEET HER NEEDS. Also another section of the document you should read is the section on “Accidents” – at 483.25(h) – starting about page 263 of 635.
I hope this is helpful to you.
JL

Leave a Reply