Least Restrictive or Least Understood? Waist Restraints, Provider Practices, and Risk of Harm

ABSTRACT

Since implementation of The Omnibus Budget Reconciliation Act of 1987, restraint use in American nursing homes has reduced dramatically. The reduction in vest restraints has resulted in an increase in “least restrictive” devices such as waist restraints. Although this analysis of U.S. Food and Drug Administration Adverse Event Reporting Data Files found that waist devices pose the same potential risk for asphyxial death as vest restraints, few health professionals and consumers are aware of this outcome. Post-marketing device reporting needs better data quality and surveillance, which can certainly benefit the Centers for Medicare and Medicaid Services in their efforts to regulate and enforce standards of care that reduce deaths and injuries to vulnerable nursing home residents.

KEYWORDS:

• Physical restraint
• nursing homes
• long-term care
• Centers for Medicare and Medicaid Services
• U.S. Food and Drug Administration
• licensing and certification

Acknowledgments

This work was supported by a grant from the Borchard Foundation Center on Law and Aging.

Notes

Centers for Medicare and Medicaid Services. (1987). Omnibus Budget Reconciliation Act of 1987. P.L. 100–203. Subtitle C. The nursing home reform act. 42 U.S.C. 1395i-3 (a)-(h) (Medicare); 1396r (a)-(h) (Medicaid).