Reducing the use of physical restraints in nursing homes: will it increase costs?

Abstract

OBJECTIVES. Reducing the widespread use of physical restraints in nursing homes is a primary goal of the federal nursing home reforms enacted as part of the Omnibus Budget Reconciliation Act of 1987. However, some nursing home operators assert that reducing restraint use could be prohibitively expensive, costing payors perhaps as much as $1 billion annually. We investigated whether nursing home residents free from physical restraint require more care and resources than similar residents who are restrained. METHODS. We examined the major component of nursing home costs--staff time--and its allocation among residents who were physically restrained and those who were not restrained. The multivariate analysis used staff-time-study data on the care of 11,932 nursing home residents in 276 facilities in seven states. RESULTS. The analyses indicate that, when differences in impairment and care needs are controlled for, residents who are physically restrained require more nursing care than other residents. Higher levels of nursing-assistant time were consistently provided to restrained residents. CONCLUSIONS. Residents free of restraints are less costly to care for than restrained residents. The 1987 federal requirements concerning restraint use, which are aimed at improving quality of care and quality of life, can be implemented without engendering a major increase in care costs.

Labor Prices and the Treatment of Nursing Home Residents with Dementia

“…Effect of nursing home wages on inappropriate antipsychotic use (1) (2) 286 D.C. Grabowski et al shown to require more staff time relative to a non-physically restrained resident (Phillips et al, 1993). The OLS results provide modest support for this hypothesis (see Table 4).…”

“…Immobility resulting from the use of physical restraints has been found to increase the risk of pressure ulcers, depression, mental and physical deterioration and mortality (Zinn, 1993). Although greater staffing is typically correlated with a lower use of restraints, research has also suggested that -conditional on the level of staffing -residents who are physically restrained require more staff time than an otherwise similar non-physically restrained residents (Phillips et al, 1993). Federal law requires facility staff to remove physical restraints and reposition the nursing home resident every two hours; in addition, the regulatory requirements increasingly mandate that the staff document, in the facility's clinical records, the factors justifying use of physical restraints at any given time, generating further staff time burden.…”

Comparisons of Restraint Use in Nursing Homes in Eight Countries

“…Rather, residents without restraints have been shown to require less care resources than residents in restraints, all other factors being equal [15]. Indeed, the negative consequences anticipated with restraint removal rarely occur.…”

Changes in Resident and Facility Risk Factors for Psychotropic Drug Use in Nursing Homes Since the Nursing Home Reform Act

“…Medicaid recipients provide a low level of funding to nursing homes (Kim, 1990). Although a recent study has shown that reductions in psychotropic drugs may be cost-effective (Phillips et al, 1993), the perception that reducing psychotropic drugs is expensive because it entails using more staff time may still persist in the nursing home industry. Therefore, facilities with a high Medicaid census may view themselves as more constrained with regard to costs because of the lower payments received.…”