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1992.02.05 :  Nursing Home Resident Protection

Contact:  Bob Hardy (202) 245-6145
February 5, 1992              

        A rule to strengthen the protection of nursing home
residents from unwarranted physical and chemical restraints was
proposed today by HHS Secretary Louis W. Sullivan, M.D.
        "Enforcement of this rule will be another important step in
our program to improve the quality of care in nursing homes and
ensure residents a decent quality of life," Secretary Sullivan
said.
        The proposed rule provides specific requirements to
implement existing law and regulations, which prohibit use of
physical and chemical restraints for discipline or for the
convenience of nursing home personnel.  Such restraints may be used
only when necessary to treat medical symptoms or to ensure the
safety of the person being restrained or other residents.  Except
in emergencies, physical and chemical restraints may be used only
under written orders of physicians.
        Freedom from unnecessary restraints is one of the "rights"
of nursing home residents set forth in the Omnibus Budget
Reconciliation Act of 1987. 
        The Health Care Financing Administration on Feb. 2, 1989,
published a final rule mandating that nursing homes honor those
rights as a requirement for participation in the Medicare and 

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Medicaid programs.  The proposed rule published in today's Federal
Register provides detailed guidance for implementing the new
standards on use of physical and chemical restraints.
        HCFA Administrator Gail R. Wilensky, Ph.D., said federal
laws and regulations to protect nursing home residents "are needed
because many residents, including the frail elderly, are especially
vulnerable to harmful effects from use of physical and chemical
restraints."
        For every use of restraints, the proposed rule requires
that a physician specify the purpose and duration of their use. 
Restraints must be part of a plan of care designed to reduce or
modify the symptoms for which the restraints were ordered.

        "We will not allow ambiguous and open-ended orders that
could permit physical or chemical restraints to be used for
disciplinary purposes or for the convenience of nursing home
staff," 
Dr. Wilensky said.

        The proposed rule provides extensive and detailed
instructions governing the use of drugs that alter behavior, mood
or mental status.  When ordering drugs, physicians must affirm that
the anticipated benefits will outweigh the potential risks.

        Other sections of the proposed rule also implement
provisions of OBRA 1987 by:

     o    Providing criteria for federal oversight of states in
          granting waivers of nurse staffing requirements for
          nursing homes.

     o    Establishing the educational and other requirements for
          nursing home administrators.

     o    Specifying the requirements that hospital providers of
          long-term care services must meet.
 
        Comments on the proposed rule may be submitted in writing
within 60 days to the Health Care Financing Administration, Attn:
BPD-488-P, P.O. Box 26676, Baltimore, Md. 21207.

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