Nursing Home Restraints

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Mr. X, and 80-year-old wheelchair-bound man, is a resident in a nursing home. He has fallen several times in the past and is currently deemed to be at high risk to fall and suffer a significant injury. The facility, with the family’s reluctant agreement, has implemented different types of physical restraints, including lap belts and a tray attached to Mr. X’s wheelchair, and has positioned Mr. X in the common area where he is more visible to staff. Mr. X is extremely resistant to these interventions and gets quite agitated. He just wants to be left alone in his room to look at magazines or watch television. He is moderate to severely demented. If permitted to do so, he is likely to get out of the wheelchair and fall again. The medical director and the nursing staff perceive Mr. X will probably suffer physical injury if not restrained or serious emotional injury if he is restrained.
How should the facility and its staff handle this situation? With each of the potential courses of action, what are the possible risks regarding civil liability, regulatory sanctions for violating resident’s rights, and sanctions for violating the regulatory provisions regarding accident prevention? Is it realistically feasible for the facility to successfully “balance protecting the resident’s right to make choices and the facility’s responsibility to comply with all regulations”? In a case like this, is the best risk management strategy also the best ethical solution?

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