RESTRAINT use down but not eliminated in nursing homes

TULSA, Okla. (AP) _ At least 14 residents of Oklahoma nursing homes suffocated or strangled to death on restraints between 1990 and 1999, according to a published report. <br><br>An analysis of death certificates

Monday, July 9th 2001, 12:00 am

By: News On 6

TULSA, Okla. (AP) _ At least 14 residents of Oklahoma nursing homes suffocated or strangled to death on restraints between 1990 and 1999, according to a published report.

An analysis of death certificates on file with the state Department of Health indicates there were also 52 deaths from falls, an issue often linked to the use of restraints, the Tulsa World reported in Sunday's editions.

Restraints have been blamed for the deaths of three Oklahoma nursing home residents during the past 18 months, according to the newspaper.

Common physical restraints include harnesses, vests, raised bed rails and other devices that are designed to limit mobility and prevent falls. Critics allege that the same straps and rails also demoralize residents and increase the risk of strangulation should a person slip.

Chemical restraints are commonly sedatives used to reduce belligerence, but they can also lead to overmedication that puts a resident at risk.

The frequent use of restraints often points to staffing problems, said Sarah Greene Burger, interim executive director of the National Citizens Coalition for Nursing Home Reform.

Staffing woes are often the result of poor pay and bad working conditions.

``Half the nursing homes in the United States don't have enough staff to prevent major injuries,'' Burger said. ``In the short term it's easier to tie people up than it is to provide the necessary care.''

Oklahoma numbers also could change significantly if nursing homes reported their restraint use total to the Health Care Finance Authority, the agency charged with overseeing the Medicare and Medicaid programs. The HCFA compiles reports from homes that accept federal funds.

In the most recent reporting period, 93 of 381 homes _ nearly one-quarter of all Medicare homes in the state _ did not report their use of physical restraints.

Burger said some nursing homes use restraints too often.

In the most recent federal report, 32 of the state's 381 nursing homes that receive Medicare or Medicaid patients reported the use of physical restraints in rates that were at least double the state average.

Eight of those homes reported restraint use that was at least three times the state average of 10 percent

Of the 32 homes, 28 were owned by for-profit corporations.

A total of 28 homes reported that physical restraints were not used on any resident. An additional 58 homes reported physical restraints used on 5 percent or fewer residents.

Nationwide, the use of resident restraints has dropped dramatically. In 1988, restraints were being used on close to 40 percent of nursing home patients. The current rate is 9 percent.

Burger said federal rules enacted in 1988 promoted closer scrutiny of restraint use and encouraged restraint-free environments.