Restraint-free facility?

Dorali, BSN, LPN, RN · Aug 10, 2010

It's their right to fall.

That is the dumbest crap Ive ever heard. I've heard it at work too. I guess if they have psych problems and they WANT to fall, but so many of my ladies are scared to death of falling because they ALREADY HAVE, that it makes my job harder because they're near panic every time they transfer. Not that restraints would have helped in some cases but still. Not that every fall could have been prevented with restraints, but still.

I'll leave my rant at that. No need to go on.

(PS-My hall is all women.)

reussir1 · Aug 10, 2010

Yeah, because you use your arms to break your own fall after the CNA before you forgets to push the cranks back under the bed, leading you to trip over them.

and don't even get me started on the bruised shins.... :rolleyes:

TheCommuter, BSN, RN · Aug 10, 2010

I have been working in nursing homes in Texas for the past few years.

Nursing homes are paid an average of $100 per day by Texas Medicaid for every resident they have that receives Medicaid. This is not a great deal of profit for nursing homes if they have too many Medicaid residents on their censuses.

However, patients that are on Medicare and receive various therapies increase the profit margin dramatically. A single patient with a Medicare payer source that receives physical therapy, occupational therapy, speech therapy, wound care, injections, diabetic management, and pain management will result in the facility being paid about $400 per day. If you have multiple Medicare residents who are receiving various therapies, management is pleased because the money rolls into the facility.

The bottom line is that the Medicare payments and rehab therapies are what keeps many nursing homes financially solvent. Most would not be able to survive on Medicaid alone.

rosey2007 · Aug 10, 2010

I hate it when they run out of fall mates and use regular mattresses on the floor. I have tripped on these and almost fallen. Oh and I almost forgot, how about when you have to do a brief change on someone who's mattress is on the floor.

reussir1 · Aug 10, 2010

I hate it when they run out of fall mates and use regular mattresses on the floor. I have tripped on these and almost fallen.

i remember one family was so worried about their grandpa falling out of bed that they brought that tan egg crate foam to cushion the floor in case he decided to get up. the mixture of the bed being right by the door and tan foam against tan tile led to slipping and falling as soon as we entered the room. the fist time i answered the call light i knocked and said "can i hel----" before i slipped and fell right on my butt in front of all his family :doh:

KimberlyRN89, BSN, RN · Aug 10, 2010

I hate it when they run out of fall mates and use regular mattresses on the floor. I have tripped on these and almost fallen. Oh and I almost forgot, how about when you have to do a brief change on someone who's mattress is on the floor.

A woman who worked @ my facility tripped on a mattress one day & messed her knee up really badly.She had to have a couple of surgeries on it. Its been almost a year and she still hasn't come back to work. :crying2:

kids · Aug 10, 2010

Facilities in SW Washington/NW Oregon have been restraint free for years. It takes some getting used to but there are a lot of stratigies for preventing falls. The biggest hurdle is usually getting staff on board with it.

Satori77, ADN · Aug 11, 2010

My facility is restraint free. We do have the bed alarms, and the wheelchair ones. And belts on the seats that go into the tubs. Otherwise, no. Side-rails were recently taken off as well. They told us at orientation (just started this week) that there have been several deaths in Colorado because of side-rails, so now they don't have them. But they have rolls to put around people in bed, special mattresses, and mats that go on the floor. Haven't worked yet on the floor, so I guess I will see how it goes.

ZefiLilyLPN · Mar 3, 2014

When I started working in my skilled rehab facility we had bolsters, floor mats, bed/wheel chair alarms, this was is 2011, now in 2014 all of these have been phased out, no bed rails, no floor mats, no lap buddies, no restraint of any kind, even family requested or dr ordered is allowed. The only thing we have that helps any more are scoop mattresses. It is very nerve wracking when you and 2 cnas have 20+ pts to look after, not all alert and oriented, and no alarms or the such to help in keeping them safe when they are in your sight, which is 90% of the time.

When I have a pt who is confused and mobile and will get up on there own, if the cnas can't watch them, I usually keep them with me on my med pass and tx rounds, some times multiple pts.

Missingyou, CNA · Mar 4, 2014

The LTC where I work is restraint free. No bed rails, the seat belts on chairs must be able to be removed by the resident.(belts have alarms when removed).

No lap buddies. Not even the wc brakes are allowed to be locked unless the resident knows how to unlock them. Our CNA/resident ratio is 10:1 (1st & 2nd shift).

We seldom have residents fall from self transfers. (but it does happen).

All beds are against the wall, some have a mattress on the floor next to the bed. The beds are ALWAYS in the lowest position when someone is in it unless providing care. (we can be written up if it is not).

For those residents who climb out of bed even with alarms, we place the beds up against the wall and a mattress on the floor next to the bed. When they get up, the alarm sounds and they rarely get more than a foot (as in toe) on the mattress.

We can also place their rolling table next to their bed. The alarm attached to their shirt pulls & sounds when they sit up. The table often distracts them (they fiddle with something on it or try to push it aside before standing)long enough for someone to "catch" them before they actually stand up. It's not considered a restraint since the table has wheels.

~NONE of our residents sleep on a mattress on the floor.

If they are in their room in a lounge chair, the feet are up and a roll table in front of them. (it works & isn't considered a restraint!). Walkers and wc are moved out of their sight. (they don't see them, they don't try to go for them).

We use chair alarms and, more often than not, the sound of the alarm is enough to get the person to sit back down.

We all help each other out. If we hear an alarm, we run (not walk) to where ever the alarm is sounding, no matter "who's resident" it is. ALL staff (Aides, housekeeping, maintainence, adminstration....everyone) is required to respond to a chair alarm sounding if at all possible.

If a resident is known to self transfer and is wide awake at night, we give them an activity to do while sitting near the nurses station. There is more staff "traffic" there and they are easier to watch.

We give the resident a lap blanket to cover the lap belt so they don't see it and don't pull at it. We give them a doll or something to hold (laundry to "fold" to keep their hands busy.

It works in our facility. I can't imagine putting any restraint on a resident. We do just fine without them.