Mom had a stroke last week and she's now in a rehab. I am being told in rehab you can't restrain her. Advice?

Depending on your state and the nursing home's rules, restraints may NOT be available. They are very strict in Illinois...and the two nursing homes I investigated for mom didn't allow them. Not in bed to keep them from falling or trying to get up, and not in the wheelchair.

When mom was in rehab/nursing home for about 2 months, she was a fall risk. They used bed and seat alarms for her. Kept her near the nurse's station or in their lovely dining room. It had a 72" TV. They'd wheel her up to a table so she could watch TV and lock the wheels. The TABLE was her restraint.

That's something I would absolutely insist on for mom . . . a nursing home BUILT as a nursing home with a large dining room that was open morning 'til night situated near the nurse's station. Old retrofitted buildings aren't that way. Very important in preventing falls.

Any/everyone in the nursing home (including frequent visitors) knew what the seat alarm going off meant and would rush to the side of someone trying to get up encouraging them to sit back down . . . and perhaps even move their wheelchair to where they wanted to go.

If your mom is continuing to fall in rehab, move her to a facility that has better controls. It's only a matter of time until she's seriously injured.

These are the Federal Medicare/Medicaid guidelines for the use of restraints. Restraints can be used when they are medically necessary, it seems. Talk to the DON, talk to her doctor. Tell them that if they won't/can't keep your mother safe, you will be talking to the Ombudsman and the Joint Commission. But try to work with the facility first.


What Are the Federal Guidelines?

In addition to meeting good nursing standards, Medicare and Medicaid certified nursing homes cannot use physical restraints unless they are needed to treat the resident's medical symptoms. Federal law requires certified facilities to care for residents in a way that maintains or enhances quality of life. Restraint use does not enhance quality of life.

Medicare and Medicaid certified nursing homes must ensure that a resident's abilities do not decline unless the decline cannot be avoided due to the resident's medical condition. Residents often lose the ability to bathe, dress, walk, toilet, eat, and communicate when they are regularly restrained. If restraints are necessary, they must be used in a way that does not cause these losses. Residents must be released from restraints and exercised at least every two hours.

Nursing homes sometimes use restrains to help keep residents in proper body alignment or position. However, proper positioning can often be achieved by using pillows, pads, or comfortable chairs. A Medicare or Medicaid certified nursing home cannot use restraints to help position residents unless it has first consulted with therapists to determine whether less restrictive support devices could meet the resident's needs.

In the rehab that my mom was in last year (NYS), seat belts were used on many patients in wheelchairs. the folks who were most debilitated and who were restratined in this way were genearlly in wheelchairs outside of their rooms so that staff could keep an eye on them. Does your mom have an alarm on her bed and on her wheelchair to alert staff if she attempts to get up unaided? this sounds preposterous! have you talked to the Director of Nursing and/or the Director of Social Work? I'm so sorry that you're going through this!