Differences in nursing homes with increasing and decreasing use of physical restraints

Area of Science:

• Gerontology
• Healthcare Management
• Nursing Home Administration

Background:

• The Nursing Home Reform Act (NHRA) of 1991 mandated reductions in physical restraint use in nursing homes.
• Understanding organizational factors influencing restraint use is crucial for effective policy implementation and quality improvement.

Purpose of the Study:

• To examine organizational characteristics of nursing homes associated with changes in physical restraint use post-NHRA implementation.
• To identify factors correlating with increased versus decreased restraint utilization.

Main Methods:

• Utilized nationally representative data from the 1992 and 1997 On-Line Survey Certification of Automated Records.
• Employed descriptive and multinomial logistic regression analyses to assess organizational factors.

Main Results:

• 2,331 nursing homes increased restraint use (>4%); 2,100 decreased use (>3%).
• Ownership, Alzheimer's units, and occupancy rates showed bidirectional influence.
• Chain membership and rehabilitation staffing correlated with increased use; Medicaid/private-pay census correlated with decreased use.

Conclusions:

• Some nursing homes increased physical restraint use despite NHRA mandates.
• Organizational characteristics differ between facilities increasing and decreasing restraint use, indicating varied responses to reform.