Restraining impaired elders in the home environment: legal, practical, and policy implications

Since the late 1980s, a combination of regulation and education has brought about tremendous changes in practices in nursing homes, and to a lesser extent hospitals, concerning the use of physical and chemical restraints on patients. However, case managers often seek to negotiate home living arrangements for impaired older persons as a less restrictive or intrusive alternative than institutional placement. This article moves the discussion about the legal and ethical propriety of restraints to this home setting. Questions are raised about theoretical legal implications, practical enforcement issues, and public policy dilemmas when restraints are applied to older, impaired individuals in the home environment either by professional agency personnel or by the individual's family. Specific questions for case managers are highlighted.