Risk factors for physical restraint use in nursing homes: pre- and post-implementation of the Nursing Home Reform Act

The purposes of this article are (1) to identify resident and facility risk factors for the use of physical restraints since the implementation of the Nursing Home Reform Act (NHRA), and (2) to compare these results with resident and facility risk factors for the use of physical restraints prior to the implementation of the NHRA. Data were collected in 1990 and 1993, and represent residents drawn from 268 facilities in 10 states. In the 1993 cohort activities of daily living (ADL) scores, cognitive performance scale (CPS) scores, age, taking antipsychotic medications, a history of falls, and mobility problems were resident-level variables significantly associated with the use of restraints. Full-time-equivalent (FTE) nurse aides per resident, FTE RNs per resident, average occupancy, Herfindahl index, Alzheimer's special care unit, and Medicaid reimbursement policy were facility-level variables significantly associated with the use of restraints. When the 1990 cohort was compared to the 1993 cohort (pre- and post-NHRA), however, only three risk factors for the use of restraints were significant. We propose that, to date, the NHRA may have been successful in reducing the use of physical restraints, but it appears to have had less impact on the types of residents who are restrained.