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Falls and Restraints: Do Nursing Home Residents Have a “Right to Fall”?

Philadelphia nursing home lawyers have been closely following a trial in Ohio last week that cast a spotlight on nursing home resident rights and caregiver responsibilities. LPN Randi Noel McKinley was placed on trial for restraining a nursing home resident, Robert Whittington, in a medical chair with a gait belt. The resident died the following day, and the coroner deemed that the death stemmed from natural causes and was unrelated to the restraining incident. While Ms. McKinley was found not guilty of the criminal charges against her, the trial itself brings up important questions about resident rights and the freedom to make medical choices. Additionally, Philadelphia nursing home lawyers say the case puts a spotlight on negligence and the use of restraints in nursing homes.

Right To Fall

In this newsworthy case, the plaintiff’s legal team advocated that the patient had a God-given “right to fall.” For most individuals who are unfamiliar with a nursing home setting, this seems like an unfamiliar and outlandish right. Do residents really have a right to fall? Is preventing a fall violating a resident’s right? To explore this further, we must scrutinize regulations that govern nursing homes to understand the concept of resident rights.

Federal Regulations for Nursing Home Resident Rights

The State Operations Manual F550 §483.10(a) states “The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility.”

While this statement may be purposefully vague, the guidance to surveyors provides further clarification. The guidance requires that nursing homes “refrain from practices that are demeaning to residents” and provides examples such as leaving a catheter bag uncovered or refusing toileting requests during mealtime.

Now, imagine being an 85-year old resident at the end of their life. You may be confused, possibly agitated, and perhaps experiencing pain that you cannot adequately convey. Any reasonable person can understand that a physically restraining a resident by tying them to a chair with a gait belt, in absence of a physician’s order and true medical necessity, would certainly qualify as a demeaning practice that strips their human dignity at their most vulnerable hour.

The survey manual is quick to point out that deficient practices cited under resident rights may have negative outcomes for the resident both physically and psychologically. Physically, restraints can result in a decline in physical functioning, respiratory complications, skin breakdowns and entrapments. They can also negatively impact residents psychologically by creating agitation, aggression, anxiety, or the development of delirium. Other psychological impacts include feelings of loss of dignity, depression, and feelings of imprisonment or dehumanization. Removing a resident’s freedom to use their own body, even when it may put the resident at risk for falls, can be a violation of resident rights.

Every day, individuals in our society make decisions that place their personal health at immediate or future risk.  Numerous people choose to smoke cigarettes, drink too much alcohol, and eat too many sweets. Individuals suffering from mental health disorders choose whether to take psychotropic medications. Motorcycle riders choose not to use a helmet. Simply residing as a resident in a nursing home does not strip you of the right to make medical decisions about your own body, even if those decisions may not be in your best interest. This includes a resident’s right to make choices about what interventions they want to accept for fall prevention, and decide what interventions, such as physical restraints, that they want to decline.

Restraints Used to Prevent Falls – An Inappropriate Intervention

Federal regulators recognize that restraints have negative impacts on residents and have implemented extensive guidelines to prohibit unnecessary use of restraints.

Philadelphia nursing home lawyers point out that the State Operations Manual has extensive regulations regarding use of restraints. These regulations are due to the inherent safety risks of using restraints as well as the potential impact of restraints on human dignity.

According to §483.12(a)(2) of the State Operations Manual, nursing homes must “ensure that residents are free from physical or chemical restraints that are imposed for the purposes of discipline or convenience and not required to treat a resident’s medical symptoms.”

Under the guidance for surveys, the State Operations Manual notes specifically that “falls do not constitute self-injuries behavior or a medical symptom that warrants the use of a physical restraint.” The reasoning behind this directive is that restraints have significant drawbacks and can lead to serious injuries. Moreover, there is a lack of evidence that use of restraints actually prevent or reduce falls. Falls that happen while a resident is restrained often result in severe injuries, such as entrapment or strangulations.

Restraints for Staff Convenience

So, if restraints are not necessarily effective and can result in serious injuries, why do staff members resort to restraints, such as the staff members did in this case? According to Philadelphia nursing home lawyers, the answer is frequently for staff convenience. According to the State Operations guidance to surveyors, reasons for restraints for staff convenience or discipline include:

  • Staff members believe that the resident does not exercise good judgment, such as forgetting their physical limitations in standing or walking, and do not wait for staff assistance.
  • Staff have notified management that there is not enough staff on a particular shift, and staffing was not adjusted to meet resident needs
  • Staff restrain residents because their workload includes monitoring too many residents
  • Staff restrain residents because they are concerned about the resident falling while they are monitoring other residents.

As noted above, restraints used inappropriately for staff convenience can occur for many reasons. Sometimes, a staff member is seeking to make their shift “easier” by not having to provide as much care to resident with high care needs. However, many times, it is nursing home understaffing that drives restraint use. A Philadelphia nurse understaffing lawyer has seen many cases in which nursing home residents are improperly restrained or fail to receive care due to inadequate nursing facility staffing. Situations in which restraints are used for staff convenience and result in resident injury should be investigated thoroughly by a Philadelphia nursing home understaffing lawyer.

Restraints and Resident Abuse

While Ms. McKinley was ultimately found not guilty of criminal abduction, the case may have ended differently in a civil court. The Centers for Medicare and Medicaid (CMS) define abuse as the willful infliction of injury, unreasonable confinement, or punishment with resulting physical harm, pain or mental anguish. A case for resident abuse may very well have been met in this circumstance.

The Philadelphia nursing home abuse lawyers at the Wieand Law Firm are staunch advocates who fight every day to protect nursing home residents from abuse and neglect. We believe that nursing home residents who are injured due to negligence at a nursing home deserve to be compensated for their injuries. Nursing homes must be held liable when their actions result in serious resident harm and assaults to their physical and mental wellness.

Contact Philadelphia Nursing Home Lawyers at the Wieand Law Firm Today

If you believe that a loved one has suffered abuse or neglect at a Pennsylvania or New Jersey nursing home, consider having your case reviewed by a Philadelphia nursing home abuse lawyer. The attorneys at the Wieand Law Firm have extensive experience in personal injury claims and have litigated many cases against nursing homes and assisted living facilities who commit negligent acts against the residents in their care.

Do you have a claim? It can be difficult for a layperson to understand if their concerns justify filing a nursing home personal injury claim. The attorneys at our firm offer a free case evaluation to help you understand your rights and legal options. If you decide to file a claim, our attorneys will work under a contingency fee agreement, in which they only earn a fee if we win money for your claim. This fee agreement helps our clients to proceed confidently with their lawsuit without fear of paying large attorney fees out-of-pocket.

Call 215-666-7777 today or send us a message via the online form to speak directly with an attorney at the Wieand Law Firm.


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