DSS is again emphasizing information it has provided to its inspectors related to equipment or supplies that could be considered a physical restraint. Numerous questions about restraints and adaptive/assistive devices were raised during the regional training sessions on the new regulations. 

The following information was provided to VHCA-VCAL by Deborah A. Lloyd, RN, Operations Consultant with the DSS Division of Licensing Programs.  She can be reached at 804.663.5536. 

Some of you have shared that individuals from your membership have expressed concerns regarding issues related to equipment or supplies that can be considered a physical restraint.  While we ultimately intend to offer providers sample tools and guidance for determining risk factors, we hope that the following information that we have already provided our staff will reduce concerns about inspection expectations. 

It is important to take note of equipment and devices that may be considered physical restraints or could pose safety hazards to physically or cognitively compromised individuals residing in the facility.

Depending on the individual, this could be anything from bed side rails of any length and other manufactured restraints to reclining chairs, bean bag chairs, trays, tables, cushions, clothing, or linens that restrict the individual’s independent movement. The determination that something is a restraint cannot be based on the object or device that is being used, but must always be based on the effect the object or device has on the individual.  The same device may have the effect of restraining one individual but not another, depending on the individual resident’s condition and circumstances. For example, partial rails may assist one individual to enter and exit the bed independently, but act as a restraint or a safety hazard for another.

Physical restraints are allowed if the individual’s condition meets the criteria for the use of restraints, a valid physician/prescriber’s order is in place and the ISP contains instructions for safe application, release and monitoring of the individual and the restraints. If these and similar devices are being used as adaptive devices to assist the individual in activities such as repositioning in bed or chair or standing from a sitting position, it is imperative that the resident and the equipment be evaluated for entrapment risks, fall risks or other potential injuries. Some if not all of the same safety measures required when restraints are in use may be required when the devices are used for this purpose.  

I hope this addresses everyone’s initial concerns.  Please feel free to contact me if you have a resident or facility specific issue that you are unable to resolve with your licensing inspector.