Restraints
A Restraint-Free Environment
All people have a human and legal right to live free from restraints and involuntary seclusion.
Physical/mechanical and chemical restraints and involuntary seclusion are dangerous and can cause
serious harm. There are many safe alternatives to restraints.
RCW 70.129.120 states a client has the right to be free from physical and/or chemical restraints in an
assisted living facility or adult family home. WAC 388-76-10650 through 388-76-10665 lists specific rules about restraints in adult family homes.
WAC 388-107-0410 and 388-107-0420 provide specific rules about the use of restraints in enhanced service facilities.
Physical/Mechanical Restraints
Anything that prevents or limits a client’s movement or access to their body is a physical restraint. Examples of physical restraints include:
- a tie, belt, or vest used to keep a client from getting out of a bed or a chair;
- clothing that a client cannot independently remove (such as a top that buttons in the back to stop a client from taking it off);
- a reclining or lounge chair, couch, or bed the client can’t get out of;
- bed rails that cannot be independently lowered or are used to keep the client in bed; or
- “lap buddies” in a wheelchair.
Other physical restraints include:
- holding a person’s hand down against their will;
- hugging a person to restrict their movements; or
- holding a person’s legs or arms to prevent them from getting out of bed.
Chemical Restraints
Chemical restraints are drugs that control mood, mental state, or behavior, but do not treat medical
conditions. Any medication or substance (even if prescribed by a doctor) may be a chemical restraint if given:
- when there are no symptoms or indications for its use;
- in too large of doses;
- for the convenience of caregivers or other staff; or
- without appropriate or enough monitoring.
Involuntary Seclusion
Involuntary seclusion or isolation is when barriers confine a person to a specific space against their
will. Examples of involuntary seclusion include but are not limited to:
- locking a client in their room; or
- forcing a client to stay in bed against their will.
When Something Becomes a Restraint
Medical devices, such as shoulder straps on a wheelchair, can help protect clients from injury. However, they can also become restraints if they are misused. Something becomes a restraint when it prevents the client from exercising their free will.
Consider these examples:
Example 1: The client enjoys sitting in their favorite chair but is unable to get out of it without help. The caregiver monitors the client and is available to help them get out of the chair.
Example 2: The caregiver leaves the client in the chair unmonitored, and goes to perform other tasks. The client is stuck in the chair, and unable to get out when they want.
In example 1, the chair is not a restraint. The caregiver is available to help the client exercise their freedom of choice. In example 2, the chair is a physical restraint. It prevents the client from moving freely. This causes harm to the client, violates their rights, and is considered abuse.
Dangers of Restraints
Contrary to popular belief, restraints do NOT:
- decrease falls or prevent injuries;
- make clients feel more secure and protected;
- prevent lawsuits or malpractice claims; or
- make caregiving more efficient and less worrisome for staff. In fact, restraints are dangerous and cause physical and emotional harm, including:
- increased incontinence and/or chronic constipation;
- pressure injuries and other risks of immobility;
- injury or possible death from a client trying to remove or get out of a restraint;
- increased feelings of hopelessness, fear, anxiety, panic, depression, anger, and humiliation;
- changes in behavior and mood;
- reduced social contact, loss of independence;
- increased agitation and confusion;
- over-sedation (being tired and groggy all the time); and
- dizziness, increased risk of falls, and hip fractures.
Alternatives to Restraints
Restraints are not the answer to difficult problems and behaviors. Instead, the care team should work
to identify the underlying causes of the issue. Then, care strategies should address the individual needs
of the client without the use of restraints. Some examples of alternatives to restraints are listed below. In some cases, professionals specializing in resolving specific behavior and/or safety concerns may need to provide help. Examples of physical alternatives include:
- assessment for pain and medications used properly for pain relief;
- massage to soothe and calm an agitated or anxious person; and
- appropriate application and use of wheelchairs (not as confinement or to limit movement).
Examples of activities include:
- structured daily routines;
- walking or pacing in a safe area such as an enclosed courtyard;
- organized physical exercises;
- an activity board that fits on a client’s lap;
- music; and
- reading.
Examples of environmental modifications include:
- silent door, bracelet, and exit alarms (loud buzzers can be frightening or upsetting);
- signs, yellow barrier tape;
- increased or decreased lighting as needed for a client; and
- reduced level of noise.