FACILITY AND AREA VARIATION AFFECTING THE USE OF PHYSICAL RESTRAINTS IN NURSING-HOMES

OBJECTIVES. Various individual characteristics increase a nursing home resident's likelihood of being mechanically restrained. However, ther e is not good information on the role played by facility characteristi cs and geographic area in determining the likelihood of physical restr aint use. This study investigates the importance of individual, facili ty, and area indicators in determining the likelihood of restraint use . METHODS. This research uses data on 2,000 nursing home residents rec eiving care in more than 250 nursing homes in 10 different areas. Resi dent-level data were collected in 1990 by research nurses using the Mi nimum Data Set for Nursing Home Resident Assessment and Care Screening . Facility-level data were gathered by telephone interviews with facil ity staff. The relations among the variables were investigated using c ontingency tables and multivariate logistic regression models. RESULTS . Controlling for residents' physical and cognitive function, facility characteristics and location had a significant impact on restraint pr actices. Those facilities with low nurse staffing were more likely to restrain residents. Furthermore, controlling for these factors, restra int practices varied significantly across the geographic areas in the study. CONCLUSIONS. Like hospitals, nursing homes exhibit significant interfacility and regional variation in their clinical practices. Futu re analyses of nursing home care might benefit from considering both f actors in much finer detail.