NURSING-HOME SURVEY DEFICIENCIES FOR PHYSICAL RESTRAINT USE

New federal regulations, implemented in 1990, severely restrict the us e of physical restraints in nursing homes nationwide. This study evalu ated the impact of these regulations on North Carolina nursing homes d uring 1991. An average of 32.6% of facility residents were restrained during that year, and 29.2% of facilities were cited for violation of the restraint regulations. Annual health department surveys of a sampl e of 195 North Carolina nursing homes were analyzed. The facility prop ortion of restrained residents was modeled using estimated weighted le ast-squares regression. A probit model was used to predict if the faci lity received a deficiency for restraint use. Facility-level factors a ssociated with overall restraint use were the ratio of licensed vocati onal nurse/nursing assistant staff to residents in the facility, and t he overall facility disability level. Factors associated with the rece ipt of a restraint violation were facility size, direct costs per pati ent day, the proportion of restrained patients, use of bladder trainin g in less than 3% of residents, and the proportion of residents with o rganic brain syndrome; variables that were of borderline significance included proprietary affiliation, the proportion of intubated resident s, the facility disability level, and the proportion of residents on p sychotropic medication. These findings indicate that, despite implemen tation of these regulations, nearly one third of North Carolina nursin g home residents remained physically restrained. The characteristics a ssociated with restraint use and with restraints violations can be use d to identify facilities most likely to benefit from assistance and ed ucation in reducing physical restraints.