RISK-FACTORS FOR PHYSICAL RESTRAINT USE IN NURSING-HOMES - PRE-IMPLEMENTATION AND POSTIMPLEMENTATION OF THE NURSING-HOME REFORM ACT

The purposes of this article are (1) to identify resident and facility risk factors for the use of physical restraints since the implementat ion of the Nursing Home Reform Act (NHRA), and (2) to compare these re sults with resident and facility risk factors for the use of physical restraints prior to the implementation of the NHRA. Data were collecte d in 1990 and 1993, and represent residents drawn from 268 facilities in 10 states. In the 1993 cohort activities of daily living (ADL) scor es, cognitive performance scale (CPS) scores, age, taking antipsychoti c medications, a history of falls, and mobility problems were resident -level variables significantly associated with the use of restraints. Full-time-equivalent (FTE) nurse aides per resident, FTE RNs per resid ent, average occupancy, Herfindahl index, Alzheimer's special care uni t, and Medicaid reimbursement policy were facility-level variables sig nificantly associated with the use of restraints. When the 1990 cohort was compared to the 1993 cohort (pre-and post-NHRA), however, only th ree risk factors for the use of restraints were significant. We propos e that, to date,the NHRA may have been successful in reducing the use of physical restraints, but it appears to have had less impact on the types of residents who are restrained.