94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
HB4089

 

Introduced 7/7/2005, by Rep. Robert F. Flider

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 45/2-106   from Ch. 111 1/2, par. 4152-106

    Amens the Nursing Home Care Act. In provisions concerning the use of restraints on nursing home residents, provides that a restraint may be used only under the supervision of a licensed health professional and only for a strictly defined period (instead of only for specific periods). Provides that in no case may a restraint be used for more than 2 hours. Requires continued assessment of a resident's condition to treat any ill effects resulting from the use of a restraint. Sets forth procedures to be used when applying a restraint. Requires that a nursing home adopt a clear, written instructional policy on the use of restraints and make the policy available to residents and their guardians or other authorized representatives. Requires a nursing home to keep records concerning the use of restraints.


LRB094 12843 DRJ 47689 b

 

 

A BILL FOR

 

HB4089 LRB094 12843 DRJ 47689 b

1     AN ACT concerning regulation.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Nursing Home Care Act is amended by changing
5 Section 2-106 as follows:
 
6     (210 ILCS 45/2-106)  (from Ch. 111 1/2, par. 4152-106)
7     Sec. 2-106. Restraints and confinements.
8     (a) For purposes of this Act, (i) a physical restraint is
9 any manual method or physical or mechanical device, material,
10 or equipment attached or adjacent to a resident's body that the
11 resident cannot remove easily and restricts freedom of movement
12 or normal access to one's body. Devices used for positioning,
13 including but not limited to bed rails, gait belts, and
14 cushions, shall not be considered to be restraints for purposes
15 of this Section; (ii) a chemical restraint is any drug used for
16 discipline or convenience and not required to treat medical
17 symptoms. The Department shall by rule, designate certain
18 devices as restraints, including at least all those devices
19 which have been determined to be restraints by the United
20 States Department of Health and Human Services in interpretive
21 guidelines issued for the purposes of administering Titles 18
22 and 19 of the Social Security Acts.
23     (b) Neither restraints nor confinements shall be employed
24 for the purpose of punishment or for the convenience of any
25 facility personnel. No restraints or confinements shall be
26 employed except as ordered by a physician who documents the
27 need for such restraints or confinements in the resident's
28 clinical record. Each facility licensed under this Act must
29 have a written policy to address the use of restraints and
30 seclusion. The Department shall establish by rule the
31 provisions that the policy must include, which, to the extent
32 practicable, should be consistent with the requirements for

 

 

HB4089 - 2 - LRB094 12843 DRJ 47689 b

1 participation in the federal Medicare program. Each policy
2 shall include periodic review of the use of restraints.
3     (c) A restraint may be used only with the informed consent
4 of the resident, the resident's guardian, or other authorized
5 representative. A restraint may be used only under the
6 supervision of a licensed health professional and only for a
7 strictly defined period specific periods, if it is the least
8 restrictive means necessary to attain and maintain the
9 resident's highest practicable physical, mental or
10 psychosocial well-being, including brief periods of time to
11 provide necessary life-saving treatment. A restraint may be
12 used only after consultation with appropriate health
13 professionals, such as occupational or physical therapists,
14 and a trial of less restrictive measures has led to the
15 determination that the use of less restrictive measures would
16 not attain or maintain the resident's highest practicable
17 physical, mental or psychosocial well-being. However, if the
18 resident needs emergency care, restraints may be used for brief
19 periods to permit medical treatment to proceed unless the
20 facility has notice that the resident has previously made a
21 valid refusal of the treatment in question. The use of the
22 restraint shall be discontinued as soon as feasible. In no
23 case, however, may a restraint be used for more than 2 hours,
24 or less if necessary, to allow for normal body functioning.
25 Following the use of a restraint, there must be continued
26 assessment of the resident's condition to treat any ill effects
27 resulting from the use of the restraint.
28     (d) A restraint may be applied only by a person trained in
29 the application of the particular type of restraint. The health
30 professional must apply and adjust the restraint so that it is
31 comfortable for the resident. The health professional must also
32 do all of the following:
33         (1) Follow the manufacturer's directions to select the
34     type of restraint recommended for the resident's
35     condition.
36         (2) Use the correct size restraint for the resident's

 

 

HB4089 - 3 - LRB094 12843 DRJ 47689 b

1     weight.
2         (3) Note the "front" and "back" of the restraint and
3     apply the restraint correctly.
4         (4) Tie knots that can be released quickly.
5         (5) Secure a bed restraint to the bed springs or frame,
6     never to the mattress or bed rails.
7         (6) In the case of a bed restraint used with an
8     adjustable bed, secure the restraint to the parts of the
9     bed that move with the resident.
10     (e) Whenever a period of use of a restraint is initiated,
11 the resident shall be advised of his or her right to have a
12 person or organization of his or her choosing, including the
13 Guardianship and Advocacy Commission, notified of the use of
14 the restraint. The facility shall display a notice of this
15 right, and of other instructions concerning the use of
16 restraints, in a highly visible location within the facility.
17 The notice shall be in English and in any other language spoken
18 by a resident of the facility who does not speak English. A
19 recipient who is under guardianship may request that a person
20 or organization of his or her choosing be notified of the
21 restraint, whether or not the guardian approves the notice. If
22 the resident so chooses, the facility shall make the
23 notification within 24 hours, including any information about
24 the period of time that the restraint is to be used. Whenever
25 the Guardianship and Advocacy Commission is notified that a
26 resident has been restrained, it shall contact the resident to
27 determine the circumstances of the restraint and whether
28 further action is warranted.
29     The facility shall adopt a clear, written instructional
30 policy on the use of restraints and shall make copies of the
31 policy available to residents of the facility and their
32 guardians or other authorized representatives.
33     (f) Whenever a restraint is used on a resident whose
34 primary mode of communication is sign language, the resident
35 shall be permitted to have his or her hands free from restraint
36 for brief periods each hour, except when this freedom may

 

 

HB4089 - 4 - LRB094 12843 DRJ 47689 b

1 result in physical harm to the resident or others.
2     (f-5) The facility shall keep well-documented records of
3 all circumstances resulting in the use of a restraint on a
4 patient, including why, how, where, and for how long the
5 restraint was used.
6     (g) The requirements of this Section are intended to
7 control in any conflict with the requirements of Sections 1-126
8 and 2-108 of the Mental Health and Developmental Disabilities
9 Code.
10 (Source: P.A. 93-636, eff. 6-1-04.)