| (a) A restraint is a restrictive intervention that
a program provider may use in accordance with this section.
(b) A program provider providing licensed assisted
living must comply with §553.267(a)(3)(A) and (D) of this title
(relating to Rights).
(c) A program provider must ensure that a six-bed ICF/IID
providing respite complies with §551.42(e)(4) of this title (relating
to Standards for a Facility).
(d) A program provider providing licensed home health
assisted living:
(1) must not use restraints:
(A) for disciplinary purposes, retaliation, coercion,
or retribution;
(B) for the convenience of a service provider or other
persons; or
(C) as a substitute for an effective, less restrictive
method;
(2) may use a restraint only:
(A) if the use is authorized, in writing, by a physician
and specifies:
(i) the circumstances under which the restraint may
be used; and
(ii) the duration for which the restraint may be used;
or
(B) if the use is necessary in a behavioral emergency
to protect an individual or others from injury;
(3) except in a behavioral emergency, must ensure:
(A) that a service provider who uses a restraint has
been trained in the use of the restraint:
(i) before using the restraint;
(ii) annually; and
(iii) when the individual's needs change; and
(B) that the training is documented in the service
provider's record;
(4) must not use a restraint under any circumstance
if it:
(A) obstructs the individual's airway, including a
procedure that places anything in, on, or over the individual's mouth
or nose;
(B) impairs the individual's breathing by putting pressure
on the individual's torso;
(C) interferes with the individual's ability to communicate;
or
(D) places the individual in a prone or supine position;
(5) must ensure that if a physical restraint is used
in a behavioral emergency:
(A) it must be a restraint in which the individual's
limbs are held close to the body to limit or prevent movement and
that does not violate the provisions of paragraph (4) of this subsection;
(B) that as soon as possible but no later than one
hour after the use of the restraint, the service provider notifies
an RN of the restraint;
(C) that after the RN is notified of the use of the
restraint, the service provider documents the RN's instructions to
the service provider;
(D) that medical services are obtained for the individual
as necessary;
(E) the program provider:
(i) with the individual's consent, makes an appointment
with a physician no later than the end of the first business day after
the use of restraint and document in the individual's record that
the appointment was made; or
(ii) if the individual refuses to see a physician,
documents the refusal in the individual's record; and
(F) that as soon as possible but no later than 24 hours
after the use of restraint, the program provider notifies one of the
following persons, if there is such a person, that the individual
has been restrained:
(i) the individual's LAR; or
(ii) an actively involved person with the individual's
care, unless the release of this information would violate other law;
(6) that uses a restraint must document in an individual's
record:
(A) the use of the restraint;
(B) time and date the restraint was used;
(C) name of person administering the restraint;
(D) type of restraint and duration used; and
(E) if used in a behavioral emergency:
(i) events preceding the use of the restraint;
(ii) actions taken after the use of the restraint;
and
(iii) types of intervention attempted before the use
of the restraint; and
(7) in order to decrease the frequency of the use of
restraint, and to minimize the risk of harm to an individual, must
ensure that a service provider is aware of and adheres to the findings
of the nursing assessment required in §260.61(c)(8) of this chapter
(relating to Process for Enrollment of an Individual) or in §260.77(b)(1)(B)
of this chapter (relating to Renewal and Revision of an IPP and IPC)
for each individual.
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