| Although nursing home use of physical and chemical restraints is associated with adverse resident outcomes and was extensively addressed by the Omnibus Budget and Reconciliation Act of 1987 (OBRA87), preliminary evidence suggests that many nursing homes are continuing their use. While the use of physical and chemical restraints adversely affect all residents, residents with dementia are at a higher risk of being restrained.;Although administrators traditionally have been reluctant to admit individuals with dementia due to behavioral problems, some nursing homes are now actively marketing services to the demented population. Some nursing homes have established a special care unit for residents with dementia which provides--or claims to provide--a care environment designed specifically to address their needs. Reduction in the use of chemical and physical restraints is a stated primary objective of many special care units. However, some researchers report that the phrase "special care unit" is primarily a marketing tool and specialized services are not provided.;The goal of this study is to identify the care environment characteristics associated with reduced restraint use, determine if special care units are associated with reduced restraint use, and provide information to policymakers engaged in setting reimbursement and regulation policies.;Using the data from the Alzheimer's Special Care Units: Longitudinal Outcome Study, this study examined differences in restraint condition as a function of resident capabilities and competence, unit physical design characteristics, and organizational and management characteristics.;The primary finding from the study is that special care units are associated with a decreased likelihood of a resident being physically restrained, but are associated with an increase in the likelihood of chemical restraint. Additionally, a higher percentage of MediCal reimbursement is associated with an increased likelihood of chemical restraint, while the presence of an exit monitor is associated with a decreased likelihood of physical restraint.;This findings have important implications for nursing home policy initiatives regarding special care units and Medicaid reimbursement rates, regulation, and the implementation of OBRA87. Additional research in special care units regarding different physical design features, regulatory effects, cost of care, and international comparisons is still needed. |
