Resident Restrained in Reclining Wheelchair, Denied Right to Stand
Penalty
Summary
A facility failed to ensure that a resident was treated with respect and dignity by not allowing the resident to get up from a reclining wheelchair, despite the resident's attempts to do so. The resident, who had a history of impaired mobility, unsteady gait, and severely impaired cognition, was observed multiple times throughout the day in a large reclining wheelchair with the chair tilted back and feet elevated. Staff interviews confirmed that the resident was kept in the chair for most of the day, with the chair often tilted back to prevent the resident from attempting to get up, as the resident was considered a fall risk. On one occasion, an Activities Assistant physically prevented the resident from getting up by placing hands on the resident's shoulder and instructing the resident to remain seated. The Activities Assistant stated that the chair was used to keep the resident from getting up due to fall risk and staff convenience, and that the chair was sometimes tilted back to make the resident more comfortable and discourage attempts to stand. A Certified Nurse Assistant confirmed that the resident required substantial assistance but was not completely dependent, and stated that if a resident wanted to get out of a reclining wheelchair, staff were supposed to assist them, as it was the resident's right. Further interviews with therapy staff indicated that using the wheelchair in this manner constituted a restraint, as it restricted the resident's freedom of movement and hindered quality of life. The facility's own policies defined restraints as any device that a resident cannot easily remove and that restricts movement, and stated that restraints should not be used for staff convenience. The Director of Nursing acknowledged that restricting residents from getting up when they wanted was a violation of resident rights, although there was confusion among staff regarding the definition and use of restraints.