• N G Castle.
• Institute for Health, Health Care Policy, and Aging Research, New Brunswick, New Jersey 08901, USA. Castle_Nick@Hotmail.com
• Med Care. 2000 Dec 1;38(12):1154-63.

ObjectivesThis article examines the organizational characteristics of nursing homes associated with increasing and decreasing use of physical restraints since the implementation of the Nursing Home Reform Act (NHRA) in 1991.MethodsNationally representative data from the 1992 and 1997 On-Line Survey Certification of Automated Records are used first to provide descriptive analyses and second for multinomial logistic regression analyses of organizational factors associated with an increase or decrease in physical restraint use.ResultsThe results show that 2,331 nursing homes increased their use of restraints by >4% and 2,100 decreased their use of restraints by >3%. Ownership, Alzheimer's special care units, and average occupancy rates have bidirectional influence and are associated with both decreases and increases in restraint use, depending on their values. Chain membership and staffing levels of rehabilitation services are associated with increases in restraint use, whereas Medicaid census and private-pay census are associated with decreases in restraint use. Change factors were also important. An increase in Medicaid census and a change to chain membership since 1991 have an unsettling effect on care practices, increasing restraint use.ConclusionsAlthough the period used in this analysis represents a time frame in which the restraint reduction mandates of the NHRA were in effect, these results show that some nursing homes have increased their use of physical restraints. The organizational characteristics of these nursing homes differ from those that decreased their use of physical restraints.

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