Costly precautions

0 Comments | La Crosse Tribune, Jan 14, 1999

A Caledonia, Minn., nursing home is one of 16 facilities in Minnesota caught between state regulators and families over the use of bedside rails.

The Lutheran Home and 18 other nursing homes were fined more than $500,000 by state Health Department officials in April when the state began strict enforcement of a federal rule limiting side rails in nursing homes.

The Lutheran Home and 15 other nursing homes appealed their fines to the federal Health Care Financing Administration, which last week said it would uphold the fines.

Lloyd Swalve, Lutheran Home administrator, said Wednesday he was disappointed with the federal ruling. Swalve declined to say how much the Lutheran Home was fined last year, but said it was "substantially above" the state average fine of $30,000.

While the fine will create a financial difficulty for the home, the restriction on the use of side rails has upset family members of some residents, Swalve said.

The federal rule allows side rail only when ordered by a physician. The rails have been blamed for at least five deaths in Minnesota over the past two years. Yet some family members are concerned for the safety of residents who may fall out of bed without the rails, Swalve said.

"It has created a lot of anger among family members over the issue of resident rights," Swalve said. "They're wondering what are the rights of family members on the issue of side rails."

As alternatives to side rails, Swalve said the 74-bed nursing home has lowered beds, put padding on floors and installed bed alarms that sound when sleepers change position.

"We, as the care provider, are caught between the mandates of the health department and the desires of the residents and the family members," Swalve said. "We are trying to resolve this."

In an effort to defuse the conflict, the state had asked the federal agency to drop the fines. but that request was denied.

"We've applauded the state for their efforts in educating providers and families on the use of side rails," said Bob Spain, the administration's regional spokesman.

Health officials said they fear the federal decision will revive the contentious debate over side rail use.

"It fuses the issues again and it makes it more difficult to talk about the policy issues regarding the use of restraints," said Linda Sutherland, director of the Minnesota Division of Facility and Provider Compliance.

State Sen. Don Samuelson, DFL-Brainerd, said the decision confirms his belief that the law regarding restraints must be changed. He introduced a bill last week to give nursing home residents or their families the right to demand any physical or chemical restraint.

"I've never seen an issue that has so many people riled up," Samuelson said.

Swalve said the Lutheran Home has not decided whether to pay the fine or continue to appeal.