Florida Official Makes It Her Job to ‘Free’ Residents of Nursing Homes

Connie Cheren doesn’t like the phrase “untying the elderly,” but she wholeheartedly supports the concept.

Cheren, who oversees 4,300 health-care facilities, has led an effort to reduce nursing homes’ use of restraints, untying 3,000 people in four months. “The only thing that I feel bad about is that I didn’t do it . . . earlier,” she said.

When Cheren became director of the state Office of Licensure and Certification two years ago, 41% of the 55,000 people in the state’s 550 nursing homes were restrained at least part of the day by vests that fasten to beds or chairs, wrist ties, lap belts and specially designed chairs. Several elderly people have strangled in recent years struggling to free themselves.

Use of restraints rose to 43.7% by April, 1989, but was down to 39% in November, federal statistics show. Cheren did not have statistics on the use of tranquilizers, but said regulators would try to ensure that chemical restraints are not overly used and do not replace physical restraints.

Cheren stepped up regulation of the use of restraints in August, when she told Ambrosia Nursing Home in Tampa it could not admit new residents until it stopped illegally using restraints simply to prevent wandering.

Under Florida law, restraints can be used to keep people from falling or from disturbing medical equipment, such as feeding tubes. They cannot be used without a doctor’s permission, and people must be released every two hours.

Restraint reduction has caught on in the industry “because, first of all, it’s right,” she said. “Second, it feels good. Nobody likes to put somebody under restraint. You interact differently with somebody in restraint. Three, it’s working, and success builds on success.”

Cheren, a registered nurse with 20 years’ involvement in long-term care, dislikes the phrase “untying the elderly” because it casts the elderly in a passive role--”just like ‘release women’ or ‘free the blacks.’ ”

Also, the use of physical restraints became established out of sincere concern for safety. However, she said, it is time to focus on better nursing home care that involves helping people keep and restore their abilities.

About 1,000 nursing home owners and operators attended three workshops on restraints in October and November. Instead of being apprehensive about meeting new standards, people were bragging about the progress they had made.

“People called me afterward . . . and told me their goal for this year was to completely move toward a restraint-free environment,” said Mary Ellen Early of the Florida Assn. of Homes for the Aging.

The 454-bed Miami Jewish Home and Hospital for the Aged, for example, cut use of restraints 18%, said associate executive director Terry Goodman. “The residents are much happier, less agitated and the staff has noted a significant decrease in the amount of agitation and less acting out.”

Many operators have reported resistance from families who think nursing home residents are safer if they are restrained, Early said.

But Cheren and other advocates of reducing restraints say the losses that occur in mobility, bladder control--and dignity--far outweigh the small risk of a serious injury due to a fall.

“The bottom line really is that the risk of falling really ain’t so bad,” said Martin Casper, executive director of the 250-bed Greynolds Park Manor in North Miami Beach, which now restrains four people, compared to 85 to 90 last summer.

And although there has been concern that restraint reduction would increase costs--Florida homes operate on a profit margin of less than 0.5%--Casper said he has found the cost of staff supervision remained the same.

Cheren can even count among her supporters the administrator of Ambrosia Nursing Home, which lost an estimated $60,000 because of the moratorium, the toughest stricture possible short of license revocation.

“I think Connie Cheren has done a fine thing,” said Albert Shepard, who had 10 of 80 beds empty during the 60-day penalty. “Connie Cheren, having zeroed in on this particular thing, . . . has made the difference.”

The home has fixed an alarm system that sounds when a door is opened and set up a “buddy” system in which workers--even office and housekeeping staff--adopt a resident for special daily attention, including walks. Except for six or eight “geri-chairs” for people who can’t sit alone, it has no restraints.

“We’re very much in agreement with the whole philosophy of non-restraint facilities,” Shepard said. “It’s an excellent thing to give people the freedom of movement.”