A majority of nursing homes attending to the elderly with mobility issues or dementia use physical restraints to prevent falls or self-injuries.

However, some critics say that using tools to tie hands and feet of patients is for the convenience of medical staffs, rather than patients, and that it even violates human rights.

The health authorities have established a related regulation to prevent abuse of physical restraints. Under the article 35 of the Medical Service Act, the use of physical constraints that limit the mobility of patients at nursing homes should be prescribed by a physician and should not be longer than two hours. The use also requires a reasonable explanation to the patient or the guardian and their agreement.

Many nursing homes still do not abide by the rules, though.

According to data from the Ministry of Health and Welfare submitted to Rep. Jung Choun-sook of the ruling Democratic Party of Korea, the authorities ordered 11 nursing homes this year to correct their use of physical restraining tools. Complaints of injuries such as bruises and bedsores due to the reckless use of such restraints are increasingly reported to the authorities every year.

Some people say physical restraints are a “necessary evil” for patients’ safety, as nursing homes are almost always understaffed.

Since May 2011, Heeyeon Hospital has phased out physical restraints on patients, including the elderly with mobility problems or dementia. (Credit: Heeyeon Hospital)

There is a nursing home that eliminated physical restraints, however. Heeyeon Hospital, located in Changwon, South Gyeongsang Province, has a slogan, “Having patients’ hands and feet tied is like having their life tied.” The hospital declared the abolition of physical restraints for the first time in Korea on May 19, 2011.

For a hospital with 500 beds, it is not easy to attend to patients without any physical restraint because of limited nursing staffs. Thus, pushing for “zero physical restraint” required the agreements of all of the employees. Heeyeon Hospital checked how hospitals in advanced countries operate the healthcare system for the elderly, and educated its employees on a regular basis.

The hospital revamped how physicians see the patients. A team – composed of a physician, a nurse, a physical therapist, a nutrient, and a social worker -- checks patients and provide customized treatment programs.

Ha Yong-ran, deputy manager of the Heeyeon Hospital’s medical assistance team, said the hospital aims to minimize the time patients stay, explaining how the hospital got to eliminate physical restraints, during the Korea Healthcare Congress 2017 held at Seoul Dragon City in Yongsan, Seoul.

“First, we started off by not tying hands and feet of a patient. Then, we put them on a pair of mittens and a spacesuit. On wheelchairs, we made them have a seatbelt. But now, we use none of them because they are part of physical restraints, too,” Ha said.

To take care of patients safely, the hospital installed emergency bells in every ward and physicians make frequent rounds, she added. “We attend to our patients, not to allow any bedsore,” she emphasized.

It is facile to use physical restraints for safety and treatment of patients, Ha said, adding that personalized medical care will allow hospitals to abandon physical restrictions. “It (eliminating physical restraints) is not a matter of choice. It is a must,” she said.

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