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Laws and Regulations Regarding Behavioral Restraint & Seclusion

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Laws and Regulations Regarding Behavioral Restraint & Seclusion California’s Protection & Advocacy System Toll-Free (800) 776-5746 Compilation of Select Laws & Regulations Regarding Behavioral Restraint & Seclusion February 2014, Pub. #5457.01 i Disability Rights California Investigations Unit 1330 Broadway, Suite 500 Oakland, CA 94612 Tel. (510) 267-1200 This document is an abbreviated compilation of select laws and regulations pertaining to the use of behavioral restraint and seclusion by setting type. It is not an inclusive list of all of the laws, regulations, and/or standards that govern the use of behavioral restraint and seclusion. Readers are invited to use this document for reference but are directed to review the specific language of the regulations and/or standards. Do not rely upon the information contained within this document as this document is abbreviated and the regulations or standards listed may have subsequently been revised. ii Table of Contents Table of Contents ....................................................................................... 1 Hospitals ..................................................................................................... 3 Federal .................................................................................................... 3 General Acute Care Hospitals ..................................................................... 7 State ........................................................................................................ 7 Acute Psychiatric Hospitals ......................................................................... 9 State ........................................................................................................ 9 Joint Commission on Accreditation of Healthcare Organizations .............. 10 Hospital Standards ................................................................................... 10 Joint Commission on Accreditation of Health Care Organizations ............. 16 Behavioral Health Care Standards ............................................................ 16 Department of Veterans Affairs ................................................................. 38 Federal .................................................................................................. 38 Programs of All-Inclusive Care for the Elderly (“PACE”) ........................... 40 Federal .................................................................................................. 40 Hospice Care ............................................................................................ 42 Federal .................................................................................................. 42 Psychiatric Health Facility (PHF) ............................................................... 19 State ...................................................................................................... 19 Skilled Nursing Facility (SNF) ................................................................... 21 State ...................................................................................................... 21 Skilled Nursing Facility (SNF) with Special................................................ 24 Treatment Program Service Unit ............................................................... 24 State ...................................................................................................... 24 Intermediate Care Facility (ICF) ................................................................ 27 Federal .................................................................................................. 27 Intermediate Care Facility (ICF) ................................................................ 29 State ...................................................................................................... 29 Intermediate Care Facility for Developmentally Disabled (ICF/DD) ........... 32 State ...................................................................................................... 32 Intermediate Care Facility State/DD - Habilitative (ICF/DD-Hab)............... 35 State ...................................................................................................... 35 Department of Corrections ........................................................................ 38 Federal .................................................................................................. 45 Department of Corrections: Adult Institutions, Programs and Parole ......... 47 State ...................................................................................................... 47 Department of Corrections: Local Detention Facilities ............................... 51 – 1 – State ...................................................................................................... 51 Correctional Treatment Centers ................................................................ 54 State ...................................................................................................... 54 Acute and Nonacute 24-hour Mental Health Care ..................................... 56 State ...................................................................................................... 56 Schools – Special Education..................................................................... 59 State ...................................................................................................... 59 Psychiatric Residential Treatment Facility for Individuals .......................... 61 under Twenty-one (21) Years of Age ........................................................ 61 Federal .................................................................................................. 61 Community Treatment Facilities ................................................................ 65 State ...................................................................................................... 65 Mental Health Rehabilitation Centers ........................................................ 68 State ...................................................................................................... 68 Chemical Dependency Recovery Hospitals .............................................. 70 State ...................................................................................................... 70 Juvenile Halls............................................................................................ 72 Group Homes ........................................................................................... 75 Facilities Limiting/Banning Seclusion and Restraint .................................. 79 Community Care Facilities..................................................................... 79 Child Care Facilities .............................................................................. 79 – 2 – Hospitals Federal Primary regulation 42 CFR §482.13 “Restraint or seclusion may only be used when Alternatives less restrictive interventions have been explored determined to be ineffective to protect the patient a staff member or others from harm.” 42 CFR §482.13(e)(2). (emphasis added) “The type or technique of restraint or seclusion used must be the least restrictive intervention that will be effective to protect the patient, a staff member, or others from harm.” 42 CFR §482.13(e)(3). “The use of a restraint or seclusion must be in Who can order it accordance with the order of a physician or other licensed independent practitioner… authorized to order restraint or seclusion by hospital policy in accordance with State law.” 42 CFR §482.13(e)(5). “The attending physician must be consulted as soon as possible if the attending physician did not order the restraint or seclusion.” 42 CFR §482.13(e)(7). When does an MD Not required or healthcare practitioner have to cosign – 3 – Patient must be seen face-to-face within 1 hour When does an MD after initiation of restraint or seclusion by physician or healthcare or other licensed independent practitioner; or practitioner have registered nurse or physician’s assistant who has to evaluate the received special training. 42 CFR §482.13(e)(12). patient See 42 CFR §482.13(f) for training requirements. If the face-to-face is conducted by registered nurse or physician’s assistant, must consult the attending physician or other licensed independent practitioner responsible for care of patient as soon as possible after completing 1 hour assessment. 42 CFR §482.13(e)(14). Duration of each “Each order for restraint or seclusion used for order management of violent or self-destructive behavior that jeopardizes the immediate physical safety of patient, staff…, or others may only be renewed in accordance with following limits up to a total of 24 hours: (A) 4 hours for adults 18 years and older; (B) 2 hours for children and adolescents ages 9 to 17; or (C) 1 hour for patients under 9.” 42 CFR §482.13(e)(8)(i). “After 24 hours, before writing a new order…, physician or other licensed independent practitioner who is responsible for the care of the patient … must see and assess the patient.” 42 CFR §482.13(e)(8)(ii). – 4 – How often must Simultaneous restraint and seclusion use is only they check on permitted if patient is continually monitored face- patients to-face by assigned, trained staff member; or by trained staff using both video and audio equipment and in close proximity to patient. 42 CFR §482.13(e)(15). Monitoring patient in restraint or seclusion… at interval determined by hospital policy. 42 CFR §482.13(e)(10). Documentation When restraint
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