Emergency Use of Manual Restraints Policy

I. Policy

• It is the policy of Apex Home Care to promote the rights of persons served and toprotect their health and safety during the emergency use of manual restraints.

• “Emergency use of manual restraint” means using a manual restraint when a person poses an imminent risk of physical harm to self or others and it is the least restrictive intervention that would achieve safety.

• Property damage, verbal aggression, or a person’s refusal to receive or participate in treatment or programming on their own, do not constitute an emergency.

II. Positive Support strategies and techniques required

• The following positive support strategies and techniques must be used to attempt to de-escalate a person’s behavior before it poses an imminent risk of physical harm to self or others:

  1. Follow individualized strategies in a person’s Coordinated Services and Supports Plan and Coordinated Services and Supports Plan Addendum;

  2. shift the focus by verbally redirecting the person to a desired alternative activity;

  3. model the desired behavior;

  4. reinforce appropriate behavior;

  5. offer choices, including activities that are relaxing and enjoyable to the person;

  6. use positive verbal guidance and feedback;

  7. actively listen to a person and validate their feelings;

  8. create a calm environment by reducing sound, lights, and other factors that may agitate a person;

  9. speak calmly with reassuring words, consider volume, tone, and non-verbal communication;

  10. simplify a task or routine or discontinue until the person is calm and agrees to participate;

  11. respect the person’s need for physical space and/or privacy.

• Apex Home Care will develop a positive support transition plan on the forms and in the manner prescribed by the Commissioner and within the required timelines for each person served when required in order to accomplish the following:

  1. Eliminate the use of prohibited procedures as identified in section III of this policy;

  2. avoid the emergency use of manual restraint as identified in section I of this policy;

  3. prevent the person from physically harming self or others; or

  4. phase out any existing plans for the emergency or programmatic use of aversive or deprivation procedures prohibited.

• Permitted actions and procedures

  1. Use of the following instructional techniques and intervention procedures used on an intermittent or continuous basis are permitted by Apex Home Care. When used on a continuous basis, it must be addressed in a person’s Coordinated Services and Supports Plan Addendum.

  2. Physical contact or instructional techniques must use the least restrictive alternative possible to meet the needs of the person and may be used to:

     • Calm or comfort a person by holding that person with no resistance from that person;

     • protect a person known to be at risk or injury due to frequent falls as a result of a medical condition;

     • facilitate the person’s completion of a task or response when the person does not resist or the person’s resistance is minimal in intensity and duration; and

     • briefly block or redirect a person’s limbs or body without holding the person or limiting the person’s movement to interrupt the person’s behavior that may result in injury to self or others.

  3. Restraint may be used as an intervention procedure to assist in the safe evacuation or redirection of a person in the event of an emergency and the person is at imminent risk of harm

• Prohibited procedures -- The use of the following procedures as a substitute for adequate staffing, for a behavioral or therapeutic program to reduce or eliminate behavior, as punishment, or for staff convenience, is prohibited by Apex Home Care:

  1. Chemical restraint;

  2. mechanical restraint;

  3. manual restraint;

  4. time out;

  5. seclusion; or

  6. any aversive or deprivation procedure.

• Manual restraints not allowed in emergencies

  1. Apex Home Care does not allow the emergency use of manual restraints. The following alternative measures must be used by staff to achieve safety when a person’s conduct poses an imminent risk of physical harm to self or others and less restrictive strategies have not achieved safety:

     1. Continue to utilize the positive support strategies;

     2. continue to follow individualized strategies in a person’s Coordinated Services and Supports Plan and Coordinated Services and Supports Plan Addendum;

     3. ask the person and/or others if they would like to move to another area where they may feel safer or calmer;

     4. remove objects from the person’s immediate environment that they may use to harm self or others

     5. refer to the above list of alternative measures that includes a description of each of the alternative measures trained staff are allowed to use and instructions for the safe and correct implementation of those alternative measures;

     6. call 911 for law enforcement assistance if the alternative measures listed above are ineffective in order to achieve safety for the person and/or others. While waiting for law enforcement to arrive staff will continue to offer the alternative measures listed above if doing so does not pose a risk of harm to the person and/or others.