CMS Pub. 100-11, ch. 5, § 30

The use of restraints must be based on the assessed needs of the participant, be monitored

and reassessed appropriately, and be ordered for a defined and limited period of time. The

least restrictive and most effective method available must be utilized and it must conform

to the participant’s plan of care. Restraints may only be used as a last resort and must be

removed or ended at the earliest possible time. Restraints of any kind should never be

used as a preferred approach to care and PACE organizations are expected to ensure that

their programs are ‘‘restraint free’’ to the greatest extent possible.

The term restraint includes physical or chemical restraints. A physical restraint is any

manual method or physical or mechanical device, materials, or equipment attached or

adjacent to the participant’s body that he or she cannot easily remove and that restricts

freedom of movement or normal access to one’s body. A chemical restraint is a

medication used to control behavior or to restrict the participant’s freedom of movement,

and that is not a standard treatment for the participant’s medical or psychiatric condition.

If the IDT determines that a restraint is needed to ensure the participant’s physical safety

or the safety of others, the use must meet the following conditions:

• Be imposed for a defined, limited period of time, based upon the assessed

needs of the participant;

• Be imposed in accordance with safe and appropriate restraining techniques;

• Be imposed only when other less restrictive measures have been found to be

ineffective to protect the participant or others from harm;

• Be removed or ended at the earliest possible time.

A PACE organization must have policies and procedures regarding restraints that:

• Define physical and chemical restraints as described above;

• Include the conditions on use described above;

• Describe how personnel will continually assess, monitor and reevaluate

(specify time intervals) the participant’s condition while in restraints.

[42 CFR § 460.114; 71 FR 71299 (Dec. 8, 2006)]