"Identifying Information: Name","Restraint Use in Long-Term Care"
"Identifying Information: Short/Other Names","Percentage of Residents in Daily Physical Restraints (RES01)"
"Identifying Information: Description","This indicator looks at how many long-term care residents are in daily physical restraints. Restraints are sometimes used to manage behaviours or to prevent falls. There are many potential physical and psychological risks associated with applying physical restraints to older adults, and such use raises concerns about safety and quality of care."
"Background, Interpretation and Benchmarks: Rationale","Long-term quality indicators were developed by interRAI, an international research network, to provide organizations with measures of quality across key domains, including physical and cognitive function, safety and quality of life. Each indicator is adjusted for resident characteristics that are related to the outcome and independent of quality of care. The indicators can be used by quality leaders to drive continuous improvement efforts. They are also used to communicate with key stakeholders through report cards and accountability agreements."
"Background, Interpretation and Benchmarks: Interpretation","Lower is better. It means that a lower percentage of long-term care residents were in daily physical restraints."
"Background, Interpretation and Benchmarks: HSP Framework Dimension","Appropriate and effective"
"Background, Interpretation and Benchmarks: Areas of Need","Living With Illness, Disability or Reduced Function"
"Background, Interpretation and Benchmarks: Targets/Benchmarks","AVÐÇÇò: None

Health Quality Ontario (external): 3% for long-term care"
"Available Data Years","2018
 to 2022"
"Available Data Years: Type of Year",Fiscal
"Availability of Results: Geographic Coverage","Newfoundland and Labrador"
"Reporting Level/Disaggregation",Province/Territory
"Reporting Level/Disaggregation: Other reporting level/disaggregation","Sector (residential and hospital-based continuing care)"
"Result Updates: Indicator Results","Web Tool:
Your Health System: In Depth
PDF:
Accessing Indicator Results on Your Health System: In Depth (PDF) 

Web Tool:
Quick Stats

Web Tool:
CCRS eReports (RAI-MDS 2.0) via My Services (log in)

Web Tool:
IRRS LTC Secure Reporting tool via My Services (log in)"
"Update Frequency: Other frequency:","Monthly (IRRS LTC Secure Reporting tool)

Quarterly (CCRS eReports)

Annually (Quick Stats)

Annually (Your Health System)

The Latest Results update date refers to the latest results publicly available. More recent results are available in the secure reporting tools (CCRS eReports and IRRS – LTC Secure Reporting)."
"Result Updates: Latest Results Update Date","November 2023"
"Result Updates: Updates","Not applicable"
"Indicator Calculation: Description","This indicator examines the percentage of residents in daily physical restraints. It is calculated by dividing the number of residents who were in daily physical restraints by the number of all residents (excluding comatose residents and those who are quadriplegic) with valid assessments within the applicable time period.

Unit of Analysis: Resident"
"Indicator Calculation: Type of Measurement","Percentage or proportion"
"Denominator: Description:","Residents with valid assessments"
"Denominator: Inclusions:","Residents with valid assessments. To be considered valid, the target assessment must
	
		Be the latest assessment in the quarter
		Be carried out more than 92 days after the Admission Date
		Not be an Admission Full Assessment (RAI-MDS 2.0) or First Assessment (interRAI LTCF)"
"Denominator: Exclusions:","Residents who are comatose (RAI-MDS 2.0: B1 = 1; interRAI LTCF: C1 = 5) or quadriplegic (RAI-MDS 2.0: I1bb = 1; interRAI LTCF: I1i = 1)"
"Numerator: Description:","Residents who were physically restrained daily on their target assessment. For this indicator, restraints included


	Trunk Restraint (RAI-MDS 2.0: P4c = 2; i interRAI LTCF: O7b ≥2)
	Limb Restraint (RAI-MDS 2.0: P4d = 2; interRAI iLTCF: N/A)
	Chair Prevents Rising (RAI-MDS 2.0: P4e = 2; interRAI iLTCF: O7c ≥ 2)"
"Numerator: Inclusions:","Residents with valid assessments. To be considered valid, the target assessment must
	
		Be the latest assessment in the quarter
		Be carried out more than 92 days after the Admission Date
		Not be an Admission Full Assessment (RAI-MDS 2.0) or First Assessment (interRAI LTCF) "
"Numerator: Exclusions:","Residents who are comatose (RAI-MDS 2.0: B1 = 1; interRAI LTCF: C1 = 5) or quadriplegic (RAI-MDS 2.0: I1bb = 1; interRAI LTCF: I1i = 1)"
"Method of Adjustment: Other method of adjustment:","Stratification, Direct Standardization, Indirect Standardization"
"Method of Adjustment: Direct Standardization - Standard Population","Standard Population:
3,000 facilities in 6 U.S. states and 92 residential care facilities and continuing care hospitals in Ontario and Nova Scotia"
"Adjustment Applied: Covariates used in risk adjustment:","Individual Covariates: None

Facility-Level Stratification: Activities of Daily Living (ADLs) Long Form Scale"
"Indicator Calculation: Geographic Assignment","Place of service"
"Data Sources","CCRS (Continuing Care Reporting System)"
"Data Sources: Other Data Source","IRRS (Integrated interRAI Reporting System)"
"Quality Statement: Caveats and Limitations","This measure uses data collected by long-term care facilities using the Resident Assessment Instrument–Minimum Data Set 2.0 (RAI-MDS 2.0) and submitted to the Continuing Care Reporting System (CCRS) or using the interRAI Long-Term Care Facilities (interRAI LTCF) assessment and submitted to the Integrated interRAI Reporting System (IRRS). 

Certain provinces and territories have transitioned to or are in the process of transitioning to the newer interRAI LTCF assessment instrument (see Trending Issues for more information). For a number of years, the national average will be based on both assessment instruments. To support inclusion of interRAI LTCF assessment data in public reporting, AVÐÇÇò has completed an analysis to understand similarities and differences between the 2 assessment instruments. Overall, indicator results are comparable and appropriate to be trended over time and across instruments. Performance allocations and top results for 3 indicators (Restraint Use, Worsened Pressure Ulcers and Worsened Depressive Mood) are currently not provided for jurisdictions that are using the interRAI LTCF. Preliminary analysis suggests that there may be differences between results for these indicators based on the assessment instrument used, which may affect performance allocations. More data is required to draw firm conclusions, as these differences may also be related to other factors (e.g., improvements in education and coding practices) or to a real change in the measure of quality."
"Quality Statement: Trending Issues","The number of long-term care homes and jurisdictions submitting data to AVÐÇÇò varies over time and has been generally increasing. Furthermore, as long-term care homes transition from the RAI-MDS 2.0 to the interRAI LTCF, there may be changes in data coverage that can impact the results (see more details below). Time series changes must be interpreted carefully, particularly when comparing the national average over time and when comparing provincial/territorial averages over the transition to the new assessment instrument. Please note that indicator results are risk-adjusted to control for population differences (factors that are beyond the facility’s control but can affect resident outcomes) to enable more appropriate and fair comparisons of the actual quality of care. Please refer to the CCRS Quality Indicators Risk Adjustment Methodology in the References section for more information.

Use of interRAI LTCF: As jurisdictions transition to/adopt the interRAI LTCF, there may be disruptions or delays in data submission to AVÐÇÇò, which can impact the coverage of data and therefore indicator results. A summary of interRAI LTCF transition/adoption by jurisdiction is provided below for reference:


	Nova Scotia started the transition in 2022; the transition is ongoing. Results for Nova Scotia for the transition year are excluded from public reporting due to low coverage in CCRS and lack of a full year of data for most facilities in IRRS. 
	New Brunswick completed adoption between 2016 and 2017 and started submitting data to IRRS in 2019. 
	Saskatchewan completed the transition in 2019 and 2020 and started submitting data to IRRS in 2020.
	Alberta started the transition in 2021; the transition is ongoing. Currently, only data from the RAI-MDS 2.0 (CCRS) is submitted to AVÐÇÇò and included in reporting.


AVÐÇÇò recognizes that the COVID-19 pandemic has affected many long-term care homes across Canada, including their ability to complete assessments and/or submit data to AVÐÇÇò. Available data may vary by jurisdiction and facility. Results should be interpreted in the context of the COVID-19 pandemic.
 "
"Quality Statement: Comments","The long-term care quality indicators use 4 rolling quarters of data for calculations in order to have a sufficient number of assessments for risk adjustment. Since residents are assessed on a quarterly basis, each resident can contribute to the indicator up to 4 times.

General criteria for public reporting of long-term care indictors in Your Health System are as follows:


	A minimum of 30 assessments are required for the denominator; otherwise, the result is suppressed as it may not be stable. 
	At the facility level,
	
		Results for a newly submitting facility are excluded if it did not submit assessments for the first quarter of the latest year of reporting.
		Results for a facility that closed in the latest fiscal year of reporting are excluded.
		Results for facilities undergoing a reorganization (split, merger, etc.) are suppressed for the fiscal year(s) prior to and encompassing the reorganization. 
		Results for a facility where more than 50% of residents are younger than 65 are excluded.
		Results for a facility that transitioned to the interRAI LTCF midway through the fiscal year are excluded for that year.
	
	
	At aggregate levels (including health region and province/territory), results are reported based on coverage. Coverage is measured as the percentage of facilities (within the respective health region or province/territory) that submitted data out of all facilities that were expected to submit data for the latest fiscal year of reporting.
	
		Coverage is considered complete at 95% or more.
		Coverage is considered incomplete at less than 95% and results are flagged as being based on partial coverage. 
		Results are suppressed if coverage is 60% or less.
	
	


Data for this indicator is also available in the Quick Stats product Profile of Residents in Residential and Hospital-Based Continuing Care, which includes province-/territory-level results for both the residential and hospital-based continuing care sectors. Please consult the Quick Stats product for more information."
References,"Canadian Institute for Health Information. CCRS Quality Indicators Risk Adjustment Methodology (PDF). 2013.

Health Quality Ontario. Long-Term Care Benchmarking Resource Guide (PDF). 2013.

Health Quality Ontario. Results From Health Quality Ontario's Benchmark Setting for Long-Term Care Indicators (PDF). 2017.

Health Quality Ontario. Health Quality Ontario Indicator Library. Accessed October 4, 2017.

Hirdes JP, Mitchell L, Maxwell CJ, White N. Beyond the ""iron lungs of gerontology"": Using evidence to shape the future of nursing homes in Canada. Canadian Journal on Aging. 2011.

Hirdes JP, Poss JW, Caldarelli H, et al. An evaluation of data quality in Canada's Continuing Care Reporting System (CCRS): Secondary analyses of Ontario data submitted between 1996 and 2011. BMC Medical Informatics and Decision Making. 2013.

Jones RN, Hirdes JP, Poss JW, et al. Adjustment of nursing home quality indicators. BMC Health Services Research. 2010."