To have a restraint-free nursing home, more nurses are needed (Let's stop tying down old people; July 19).

However, nursing homes operate on a tight budget. To increase manpower, they would need to increase fees or request more subsidies from the Health Ministry.

Even if there were more subsidies or if patients' families were willing to pay, the recruitment of trained staff is another issue. Not many trained and qualified nurses like to work in nursing homes. Most nursing homes hire foreign nurses, but they are not state-registered or state-enrolled nurses.

Physical restraint causes more harm than good. It is disrespectful and infringes on the autonomy of older people.

Its use offers practical therapeutic solutions for patients, but it does not ensure safety, and raises ethical and legal issues.

However, this does not preclude the use of physical restraint in exceptional cases.

There should be rules to control such usage, and restraints should be used as a last option.

Consent forms have to be filled in by the patient's family. When used, the nurses should monitor the patient periodically. They should be mindful of any physical and psychological suffering.

The Health Ministry could conduct courses to enlighten staff in nursing homes on the consequences of the use of restraints, as well as the alternatives that homes in countries like Japan and the United States use and the benefits of these.

Nursing education must focus on determining risk factors for injury and on how to create a safe environment.

We need a restraint protocol in every nursing home that requires a doctor's approval for the long-term use of restraints, and intermittent reviews by a doctor to assess the continued need for it.

Francis Cheng