Where once physical restraints were common in nursing homes, today many nursing home residents will be subjected to chemical restraints. These powerful psychoactive drugs are used to sedate and to control residents, often because it is a lot cheaper to drug patients than to hire staff to provide for residents’ needs.

  • Nearly 60% of all California nursing home residents are given psychoactive drugs, a 30% increase since 2000, reports California Advocates for Nursing Home Reform.
  • A study reported in the Journal of Gerontology, Oct. 2009, found that 71% of new Florida nursing home residents were put on psychoactive medication within 3 months of admission, and 15% of Florida nursing home residents were put on 4 or more drugs.

These statistics are not particular to California and Florida. They generalize across all 50 states.

The Office of the Inspector General in the United States Department of Health and Human Services released a study in May 2011 that found 305,000 (about 14%) nursing home residents had Medicare claims for atypical antipsychotic drugs. Of these, about 1 in 5 residents were prescribed antipsychotics in a way that violated government standards for their use, such as being on a drug too long and at too high a dose.

What Are Psychoactive Drugs
Psychoactive drugs contain powerful chemicals designed to influence the brain in order to change a person’s mood, personality, behavior, and/or level of consciousness. Within this class are:

  • Anti-psychotics: Designed to treat schizophrenia, psychosis, and bipolar, they are used frequently in nursing homes to residents with dementia in spite of the FDA’s warnings that such drugs can kill people with dementia. The most commonly used antipsychotics are Risperdal, Seroquel, Zyprexa, and Haldol.
  • Anti-anxiety drugs: Often prescribed to nursing home residents for unapproved uses, they have serious side-effects. These include Ativan and Valium.
  • Anti-depressants: These can have numerous negative side-effects, including increasing the resident’s risk of a fall. These include Prozac and Zoloft.
  • Sedatives/hypnotics: Often Halcion and Restoril are given to residents.

These are not the only drugs used to sedate or to subdue residents. Anti-seizure drugs like Depakote and Neurontin also are given to nursing home residents inappropriately.

Residents with dementia are particular victims of chemical restraints, in spite of the Food and Drug Administration’s warnings. The researchers in the OIG study reported that 88% of the time, psychoactive drugs were prescribed to elderly people with dementia.

Because these drugs can be deadly to those with dementia, the FDA puts its “black box warning” on these antipsychotic drugs. This is the agency’s strongest warnings.

When a doctor recommends psychoactive drugs for your loved one, there may be a good reason for it. But it is important that you ask a lot of questions and demand factual answers prior to giving your approval for this course of treatment.

What To Ask If Psychoactive Drugs Are Proposed
A few of the things you want to know:

  • The reason and the medical condition for the psychoactive drug.
  • How long and how often will the drug be used.
  • The mental affect on your loved one and all the possible side-effects.
  • The reasonable alternative treatments.
  • Interactions with other medications.
  • The schedule for reassessing the need for the drug and the monitoring of side-effects.

No one can require you or your loved one to consent to any medical treatment, including psychoactive drugs. The law also permits you or your loved to revoke consent for any treatment at any time and for any reason. No matter what the doctor or the nursing home tells you. And by law, the nursing home cannot threaten to evict you.

But be wary, nursing homes and doctors sometimes ignore or partially ignore your and your loved ones right to informed consent. That is why it is so important to look for signs of over-medication. They are not clear-cut, but if your loved ones personality does a significant shift, you might want to look a little further. Other signs can be:

  • Fatigue.
  • A change in motor abilities, especially when standing or walking.
  • Unexplainable weight loss or gain.
  • Skin flushes or rashes.
  • Mood swings.
  • Hallucinations, both visual and auditory.
  • Memory problems.
  • Confusion.
  • Thinking and reasoning problems.
  • Changes in personal hygiene.

If your loved one has dementia, these signs may be more difficult to spot. You may want to request medical records and ask another physician to review them.

If you find your loved one is being treated with psychoactive drugs, the nursing home must, by law, attempt to reduce or eliminate the drug when possible. In California and some other states, the nursing home is required to reassess the use of psychoactive drugs every three months.

Alternatives To Psychoactive Drugs
If your loved one is on a psychoactive drug it will have to be reduced gradually. Possible alternatives to medication are:

  • Insist on individualized attention for your loved one. This requires adequate staffing but includes adapting to the resident’s preferences for personal care, sleep schedules, meals, baths.
  • To relieve the resident’s anxiety, improve the resident’s environment by eliminating distracting noises like intercoms and buzzers, making sure the temperature is comfortable, that the lighting is pleasant, that your loved one is not left sitting in a wheelchair all day. Personalize your loved ones room.
  • Make sure your loved one has pleasurable activities throughout the day. This could include music, walks, exercise, being read to, and visits from pets and volunteers.
  • Meet with staff for care plan meetings and monitor that the plan is being followed.
  • Encourage staff training in how to work with residents with dementia. Suggest representatives from such organizations as the Alzheimer’s Association be brought in to do staff training.

If the nursing home insists on using chemical restraints to subdue your loved one and you need help, contact your local long-term care ombudsman. They can help you resolve concerns about your loved ones care and rights.

Regardless of what state you and your loved one life in, California Advocates for Nursing Home Reform offers an excellent free, downloadable guide, “Toxic Medicine: What You Should Know to Fight the Misuse of Psychoactive Drugs in California Nursing Homes.”

If the worse happens, and your loved one has suffered a personal injury or a wrongful death, contact Garcia, Artigliere & Shadrack to learn what legal options may be available to you or your loved one.