New Law Addresses Chemical Restraints in Nursing Homes

A new Oklahoma law seeks to put a stop to the widespread and immoral use of antipsychotic drugs as chemical restraints for nursing home residents.  Though chemical restraints are an issue of national concern, Oklahoma ranks number one in the United States for the most widespread inappropriate antipsychotic use on seniors. 

The new law should provide some measure of relief for the thousands of Oklahoma seniors who are drugged into docility for the convenience of nursing home staff.

What are Chemical Restraints?

American Nurse Today, the official publication of the American Nurses Association (ANA), has this to say about chemical restraints,

“[It] involves the use of a drug to restrict a patient’s movement or behavior, where the drug or dosage used isn’t an approved standard of treatment for the patient’s condition…Many healthcare facilities prohibit the use of medications for chemical restraint.”

Essentially, nursing home caregivers administer powerful antipsychotic drugs to residents with Alzheimer’s disease, dementia, or other cognitive impairments because it restrains their behavior and renders them more docile.  Antipsychotics are not intended to be used on dementia patients, but nursing homes have drugged thousands upon thousands of America’s most vulnerable citizens into docility.

To be clear, using antipsychotics for a patient with a disorder like bipolar or Tourette’s is indeed the indicated use of the medicine, and is the standard of care for those conditions.  That is not what is happening in nursing homes, however, and that is not the practice the new Oklahoma law seeks to amend.  Rather, nursing homes know antipsychotics will treat the irritability and other inflammatory behaviors associated with Alzheimer’s or dementia, and so they inappropriately use them to control nursing home resident behavior.

The Misuse of Antipsychotics as Chemical Restraints

Alarmingly, misuse of antipsychotic medications is not a new problem.  It is a well-documented, decades-long, deplorable practice.  The U.S.  Food and Drug Administration (FDA) has had a warning label on antipsychotic drug packaging since 2008 specifically warning against the use of antipsychotics for dementia.

Though a step in the right direction, the new Oklahoma law is the proverbial band-aid on a bullet wound for this problem.  Legislative bodies and government agencies have been reporting and passing laws on this practice for over 40 years.  Examples include:

• 1975 – A U.S.  Senate committee published a report of the abuse in nursing homes that referenced contemporary cases as well as some dating back to the 1950s.
• 1986 – The Institute of Medicine (IOM) reported misuse of antipsychotic drugs involving nursing home residents, along with many other abuses, prompting the Nursing Home Reform Act of 1987.
• 2007 – An FDA agent testified before the House of Representatives, “I would pay careful attention to antipsychotic medications.  … The problem with these drugs are that we know that they are being used extensively off label in nursing homes to sedate elderly patients with dementia … .  It is known that the drugs don’t work in those settings.  … But the fact is, is that it increases mortality perhaps by 100 percent.  It doubles mortality.  So I did a back-of-the-envelope calculation on this and you probably got 15,000 elderly people in nursing homes dying each year from the off-label use of antipsychotic medications for an indication that FDA knows the drug doesn’t work.  This problem has been known to FDA for years and years and years.”
• 2010 – The Centers for Medicare and Medicaid Services (CMS) reported 40% of nursing home residents who had no diagnosis of psychosis received antipsychotic medications.
• 2011 – The Department of Health and Human Services (DHHS) reported 83% of submitted Medicare claims for use of antipsychotic drugs on nursing home residents in 2007 were for use in cases where there was no clinical indication.

Clearly, the problem is well-known, widespread, and not likely to go away anytime soon.  Human Rights Watch (HRW) wanted to know why.  They visited 109 nursing homes across America and released a report in 2017 called, “They Want Docile: How Nursing Homes in America Overmedicate People with Dementia.”

The HRW report suggested 179,000 nursing home residents per week inappropriately receive antipsychotic drugs as chemical restraints for one reason: profits.  The drugs manage the time-consuming, and therefore costly, behaviors of dementia sufferers so that nursing homes can staff their facilities with the bare minimum of workers to watch over zoned-out and docile residents. 

Do You Have a Loved One with Dementia in a Nursing Home?

If so, you should be concerned.  The HRW report found that many residents receive the medication against their will, without their knowledge, or even under coercion.  The report observed nursing home staff:

• Secretly administer the drugs to residents
• Fail to identify the drug as an antipsychotic
• Make claims the resident would get hurt without the drugs
• Guilt family members into consenting to the drug’s use
• Fail to inform the resident or their family about the potential side effects and risks
• Threaten to discharge the resident from the facility

If you have a loved one in a nursing home with dementia, they should not be on antipsychotic medication unless specifically prescribed by a trusted healthcare provider.  Any nursing home that attempts to convince you otherwise is not being frank about the dangers these drugs pose.  These dangers include the following side effects:

• Blood clots
• Diabetes
• Dyskinesia
• Fall risk
• Irreversible cognitive decline
• Pneumonia
• Severe nervous system problems
• Stroke
• Visual disturbances
• Death

Bear in mind, the FDA spokesman quoted above testified to Congress that antipsychotics increase the risk of death for dementia patients by 100%.  And yet, they continue to be misused at alarming rates all over the U.S.

What to Do If Your Loved One is on Antipsychotics

Chemical restraints have garnered national attention once again, and the new Oklahoma law is hopefully just the beginning of a sweeping change for the better for residents living in one of the 15,000 nursing homes across the U.S. 

In March, CMS has announced their goal of a national 15% reduction in the use of chemical restraints.  While the wheels of legislation slowly turn, seniors are in danger right now. 

The Nursing Home Reform Act of 1987 created a nursing home resident “bill of rights,” which includes the right to be free of abuse and maltreatment, and also to be fully informed about their care.  If you have a loved one with dementia in a nursing home, question the facility about chemical restraints. 

Common names of antipsychotic drugs your loved one may be receiving are:

• Haldol
• Seroquel
• Risperdal

The practice of chemical restraints is not only morally repugnant, but also dangerous to dementia patients.  Nursing homes have a responsibility to treat their residents within the standard of care, and antipsychotics have no place in the treatment of dementia, Alzheimer’s, or a number of other cognitive impairments often used as an excuse to medicate. 

Consult a Nursing Home Abuse Attorney

At Nursing Home Abuse Center, we are passionate about justice for the vulnerable nursing home residents who have been failed so completely by nursing homes that use chemical restraints.  If your beloved family member has been the victim of a chemical restraint, we want to help you.

Learn more about the legal rights of nursing home residents, and what you can do to hold facilities accountable when they violate those rights and the standards of care.  Contact Nursing Home Abuse Center by calling 1-800-516-4783, or complete our online form to schedule a free consultation of your chemical restraint claim.

Sources:

• https://www.americannursetoday.com/use-restraints/
• https://www.tulsaworld.com/news/state-and-regional/bill-cracks-down-on-antipsychotic-medication-given-to-nursing-home/article_375b311b-8a60-5628-9c7c-53d3966c4383.html
• https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationgeninfo/national-partnership-to-improve-dementia-care-in-nursing-homes.html
• https://www.healthaffairs.org/do/10.1377/hblog20180424.962541/full/

Written By Meagan Cline

Meagan Cline is a professional legal researcher and writer. She lends her expertise to FNHA and our websites, including Birth Injury Guide and MedMalFirm.com.