“Chemical restraints” are the use of drugs in order to restrain, or subdue, nursing home residents and patients. Drugs can be prescribed by doctors as a means to keep patients subdued or calm where they would otherwise be prone to physical and even violent outbursts in behavior. Patients with dementia or some type of psychosis, for example, can experience these episodes, and pose a safety issue to others around them, and of course themselves. These medications are often referred to as antipsychotic medications. In many instances, however, patients do not truly need these antipsychotic drugs, or do not need nearly the amount that they are given by nursing home staff. Sometimes staff will use antipsychotic medications to subdue patients who were not even prescribed the medication. This is where prescribed or non-prescribed drugs all of the sudden become a form of chemical restraint. Nursing home staff may simply use these chemicals improperly to make their own jobs easier so they keep patients subdued, and pharmaceutical companies certainly must not mind the continuing business.
A recent AARP article has highlighted the use of chemical restraints through antipsychotic drugs. It discusses the example of a woman who, after less than three weeks at a nursing home for treatment and recovery from a broken pelvis, and left “withdrawn, slumped . . . chewing on her hand, her speech garbled.”
The woman died weeks later. It was found that she received “so many heavy-duty medications, including illegally administered antipsychotics” that she lost her normal function. As can be common across nursing homes, the woman would be given different medications that were intended to counterbalance one another – one medication would keep her from sleeping or cause her agitation, so she would be given another to counteract those things. The constant back-and-forth and constant provision of antipsychotic medications, especially for someone who did not need them, completely ruined her quality of life, and potentially spurred a faster decline until her death.
There has been a reported increase in the use of chemical restraints in nursing homes. A study in the Journal of the American Geriatrics Society found that a decrease in the use of physical restraints of patients correlated with an increase in chemical restraints. Efforts were made in the past to reduce the use of physical restraints of patients, but apparently staffers merely switched to drugs and medications in order to accomplish the same goal of restraining patients.
It is also interesting historically because the use of psychotropic drugs in nursing home facilities decreased from the 1980s into the 1990s after federal legislation restricted their use, but chemical restraint drugs bounced back by the 2000s through today because of the development of drugs considered to be acceptable. Physical restraints saw a steady decline over the course of recent decades, reducing from about 21% in 1991 to 3% now, while chemical restraints made a comeback.
The use of any restraint, including chemical, is unacceptable except where absolutely necessary and prescribed by a doctor. Nursing homes and their staff members must be held accountable for the improper or even illegal use of medications. Medications, especially those used in high volume and in tandem, can have permanent debilitating effects on a patient, and patients and their families must know their rights in these circumstances.
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