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Recent News
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Involuntary Discharge from Nursing Homes

Do you feel you (or your family member) are being discharged from a skilled nursing facility against your will? The National Consumer Voice for Quality Long-Term Care has released a fact sheet that it created with the National Long-Term Care Ombudsman which outlines information about resident rights and what to do if you are being discharged from a nursing home involuntarily.

For more information, visit the Consumer Voice website.

cover of Justice in Aging's 25 Common Nursing Home Problems

Guide to Common Nursing Problems and Solutions

The Justice in Aging advocacy group has updated their 25 Common Nursing Home Problems & How to Resolve Them guide. According to their website: “The revised guide includes focused information on how to fight evictions, updated eligibility standards for Medicare coverage, and more.

The 25 problems identified in the guide are common across the country and in all types of nursing homes. The guide gives residents, family members, friends, and other advocates the tools they need to identify and solve the problems residents most frequently face.”

Chemical restraints

Chemical Restraints – How Nursing Homes Use Drugs To Control Residents

All too many Americans believe that the sedate, docile elderly people they’ve come to expect in nursing homes are a normal state of affairs. It’s not unreasonable to assume this behavior is a result of aging or chronic illnesses like dementia. However, for many nursing home residents, this sedation is not caused by old age but by the side effects of their medications – medications they should have never been prescribed in the first place.

The use of chemical restraints to subdue nursing home residents is dangerous, illegal, and yet also a widespread practice among nursing homes. Federal regulations define chemical restraints as any drug that is used for disciplinary purposes or the convenience of staff, rather than for treating medical symptoms. These drugs are administered to an individual for the purpose of controlling their behavior, especially if they have dementia, which may make care more difficult.

Chemical restraints usually come in the form of antipsychotic drugs. Antipsychotics alter consciousness and can adversely affect an individual’s ability to interact with others. While their use is valid when treating diagnosed bipolar disorder, schizophrenia, or other psychiatric disorders, nursing facilities commonly administer these drugs to residents who do not have these diagnoses.

Haldol, Zyprexa, Seroquel, and Risperdal are all antipsychotics commonly used in long-term care facilities as chemical restraints. These and other antipsychotics sedate residents so that not only their behaviors but also the underlying causes for those behaviors do not have to be addressed. Like other resident care problems in nursing homes, the use of chemical restraints is attributable to a lack of adequate staff.

Antipsychotics are powerful, and responsible doctors will only prescribe them with extreme caution even when treating diagnosed psychiatric disorders. Many risks come along with taking antipsychotics, and those risks become a magnitude greater when they’re used as restraints rather than for their intended medical purpose. Common side effects include agitation, sedation, disordered thinking, muscle disorders, low blood pressure, constipation, and loss of appetite. The lethargic behaviors exhibited among drugged-up residents also substantially increase the risk of falls which are injuring or fatal. This is why antipsychotics usually have “black box warnings” – FDA labels warning of an increased risk of death if administered to elderly people with dementia.

Through the National Partnership to Improve Dementia Care in Nursing Homes, the federal government has sought to reduce the illegal use of chemical restraints, but many nursing homes still rely on antipsychotics to subdue their residents. State officials do little to enforce the laws prohibiting chemical restraints, and doctors tend to rubber-stamp drug orders requested by nursing homes.

The culture of a nursing home, rather than a resident’s medical needs, decides if you or your loved one will be subjected to chemical restraints. Human Rights Watch’s report, “They Want Docile”: How Nursing Homes in the United States Overmedicate People with Dementia, notes that in an average week, nursing homes in the US administer antipsychotics to over 179,000 people who do not have the diagnoses for which the drugs are intended to treat.

Should a nursing home administer these drugs to your loved one without consent, you have the right to demand them to stop. Nonconsensual chemical restraints are illegal and constitute battery. You have no obligation to accept a doctor’s recommendation to use antipsychotics – strongly consider seeking a second opinion. Antipsychotics can be deadly, and harm from their wrongful use may be cause to seek legal action.

To find out more about chemical restraints and what can be done to prevent their use, please refer to CANHR’s guide Restraint-Free Care and the Long Term Care Community Coalition’s Protecting Nursing Home Residents From Chemical Restraints.

Physical Restraints in Nursing Homes

It is an unfortunate truth of the nursing home industry that families must maintain constant vigilance to ensure their loved ones are receiving decent care. Neglectful and even malicious treatment can arise in both “good” and “bad” nursing homes, and even better nursing homes often have standard procedures that violate U.S. law to the detriment of their residents.

An important red flag to keep an eye out for is the use of physical restraints. According to Justice in Aging’s 25 Common Nursing Home Problems & How to Resolve Them, the most common physical restraint is a vest which ties residents into wheelchairs or beds. However, seat belts, bed rails, and chairs angled to prevent residents from standing up have also been frequently employed in nursing homes.

Federal law mandates that physical restraints can only be used to treat very specific medical conditions or symptoms, but it’s all too common for nursing homes to tie down residents to prevent them from wandering. It’s important to know that physical restraints require consent from either the resident or their representative. Nursing homes or their medical staff do not have the authority to restrain someone without permission. Additionally, they are obligated to make alternatives available.

Restraints can never be used for punishment or a nursing home’s convenience. A vast medical consensus indicates that restraints are harmful to residents. Far from ensuring a resident’s safety, they may actually cause residents to become more at risk of falls and injuries. Worse, some residents have been known to die of asphyxiation after becoming tangled in their restraints. A resident’s frustrated attempts to escape can easily become more dangerous than them having no restraints at all. This is to say nothing of the psychological toll of restraints either.

If a nursing home recommends restraints to prevent your loved one from wandering, you should say no if it is clear restraints would be imposed for the nursing home’s convenience. It’s incumbent upon the nursing home to increase staffing levels, install monitoring systems, or offer mentally stimulating activities to mitigate wandering, rather than punish your loved one. If a doctor proposes restraints to treat medical symptoms, it is important to discuss care plans and examine alternatives to ensure this is a solution with more benefits than risks.

Should a nursing home put restraints on your loved one without consent, you have the right to demand their immediate removal. Imposing restraints without permission is illegal and constitutes false imprisonment and battery. Lasting harm as a result of physical restraints may be cause to seek legal action.