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.

Nursing Home Ratings – is 5 Star Really 5 Star?

For the millions of families in America faced with the tough time of placing their loved ones in a nursing home, Medicare’s online quality ratings are meant to help them make the right choice. Since 2008, Medicare has published quality ratings for every nursing home in its network according to a five-star system. A nursing home awarded five stars is meant to be a top tier facility, but for many homes that rating doesn’t hold up under scrutiny.

A 2019 study by Amanda Sharkey and Amandine Ody-Brasier found little correlation between a nursing home’s ratings and its actual health outcomes. Worse, the findings of their study concluded that nursing homes are likely gaming the Medicare rating system, utilizing dishonest tactics to inflate their scores.

The amount of stars a nursing home is awarded is determined by three sub-ratings: patient outcomes, results from onsite inspections, and staffing levels. Critically, the patient outcome and staffing level sub-ratings are based on the nursing home’s self-reported numbers and payroll information, meaning they can adjust their own scores to receive more stars. It’s a method that relies far too much on the honor system – if a nursing home overstates its staffing levels or does not disclose negative patient outcomes, it can receive a five-star rating it does not deserve. This means countless families are deceived into believing their loved ones will be properly cared for at a well-staffed facility.

Sharkey and Ody-Brasier were first alerted to this tactic when studying a change in the Centers for Medicare and Medicaid Service’s parameters for maintaining each star rating. In 2012, the staff number requirements were raised for every star rating, meaning many nursing homes had to hire new nurses if they wished to maintain their previous rating. Sharkey and Brasier expected to find data indicating that an increase in nursing hours for each patient leads to better health outcomes. This wasn’t an unreasonable hypothesis, considering it’s backed up by countless studies and nursing experts, in addition to being general common sense.

Instead, they found that nursing homes which reported staff increases failed to see a correlated increase in quality of care. The rate of bedsores, for example, did not decrease even though they are extremely preventable with a sufficient amount of care. This is a strong indicator that nursing homes are cheating the system by reporting staff numbers that just aren’t consistent with the reality on the ground.

Families seeking a clean and attentive nursing home for their loved one should regard the Medicare ratings with caution. Poor quality nursing homes can often be fatal for the elderly residents that wind up in them, as well as deeply traumatic for the surviving families. The safest course of action is to visit nursing homes personally, assessing the overall cleanliness and speaking to current residents and staff. Don’t be deceived by facilities that would rather cheat the ratings than make your loved one’s health a priority.

Nursing Home Chain Rakes in Millions

CA’s Largest Nursing Home Chain Rakes in Millions Amid Controversy and Death

Home to 40 million, California alone comprises approximately 12% of all Americans. It’s a ripe market for nursing home chains eager to fill beds, which all too often is a recipe for trouble when regulations and government enforcement measures can’t keep up with the tricks and loopholes employed by corporations. The Washington Post recently came out with an article exposing one such tactic used to funnel money out of patient care and into the pockets of profiteers – a tactic which the largest for-profit nursing home operator in California seems to be employing.

Known as Brius Healthcare, the chain received more than $800 million from Medicare and Medicaid in 2018 to care for residents in their approximately 80 nursing homes. Yet much of that money may have never reached those residents in any capacity. Instead of relying on outside businesses to supply services such as food and rental space, Brius pays businesses financially tied to them instead, resulting in multi-million dollar payments to themselves.

This practice may be both common and legal, but that doesn’t make it benign. Over 70% of American nursing home operators use Medicare and Medicaid funds to pay themselves through other companies they or their family members own. Watchdog groups have decried the practice on account of it allowing nursing home owners to excessively enrich themselves using public funds, often at the expense of their residents’ care. The problem is exacerbated by a lack of transparency; related businesses, such as those owned by a family member, do not have to disclose their profits, rendering regulators unable to keep an eye on the millions these owners are reaping.

Yet despite the widespread use of this tactic, few nursing home chains have drawn as much scrutiny in California as Brius Healthcare. The company, owned by Shlomo Rechnitz, stands out for how often its financial practices and quality of care have been investigated and criticized by state legislators and attorneys. Staffing levels and safety ratings for Brius Healthcare homes are well below state average, and there have been a number of lawsuits regarding their standards of care.

The Washington Post investigation found that Brius homes pay 40% more per bed to related companies compared to other for-profit nursing homes in California. In 2018, Brius paid over $100 million to dozens of these related companies. Four of these – Brius LLC, Brius Management, Citrus Wellness Center LLC, and Sol Healthcare LLC – took in a total of $38 million in 2013. The Washington Post was able to verify that of the money those four companies were handed, almost $28 million went to Rechnitz and his wife.

Data from other years was unable to be tracked on account of a lack of transparency laws, so there is no way to know Rechnitz’s total income. But criticism of transparency problems has increased amid the COVID-19 pandemic, as Brius Healthcare has received $54 million in relief aid and the industry continues to push for more.

California assemblyman Jim Wood wrote legislation two years ago requiring nursing homes to disclose the profits of related parties. The new law went into effect in 2020, but it’s only a necessary first step to reigning the nursing home industry’s worst actors.

“We hear all the time from these facilities, ‘Well, we’re not profitable, therefore we can’t pay our workers more,’” Wood said. “But I can’t help but think that when you add all of this together, somebody is making a lot.”

Image: Getty images

Amid Covid-19, Nursing Home Deaths Due To Neglect Skyrocket in the Shadows

The COVID-19 pandemic has had a devastating impact on society, and that impact has hit the elderly the hardest. Though the virus is spreading like wildfire through nursing homes and other long-term care facilities, reporting from The Associated Press demonstrates that deaths from COVID are only a shadow of the dangers posed to elderly loved ones in this troubled time.

Chronic understaffing at nursing homes had been a problem long before the COVID-19 pandemic, one serious enough that it was a common cause of elder abuse in said facilities. COVID-19 exacerbated this understaffing issue to previously unseen levels, as nurses already in stressful, low pay positions prior to the pandemic have been overworked from colleagues testing positive or calling in sick. Federal data indicates that in states where virus cases are surging, almost a quarter of nursing homes are reporting staff shortages.

This has had deep consequences on the level of care afforded to our elderly population. When long-term care facilities were initially sealed off in March, inspectors and advocates were locked out as well, even as disturbing reports leaked about major medical declines in nursing home residents. As families have gradually been permitted to visit their loved ones once again, they’ve often been horrified at what they see.

Grandmothers kept in soiled diapers so long their skin peeled off, grandfathers with tunneling black bedsores, and reunions that became funerals as loved ones perished from dehydration or starvation – this is the toll of the neglect that has become far too common in the wake of the pandemic. As more than 90,000 Americans in long-term care facilities have died to COVID-19, elder advocates report that deaths from neglect have also spiked and could total more than 40,000.

An expert who analyzed data from the nation’s nursing homes on behalf of The Associated Press estimates for every two COVID-19 deaths in long term care facilities, there is a premature death resulting from physical neglect or “failure to thrive.” The latter is the term listed on some death certificates for instances where doctors believe the deaths resulted from the despair of prolonged isolation.

Considering the scale of the dangers posed to nursing home residents in these times, it is vital to safely be there for your loved ones if they live in such a facility. To better understand what indicators to be on the alert for in order to keep them safe, please refer to the post, “COVID-19: What to Look for When Visiting Long-Term Care Facilities.”

COVID-19: What to Look for When Visiting Long-Term Care Facilities

COVID-19 has necessitated lifestyles changes from all of us, but many don’t fully realize the deep impact it has left on the elderly. Economic insecurity has broadened, depression-inducing levels of isolation have become typical, and some long-term care facilities have adopted harmful practices to handle the additional burdens COVID-19 has introduced to their staff.

With a vaccine still months away from achieving widespread inoculation, the National Consumer Voice for Quality Long-Term Care and AARP Foundation have released a guide on things to keep in mind as you visit loved ones in nursing homes and other long-term care facilities.

One of the first things Consumer Voice recommends doing when reuniting with a loved one living at a long-term care facility is to note both their mental and physical states. Have they gained or lost weight? Is their skin healthy, with no pressure sores or bruises? Is their energy level and alertness what it should be, or do they appear confused? Be on the alert for signs of harmful medication changes.

Observing the state of the facility is also crucial to ensuring your loved one is getting the care they need. Are facility areas such as the bedrooms, bathrooms, and common rooms clean? Are the residents and staff wearing masks? Does there seem to be a sufficient number of staff in the building – with the number of nurses and certified nursing assistants on shift posted as required? A ‘No’ to any of these questions suggest problems that could put your loved one at risk.

You don’t need to rely solely on your own observations, however. It’s worth asking questions directly to your loved one to ensure they’re satisfied and truly receiving the care they need.

If concerns or issues arise during your visit, it is of the utmost importance that you act on what you know. Talk to the nurse on duty about your concerns, request a care plan meeting, ask the director of nursing or the administrator what will be done to address issues, and possibly file a complaint with your state survey agency. There are a multitude of options available to you, but keep in mind that just because you’ve expressed your concerns doesn’t mean the facility will take action on them. To truly be certain your loved one is safe, it is vital to follow up and act as an advocate until you’re certain the matter is resolved.

COVID-19 has brought much uncertainty into the world, but knowledge and foresight can help keep those you care about safe until the pandemic is behind us.

Photo credit: dpa/picture alliance via Getty

Nursing home resident

California Nursing Homes Got Insider Access to Newsom’s Health Care Regulators. Here’s How

From the 7/2/20 Sacramento Bee:

On April 9, California nursing homes were already in a state of crisis. Employees were staying home, fearing for their safety without proper protection. Facilities reported deaths daily.

At 12:30 p.m. that day, the chief advocate for California’s nursing home industry dispatched an email to officials at the California Department of Public Health. The email listed seven urgent concerns facing nursing homes, including child care and housing for workers.

The most detailed priority on the list: “The continuing bleed of $$$ to respond to COVID.”

“We’ve been working … on getting rate increases but making that happen sooner than later will help,” the industry advocate wrote.

Increased protective equipment for staff members and testing were the final items on the list.

Those priorities came from Craig Cornett, the CEO of the California Association of Health Facilities, an industry group representing 80 percent of the nursing homes in the state.

Cornett’s email to the Department of Public Health, among a flurry he sent in the early weeks of the pandemic, highlights how one industry official gained open-door access to the department that regulates his clients, according to emails and documents obtained by The Sacramento Bee through a public records request.

Cornett asked for standards to be relaxed and regulations to be waived. He recommended that COVID-19 patients be housed by one of his for-profit clients — a move that would make them eligible for higher federal payments. He swapped ideas with state officials about moving patients to a hospital ship and solicited their expertise on antibody testing.

All of this came while Cornett and a host of industry officials were asking Gov. Gavin Newsom to grant nursing homes immunity from criminal prosecution and make it harder to sue when residents get sick or die. (Newsom has yet to endorse or reject the idea.)

Read the rest of the article at the Sacramento Bee website.

CDPH logo

CA Dept of Public Health to Require Inspectors to “Adopt” a Nursing Home & Serve as Consultants

Last week – while the staggering death toll for California nursing home residents from COVID-19 surpassed 2,000 – a top official at the California Department of Public Health (CDPH) testified at separate Assembly and Senate oversight hearings on its plan to reform nursing home oversight.

Inconceivably, the central feature of CDPH’s plan is to turn hundreds of its nursing home inspectors into free, part-time consultants to the very same nursing homes they are required to inspect and regulate. It’s calling this plan the “Adopt a SNF Model.”

CDPH presented its plan at a June 9 hearing by the Assembly Committees on Health and Aging & Long-Term Care and a June 10 hearing by the Senate Special Committee on Pandemic Emergency Response. The hearings examined what went wrong in California skilled nursing facilities and with the State’s response and what lessons have been learned.

Read the rest of the article on the California Advocates for Nursing Home Reform website

Stimulus check photo

Nursing Homes Warned Against Seizing Stimulus Checks From Residents

Carole Herman from FATE writes:

Nursing homes are coming under more scrutiny during the Covid-19 pandemic, this time for complaints about efforts to confiscate coronavirus stimulus checks as published by The Hill today 6/11/20.

State and federal authorities have recently notified the public about complaints of long-term care facilities demanding residents on Medicaid turn over their relief payments. Those alerts prompted prominent lawmakers to lean on various federal agencies urging them to investigate the issue and make it clear to facilities that they are not entitled to the checks. Rep. Gwen Moore of Wisconsin told the Hill…”we have provisions that protect the elderly.” She urged the Treasury Inspector General for Tax Administration to exercise its oversight authority to protect residents of nursing homes and assisted living facilities. The main message is that the money belongs to the resident and that is the word the government wants to get out loud and clear. Missouri Attorney General Eric Schmitt said in a statement that his office received complaints concerning this issue. Oregon’s Attorney General Ellen Rosenblum issued a similar statement that she has had complaints and stated “These stimulus checks are the property of the residents and must be returned to them.” It is unclear how many nursing homes have tried to take the residents’ checks.

The Centers for Medicare and Medicaid Services (CMS) has added its own warning to nursing homes that any attempts to confiscate resident stimulus checks could result in federal enforcement actions.

Nursing home resident in wheelchair

Govt Releases Names of 34 Under-Performing Nursing Homes in California

AP News reported in June 2019, that the federal government has released a list of nearly 400 facilities nationwide that have “persistent record of poor care” including serious ongoing health, safety or sanitary problems. According to the April 2019 list, 22 of those facilities are in California.

“We’ve got to make sure any family member or any potential resident of a nursing home can get this information, not only ahead of time but on an ongoing basis,” said Sen. Bob Casey, D-Pa., who along with Sen. Pat Toomey, R-Pa., issued the report.

The CA nursing homes on the list are:

    Alexandria Care Center
    Beverly West Healthcare
    Corona Post Acute
    Del Rio Gardens Care Center
    Downey Community Health Center
    Fircrest Convalescent Hospital
    Fortuna Rehabilitation and Wellness Center
    Good Shepherd Health Care Ctr Of Santa Monica
    Hollywood Presbyterian Medical Center
    Kingston Healthcare Center
    La Mariposa Care And Rehabilitation Center
    Lake Forest Nursing Center
    Lakeview Terrace
    Lakewood Healthcare Center
    Lancaster Health Care Center
    Las Flores Convalescent Hospital
    Long Beach Healthcare Center
    Merritt Manor Convalescent Hospital
    Millbrae Skilled Care
    Olympia Convalescent Hospital
    Riverside Heights Healthcare Center
    Riverside Postacute Care
    Royal Palms Post Acute
    San Fernando Postacute Hospital
    Santa Anita Convalescent Hosp
    Shadowbrook Post Acute
    Sky Harbor Care Center
    Terracina Post Acute
    Wellsprings Post Acute Center
    Windsor Gardens Convalescent Center of Long Beach
    Windsor Palms Care Center of Artesia
    Willows Center
    Woodland Care Center
    Yuba Skilled Nursing Center

To read the article click here.