The use of physical and chemical restraints in California nursing homes is sometimes a necessary way of protecting patients from injuring themselves and others. When used excessively and, more importantly, without consent, the practice becomes outright abusive. Often this method is used not simply to protect the patient, but rather to make a staff member's job easier. Overuse of restraints is exacerbated by the growing number of understaffed nursing facilities.
Physical restraints are used to keep patients from wandering around the facility, a potential hazard for the patient and others. A nursing home is required by law to have the resident's consent before using a physical restraint. Symptoms of physical restraints include sores or bruising on the arms and legs, usually on the ankles and wrists.
Chemical restraints involve the administering of powerful psychotropic drugs to sedate and confine the patient by taking away his or her cognitive abilities. These drugs are not permitted under any circumstances unless the nursing care facility outlines a legitimate medical reason for their use and further provides the frequency and dosage. Because most people are not familiar with the side effects of psychotropic drugs, it can be more difficult to identify chemical restraints than physical restraints.
Psychotropic drugs are administered to nearly 60% of all California nursing home patients, a 30% increase since 2000, according to a report by California Advocates for Nursing Home Reform. A May 2011 study by the Office of Inspector General in the U.S. Department of Health and Human Services found that 305,000, or 14%, of nursing home patients had Medicare claims for atypical antipsychotic drugs. The study was requested by a member of Congress concerned by the number of drugs being prescribed unnecessarily and the cost to taxpayers. The study also determined that 22% of the atypical antipsychotic drugs associated with the claims were not administered in compliance with standards established by the Centers for Medicare and Medicaid Services.
Some common psychoactive drugs are:
- Anti-Psychotics: These drugs are prescribed for psychosis, schizophrenia, and bipolar disorder. Nursing homes often prescribe anti-psychotics to dementia patients despite the FDA's strong warnings that they can be fatal to residents with dementia. Haldol, Seroquel, and Zyprexa are common antipsychotics.
- Anti-Depressants: Common brands are Prozac and Zoloft. Nursing homes have been known to over-prescribe these medications. They can have dangerous side effects such as impaired motor skills, which increase the risk of a patient falling while under a nursing home care.
- Anti-Anxiety drugs: These drugs also tend to be over-prescribed, and lead to impaired motor skills. Ativan and Valium are popular anti anxiety drugs.
- Sedatives/hypnotics: Restoril and halcyon are brands commonly administered to patients.
These drugs can be helpful to your loved one's condition, but it is important that you thoroughly research any prescribed medication and thoroughly interview the prescribing doctor as to why the drug is being prescribed and what its potential side effects are.
If a doctor recommends psychoactive drugs for your loved one, a few questions you will want to ask are:
- What is the medical condition that necessitates the use of this psychoactive drug?
- What is the frequency with which the drug will be used?
- Over what period of time will the drug be used?
- What are the possible side-effects?
- Are there any reasonable alternative treatments?
- What are the interactions with other drugs being used?
Signs of possible psychotropic drug use are: fatigue, impaired motor abilities, unexplained changes in weight, mood swings, deterioration in mental skills, and hallucinations, among others.
If you see these symptoms, and have not given consent to the use of psychoactive drugs, you should consider making inquiries to your doctor and nursing home staff. You or your loved one can refuse medical treatment, or revoke prior consent to any medical treatment. It is important to note that nursing homes are forbidden by law from threatening to evict patients for refusing chemical or physical restraints.
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