Imagine you’re in a nursing home in desperate need of assistance, but the nursing staff is so busy and so frustrated with your pleas for help that they just put you to sleep with a sedative. This situation happens so frequently at U.S. nursing homes that it has a name: chemical restraints. It’s also called a chemical straitjacket, it’s a form of nursing home abuse, and it’s against the law.
What Is a Chemical Restraint?
Chemical restraints are the inappropriate use of medicines to make severely disabled or difficult residents go to sleep or make them “drugged out” and easier to manage. Commonly, cases of chemical restraints involve the use of antipsychotic drugs, which are strictly indicated for patients and residents diagnosed with serious disorders, particularly schizophrenia.
People would be furious if they saw their loved ones in nursing homes in handcuffs or bound to their bedposts because they were being difficult. However, if we saw an elderly resident sleeping, we probably wouldn’t think twice. That is the evil of chemical restraints. It is the same thing as a straitjacket, but it is invisible to the untrained eye.
Loved ones need to be aware when the resident is sleeping more than usual or frequently unable to have a normal conversation due to the influence of sedation. Some residents might be unaware it’s happening or afraid to discuss the use of chemical restraints. In many cases, the staff will threaten the use of chemical restraints on residents to intimidate them.
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Chemical Restraints Are Dangerous & Illegal
The use of chemical restraints is a form of physical abuse at nursing homes. The practice was officially banned by the Centers for Medicare and Medicaid (CMS) in 1987. Nursing homes are legally required to document the use of all medications, including antipsychotic medications. Sadly, the nursing home industry has simply been tacking on dubious diagnoses of schizophrenia to justify their misuse of the drugs. An investigation conducted by the New York Times found that the incidence of schizophrenia diagnosis in nursing home residents jumped by 70% since the use of chemical restraints became illegal in 2012.
It’s more than just cruel to drug the elderly; it’s dangerous. According to research cited in the National Library of Medicine, “Chemical restraint use can lead to a decrease in functional and cognitive performance, falls and fractures, excess sedation, and respiratory depression.”
Why Do Chemical Restraints Happen?
The simple answer is that it is quicker and easier to sedate a difficult resident than to serve them properly.
Many of the residents of nursing homes need around-the-clock assistance with daily activities. They need help getting up, sitting down, moving around, going to the bathroom, getting dressed, eating, drinking, and more. Some are so gravely ill that they have trouble communicating exactly what they need. Many have conditions that make them extremely agitated, difficult, and even violent. Aggressive and difficult behavior is especially common for those who suffer from dementia, such as Alzheimer’s. It’s not an easy job for nursing home staff.
Most nursing home staff members are caring and hardworking. Of course, there are bad apples, but the primary cause of shortcuts like chemical restraints is that nursing homes are nearly always understaffed. Even the best of us would find the working conditions in nursing homes unsustainable. Nursing home employees, mostly comprising certified nurse’s assistants (CNAs), are the lowest paid in all of the health care. On top of that, there are simply not enough staff members at most nursing homes to meet the needs of all the residents in their care.
Every day, they must make choices on whom to help and whom to leave stranded. When that situation is present, you can expect the misuse of antipsychotic drugs as chemical restraints.
With the proper training and the appropriate number of staff members for the population of residents, the needs of even the most challenging residents can be met. Unfortunately, the U.S. nursing home in 2022 rarely has the bare minimum of staff members required by law, much less a safe level.
Understaffing Leads to Nursing Home Abuse
Meeting the needs of the elderly, especially those with dementia, is often stressful, strenuous, and time-consuming work for the staff at nursing homes. The reason that many Americans enter nursing homes in the first place is that their loved ones can no longer meet these intense needs around the clock. It requires hard work and patience. It also costs money.
Nursing homes are designed to deliver around-the-clock care, and it is not cheap. According to the American Council on Aging, it costs about $100,000 per year for each nursing home resident. Few can afford this expense “out of pocket,” but Medicaid steps in for most residents in U.S. nursing homes. The cost of long-term care to taxpayers for long-term care was $130 billion in 2020. What are taxpayers and residents getting for this massive investment of cash?
This money goes directly to the nursing home, the majority of which are for-profit enterprises. It’s up to management and their investors how to allocate those funds to residents at the nursing home. Since the 1980s, there has been a shift in which independent and nonprofit homes have been acquired by corporations and private equity groups who are drooling at the billions in government funding they can count on no matter how poorly they perform. Many nursing homes, especially those that are privately held, have no problem cutting staff to the bare minimum, despite the well-documented fact that higher staffing levels translate to better health, safety, and well-being of residents. As part of their penny-pinching, staffing levels at for-profit nursing homes have plummeted to dangerously low levels.
In addition to creating a situation where there are too few staff members to adequately meet the needs of residents, understaffing is driving frustrated nurses to actions of abuse and neglect. If you suspect that a loved one is a victim of nursing home abuse or neglect, including chemical restraints, contact a legal professional. For a free, no-obligation review of your situation, contact Brown & Barron online or call (410) 698-1717.
