Use of chemical restraints in nursing homes

Warren Wolfe of the Star Tribune in St. Paul, Mn. wrote a great article on the overuse of medications in the nursing home population.

Thousands of nursing homes nationwide are using powerful antipsychotic drugs to quiet disruptive people with mild dementia — at times a step that’s easier and cheaper than training staff to fix the problem.   The practice is alarming Medicaid officials so they ordered state nursing home inspectors to crack down on it.

The Food and Drug Administration requires some to carry a “black box warning” that they heighten risk of death for older patients, a warning that it might extend to all antipsychotic drugs. They also increase the risk of confusion and falling.   The drugs often are prescribed whether the resident is psychotic or not.

Antipsychotic drugs have become the No. 1 drug paid for by Medicaid, which regulates and pays for nursing home care.  It’s easy to understand why an overworked and burnt out nurse might want a resident drugged as a chemical restraint.  However, unless the resident is combative because of a mental illness such as paranoia, there’s always a better way to control disruptive behavior in someone with dementia than with drugs, said John Brose, a Minneapolis psychologist who consults at more than 100 nursing homes, including Hopkins.

“Usually, that person is trying to communicate something — I’m too cold, too hot, constipated, frightened, tired, thirsty,” he said. “Figure that out, then deal with the real problem.”