Chemical Restraints

This article discusses how in nursing homes across the U.S., vulnerable dementia patients are being prescribed antipsychotic medications at concerningly high rates, often for reasons that go beyond their intended use. These facilities use these drugs as “chemical restraints” to manage behaviors in dementia patients that become too difficult to manage.

The analysis by the Long Term Care Community Coalition revealed that over 1 in 5 nursing home residents is being given antipsychotic drugs, even though these medications are supposed to be a last resort when non-drug interventions have been exhausted. Disturbingly, some facilities show drugging rates of 50% or higher. These high of numbers suggest not just overprescription, but irrefutable abuse and neglect.

The Nursing Home Reform Act of 1987 was intended to guarantee residents the right to be free from unnecessary physical and chemical restraints. Yet, more than 30 years later, it is still such a prominent issue in nursing homes across the US.  Misdiagnosing elderly patients to justify the use of antipsychotic drugs isn’t just a mistake, it should be illegal. Many residents experience severe side effects, including heart failure, infections, immobility, and even death. In some cases, this could clearly amount to medical malpractice or criminal negligence.

My question is why aren’t more facilities facing criminal charges or more significant penalties for these misdiagnoses and uses of chemical restraints on patients? The response is merely regulatory: CMS lowers a facility’s quality rating or imposes fines. While this is important, it most certainly does not match the seriousness of the offense in my opinion.

The problem is systematic: pharmaceutical companies are driven by profit, and nursing homes are often understaffed and underfunded. These facilities turn to antipsychotics because it’s easier and cheaper than employing more staff or using non-drug interventions. Without stronger regulation and corporate accountability, this cycle is unlikely to change. Despite CMS’ efforts, over 21% of nursing home residents are still being prescribed antipsychotics.

My proposed solution would be rewarding nursing homes with good quality care; however, the nursing home industry is stuck in a paradox: the facilities that struggle the most with care quality, including overuse of antipsychotics, understaffing, etc, are typically the ones that don’t have the money or funding to improve in the first place. Therefore, this would just create a cycle that makes it even harder for those facilities to improve. A solution would have to look like a more comprehensive reform that somehow not only penalizes poor care but also provides targeted support for struggling facilities. Additionally, I think stricter regulation of pharmaceutical companies to limit the influence of profit-driven motives is important.