Restrictions Sought in Illinois for Chemical Restraints in Nursing Homes

Nursing home resident advocates in Illinois are pushing for new, stricter rules on the use of antipsychotic drugs among elderly nursing home residents, in order to prevent misuse of the drugs as a form of chemical restraint in nursing homes.

Illinois Citizens for Better Care, a grassroots organization that fights to improve nursing home care in the state, is pushing for new state laws and regulations that would prevent nursing homes and doctors from using antipsychotic and psychotropic drugs as a form of chemical restraint on the elderly, according to a report by the Chicago Tribune and ProPublica.

Concerns over the use of such drugs have increased considerably as the result of an ongoing series of in-depth nursing home investigative reports conducted by the Tribune on nursing home problems in Illinois. The stories have unveiled a series of critical failings in the Illinois nursing home system. In addition to investigations which uncovered unapproved use of antipsychotics on non-consenting elderly nursing home residents in order to control them, the stories have also found incidents of murder, rape and abuse, largely due to the housing of the criminally insane within the same facilities as elderly patients.

Illinois Governor Pat Quinn has established the Nursing Home Safety Task Force to address problems uncovered by the investigations, and Illinois Citizens for Better Care are pushing that task force to come up with a firm, durable solution that would prevent doctors and facilities from using antipsychotics to control and restrain nursing home residents.

A recent report from the United Kingdom found that the side effects of antipsychotics, like Seroquel, Zyprexa, Risperdal and Abilify, could be linked to as many as 1,800 deaths and 1,620 strokes per year in elderly patients with dementia. The drugs are not approved to treat dementia here or in the U.K., but in both countries the drugs are often given to elderly patients by doctors, who are able to prescribe drugs for “off-label” uses not approved by federal regulators.

The U.K. report estimated that 180,000 elderly people in that country are prescribed antipsychotics for dementia, but only about 36,000 appear to actually derive any benefit.

Nursing home care advocates say that the state could prevent the “off-label” use of antipsychotics in elderly patients by refusing to pay for the use of antipsychotics to treat dementia or to be used as an injection (which advocates say is usually a sign that they are being used as a sedative) unless the doctor gets permission from the Illinois Department of Healthcare and Family Services on a case-by-case basis.

Care advocates also suggest other potential policies, such as the use of standardized forms be required by all nursing homes to insure they have permission from residents or their family to administer antipsychotic drugs, and a formal process required by all nursing homes to explain the potential side effects of such drugs. They are also pushing for drug companies to be forced to disclose any payments made to doctors in order to monitor potential conflicts of interest.