Report Details Nursing Home Abuse Against Dementia Patients In the Form Of “Chemical Restraints”

Nearly 200,000 nursing home residents each week are subjected to unnecessary antipsychotic medications, which are used to subdue them, often placing their health at risk, according to a new report. 

The Human Rights Watch issued a report of February 5, called “They Want Docile”, which warns about the rampant use of drugs meant to mollify elderly residents. The practice is often referred to as “chemical restraint,” and is widely considered a form of nursing home abuse.

For years, concerns over nursing home drug practices have focused on antipsychotics, such as Risperdal, Zyprexa, Seroquel and others, which may pose serious risks when prescribed for “chemical restraint”.

In many cases, patients receiving these medications in nursing homes suffer from dementia, and studies have shown that antipsychotics not only provide no treatment benefits for dementia patients, but could increase their chance of dying. The FDA has previously warned against the use of antipsychotics with dementia patients, indicating that the medications provide no benefits and may increase the risk of death.

The Human Rights Watch study involved interviews with 323 people in New York, Texas, Kansas, Illinois, California and Florida from October 2016 to March 2017. In addition, phone interviews were conducted from September 2016 to April 2017, and involved secondary sources, background research and data analysis.

According to their findings, about 179,000 nursing home residents per week are given unnecessary antipsychotic medications, most of those suffering from dementia or Alzheimer’s disease. These drugs are often given without the informed consent of the residents or their family members, the researchers found. In addition, residents are often pressured to consent, or family members are informed of use of the drugs on short notice and without any explanation of the risks or benefits.

“Such nonconsensual use and use without an appropriate medical indication are inconsistent with human rights norms,” the report states. “The drugs’ use as a chemical restraint — for staff convenience or to discipline or punish a resident — could constitute abuse under domestic law and cruel, inhuman, and degrading treatment under international law.”

The report found that while there are firm laws on the books against such activities, the U.S. Centers for Medicare and Medicaid Services (CMS) regularly fails to enforce them. The weak enforcement has led to the drugs being routinely misused without fear of significant penalty, and Human Rights Watch noted that “[a]lmost all antipsychotic drug-related deficiency citations in recent years have been determined to be at the level of causing ‘no actual harm,’ curtailing the applicability and severity of financial sanctions.”

In addition, the report’s findings indicate that lack of minimum staffing regulations also play a role. Overworked nursing home employees, dealing with too many patients, turn to chemical restraints in many cases, the group found.

The report notes that experts recommend minimum adequate nursing staffing time should be 4.1 to 4.8 hours per resident per day, but most facilities in the U.S. report providing far less, with almost 1,000 facilities reporting that they provided less than three hours of staff time per day. However, there is no law setting a minimum nursing hours per patient level in the U.S.

“With such vast numbers of nursing facility residents still getting antipsychotic drugs that many do not need, do not want, and that put their lives and quality of life at risk, federal and state governments need to do more to ensure that the rights of residents are adequately protected,” the report concludes. “An industry entrusted to provide care—and paid billions of public and private dollars to do so—cannot justify compounding the vulnerabilities, challenges, and loss that people often experience with dementia and institutionalization.”

In September 2014, the National Partnership to Improve Dementia Care announced that it has set a goal of reducing the use of antipsychotics in long-term care facilities. However, currently about 25% of elderly dementia patients in nursing homes throughout the U.S. are still treated with antipsychotics, even though they may not need the drugs.