Chemical Restraints in Nursing Homes

When your loved one enters a nursing home, you hope they'll receive the best care possible from a compassionate and attentive staff. However, that isn't always the case. Although it's illegal to do so under federal law, aides often use physical and chemical restraints on elderly residents in nursing homes. The use of these restraints can result in serious injury and sometimes death.

What Are Chemical Restraints?

Certain classes of psychoactive drugs have a calming effect on those who take them. They can ease restlessness and temper overly enthusiastic behavior. When taken due to necessity, these drugs can be beneficial. However, in nursing homes, these psychoactive drugs are sometimes used to restrain patients whom staff members find difficult. A recent AARP investigation found that 16% of nursing home patients were inappropriately receiving antipsychotics.

In 2007, a Food and Drug Administration (FDA) spokesperson told a House Energy and Commerce Committee meeting about the off-label use of antipsychotic drugs in nursing homes. Although the FDA has stated that they double the risk of mortality, the drugs are still used in nursing homes to restrain patients with dementia and other disorders. His calculations put the number of preventable deaths due to incorrect use of these drugs in nursing homes at 15,000 per year.

Why Are Chemical Restraints Used on the Elderly?

Medical staff often use chemical restraints to sedate a patient whose behavior is considered violent or erratic. These drugs can calm the patient down and reduce their mobility. However, many nursing homes use these effects for convenience rather than safety. For example, patients with Alzheimer's and similar diseases may be prone to outbursts or confused wandering. A staff member might sedate such a patient to reduce their own inconvenience.

Human Rights Watch has compiled a sobering report outlining this practice. It includes several examples, including:

  • A facility social worker said that behaviors as benign as crying out for help were commonly used as excuses to administer antipsychotic drugs.
  • An 87-year-old woman who was given drugs against her will explained that the home "Just wanted you to do things just the way they wanted."
  • A nursing home gave a 62-year-old woman an antipsychotic drug without her knowledge. "It's a powerful, powerful drug. I sleep all the time. I have to ask people what the day is," she said.
  • The daughter of a 75-year-old woman told HRW that her mother "Just sits there. No personality. Just a zombie."
Types of Chemical Restraints

The most common classes of drugs used as chemical restraints are antipsychotics and benzodiazepines. These are potent and fast-acting sedatives. Other drugs used for this purpose include mood stabilizers and antidepressants.

  • Antipsychotics: These treat psychosis symptoms brought about by schizophrenia and other illnesses and include drugs such as Risperdal, Seroquel, Zyprexa, and Haldol. In patients who have psychosis, they can reduce delusions, hallucinations, and paranoia.
  • Benzodiazepines: This addictive class of drugs primarily treats anxiety, panic attacks, and insomnia. Examples are Ativan, Restoril, Valium, Xanax, and Klonopin. They quickly cause relaxation and sedate the patient.
  • Mood Stabilizers: Typically prescribed to prevent manic and depressive episodes, mood stabilizers work by decreasing abnormal activity in the brain. The most commonly used mood stabilizer is Valproic acid.
  • Antidepressants: Many drugs in this category take months to work and have little effect on patients who don't have clinical depression. However, some, such as Trazodone, do have a sedative effect.
How Are Chemical Restraints Administered to Patients?

There are proper conditions under which to use chemical restraints. The drugs should be a last resort when less invasive options fail, and only when used to avert violence or manage dangerous and uncontrollable behavior.

Any medical provider should ask the following questions before administering a drug for chemical restraint:

  • Is the patient capable of making rational decisions?
  • Does the patient pose a serious threat to themselves or others?
  • Do any health conditions preclude the use of chemical restraints?
  • Do any medical causes for the agitation exist? These could include low oxygen, dementia, low blood sugar, or delirium.

Due to the possibility of medical complications, only trained medical personnel should make the decision to administer chemical restraints. It's also essential to get the consent of the patient or a family member. Like any controlled medication, chemical restraints require a doctor’s order.

Harmful Effects of Chemical Restraints infographic for harmful effects of chemical restraints

Any drug that can restrain someone carries a number of risks inherent to its use. The loss of fine motor control and cognitive function can cause injury even in younger, healthy people. In older adults, the problems can be acute. Common dangers posed by chemical restraint include:

  • Risk of falls
  • Risk of stroke
  • Confusion or agitation
  • Delirium
  • Dizziness
  • Difficulty walking or balancing
  • Nausea and other gastrointestinal problems
  • Insomnia
  • Memory loss
  • Death
  • Immobility leading to development of pressure sores

These drugs can also have long-term effects if used repeatedly. This is especially true in elderly patients who are already experiencing mental and physical health problems. Many of the drugs used for chemical restraint can cause a worsening of their cognitive decline.

Some drugs used as chemical restraints are also addictive, and patients may develop withdrawal symptoms.

How to Prevent Injuries Due to Restraints

The best way to prevent injury from restraints is not to use them. Most doctors will limit the use of such restraints to when they are unavoidable, when they have exhausted all other options, or when a patient poses an immediate threat to themselves or someone else.

In cases that necessitate chemical restraint, medical staff should be careful to avoid any potential contraindications. Elderly people often have pre-existing conditions and medicinal regimens that could increase the likelihood of adverse side effects from the types of drugs used as chemical restraints.

When a doctor determines it is necessary to administer chemical restraints, they should do so infrequently and for limited periods. While a patient is under the influence of the drugs, medical staff should monitor them to ensure they do not react poorly to the medication.

There are many alternatives available to medical staff. These include:

  • Learning triggers for a patient’s violent behavior and avoiding them
  • Training staff for improved behavioral competency, allowing them to diffuse situations more effectively
  • Training staff on strategies for de-escalation
  • An increased presence of nursing staff and conversations with patients
  • Better communication about the need for medication, difficulties the patient is having, and criteria for restraint
Federal Laws for Chemical Restraints in Nursing Homes

Federal law limits the use of restraints to the least restrictive and most effective methods. Furthermore, if it's determined that restraint is necessary to ensure patient safety or the safety of others, several conditions must be met:

  • Staff restrains a patient only for a defined and limited time.
  • The restraint is used in accordance with safe and appropriate techniques.
  • Restraints are a final intervention, used only when other methods have been found ineffective at protecting the patient or others.
  • Restraints are removed or ended as soon as possible.
  • While restrained, the patient is continually evaluated and monitored.

Several states also have their own laws regulating the circumstances under which both chemical and mechanical restraints can be used on patients in nursing homes. For example, the Illinois Nursing Home Care Act requires that:

  • Restraints are used only when the resident, their guardian, or other authorized personnel consents.
  • The resident is informed of their right to report the use of restraints to an individual or advocacy group of their choice.
  • Restraints are used only when necessary to attain or maintain the resident's highest practicable physical, mental or psychosocial well-being.
What to Do if Your Loved One Was Chemically Restrained in a Nursing Home

If your loved one suffered due to chemical restraint in a nursing home, the first step is to contact an attorney for guidance to determine next steps. Because the law requires that health care providers obtain the consent of the patient or a family member before using physical or chemical restraints, you and your loved one have the power to put an end to this practice. If you believe the home administered restraints illegally, call us for a confidential case evaluation.

The Levin & Perconti Nursing Home Abuse Lawyers Can Help You Take Legal Action

The dangers posed by chemical restraints are present and genuine. If you believe your loved one has been subject to chemical restraints in violation of the law, you may be able to file a case for compensation in response to this illegal and negligent action.

Levin & Perconti has a track record of securing legal victories for patients injured or neglected in cases of nursing home abuse. Successful settlements and awards include a $4.1 million verdict after a woman received mismanaged medication.

Contact us today for a free consultation for more information about your possible legal options.

Margaret, Daisy and Bryan. This magnificent cohesive team led by Margaret represented us for my mom's nursing home wrongful death case. They were most patient and responded timely to many questions throughout the entire process. All demonstrated professionalism and extensive knowledge of case and state laws. Their in-depth investigative work uncovered details which were unknown to us and yet sadly confirmed our suspicions. We would recommend the Levin and Perconti Law firm and especially this team. Kathy and Ron
Mr. Levin, Mr. Perconti and the firm handled a medical malpractice suit for my family. During that time, my family and I suffered the loss of my mother. Mr. Levin and Mr. Peconti were more than just our lawyers. Words can’t really express our gratitude. My family and I will always be grateful for the compassion that they showed us. I want to thank you for what you did for my family, and for always being there for us. W.R., Medical Malpractice Client
Our deepest appreciation to the law firm of Levin & Perconti, and in particular to Margaret Battersby Black, in the handling of the lawsuit we field n behalf of our sister who sustained life-threatening injuries as a nursing home resident. Margaret’s representation, guidance, and professionalism gave us the sense that we could put our trust in Levin & Perconti and the final outcome proved that to be true. D.G., Nursing Home Client
I want to send my heartfelt thanks to John Perconti and the Levin & Perconti staff in taking our case. Not only were they so professional but also so caring and thoughtful. It was very difficult going over the facts in our mother's case but they were so compassionate and understanding and allowed us to be with them every step of the way. We were able to sit in on the depositions and we were really able to see how hard they worked on our behalf. M.R.Z., nursing home client
Mr. Levin, Mr. Perconti, and the firm handled a medical malpractice suit for my family. During that time, my family and I suffered the loss of my mother. Mr. Levin and Mr. Perconti were more than just our lawyers. Words can’t really express our gratitude. W.R., medical malpractice client