An Over-Medicated Nursing Home Resident Is Docile and More Profitable for the Facility
By Louthian Law Firm, PA, South Carolina
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Over-medicating, or chemically restraining, nursing home residents to make them easier to manage is a poorly kept industry secret. This practice allows for facilities to house more residents because they pose fewer demands on staff. Often residents without psychiatric conditions are given antipsychotic drugs to sedate them -- sometimes to the point of unconsciousness.
Human Rights Watch (HRW) issued a report in February estimating that about 179,000 nursing home residents are given antipsychotic drugs even if they don't have the serious mental illnesses they’re meant to treat. Most of these residents suffer from dementia but these medications aren’t approved to treat the disease. The Food and Drug Administration (FDA) warns that these drugs increase the risk of cardiovascular problems and death in elderly people with dementia.
Many Nursing Homes Use Drugs to Restrain Residents and Make Them Easier to Supervise
Antipsychotic drugs alter consciousness and can impair a person’s ability to interact with others. Side effects include trouble swallowing, insomnia, anxiety, sedation, cognitive decline, fear and frustration at not being able to communicate. Use of antipsychotics can result in the use of more drugs to treat their side effects.
As part of its study, HRW interviewed nursing home residents, their family members, staff and those who investigate nursing home complaints for state agencies.
• 62-year-old woman in a nursing facility stated she was given Seroquel, a common antipsychotic drug, without her knowledge or consent. She said, “It’s a powerful, powerful drug. I sleep all the time.”
• The daughter of a 75-year-old woman in Kansas told HRW that when the nursing facility gave her mother an antipsychotic drug, she “would just sit there like this. No personality. Just a zombie.”
• One director of nursing said, “You actually see them decline when they’re on an antipsychotic. I think it’s sadder than watching someone with dementia decline.”
Many Nursing Homes Don’t Bother Getting Informed Consent before Antipsychotics Are Used
If the residents aren’t capable of making their own healthcare decisions, normally their next of kin make decisions for them. These family members may not be informed that the drugs are being used, or not be fully informed of their dangers.
HRW states that the practice of using antipsychotic drugs to control people without their knowledge or against their will in nonemergency situations violates their human rights. HRW documented cases where nursing homes made no efforts to obtain meaningful, informed consent from the individual or a healthcare proxy before administering the medications even when it clearly would have been possible to do so.
A current director of nursing admitted to an HRW investigator, “We are supposed to be doing informed consent. It’s on the agenda. But really antipsychotics are a go-to thing. ‘Give ‘em some Risperdal and Seroquel.’ We tell the family as we’re processing the order. The family is notified.”
In many other instances nursing homes that claim to seek consent don’t give enough information for consent to be informed, and they pressure individuals to give consent. HRW states that under international human rights law, without free and informed consent a nonemergency medical intervention that’s unnecessary to address a life-threatening condition is forced treatment and illegal.
The use of these drugs as a chemical restraint makes work easier for staff; to discipline or punish a difficult-to-control resident could be considered abuse under U.S. and state law and cruel, inhuman and degrading treatment under international law, according to HRW.
After eliminating or addressing underlying medical, physical, social or environmental causes of manifestations of distress due to dementia, antipsychotic drugs “can be appropriate” as a means to “minimize the risk of violence, reduce patient distress, improve the patient’s quality of life, and reduce caregiver burden,” according to the American Psychiatric Association (APA) Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia.
The APA guideline also states that the benefits of using these drugs are limited; there’s “consistent evidence that antipsychotics are associated with clinically significant adverse effects, including mortality,” so these drugs should be used only when appropriate.
Antipsychotics not only sedate nursing home residents, they harm them as well.
Unnecessary antipsychotics not only chemically restrain nursing home residents, they cause physical harm. University of Michigan researchers looked at data from nearly 91,000 U.S. veterans older than 65 who had dementia. Those who took antipsychotics were more likely to die early, according to the study, which was released in 2015. Those using newer, more common antipsychotics were more at risk of premature death as the dose increased.
Side effects of antipsychotics could also result in falls and related injuries. They include increased confusion, reduced mobility and unsteadiness. The drugs can damage the extrapyramidal motor system, a neural network in the brain that coordinates movement, which can result in a shuffling gait, tremors, rigidity, muscle contractions and involuntary movements.
The profit motive by nursing homes isn’t restricted to being able to have limited staff oversee more residents. Drug-maker Johnson & Johnson and its subsidiaries were fined more than $2.2 billion in 2013 to resolve criminal and civil charges due to their overly aggressive marketing of drugs, including antipsychotics, to nursing homes, when the company knew the drugs weren’t approved by the FDA as safe and effective for a general elderly population. The corporation was also accused of paying kickbacks to physicians. Eli Lilly paid $1.4 billion in 2009 to settle similar claims involving their marketing of the antipsychotic Zyprexa.
The federal government, working with the nursing home industry and patient advocacy organizations, started a program in 2012 to reduce antipsychotic drug use in nursing homes. Since then the use of the drugs has dropped by about a third. But HRW argues that the federal government hasn't done nearly enough to enforce laws meant to protect nursing home residents.
The physical and mental declines, including dementia, that can come with age are cruel enough. Being given harmful, inappropriate medications you don’t want or understand in order to make you a docile, easily managed resident in a nursing home that’s actually just a warehouse where the elderly are stored and not cared for adds a layer of manmade cruelty to what declining health already imposes.
If the government won’t do the right thing and do more to prevent this from happening, nursing home residents harmed by antipsychotics and their families can turn to the court system to right these wrongs.
ABOUT THE AUTHOR: Bert Louthian
Bert Louthian has been practicing law in Columbia with his father, Herb, since 1985. After receiving his Juris Doctorate from the University of South Carolina, Bert launched his legal career in his father’s firm. With 80 years of legal experience between them, Louthian Law, P.A. remains Family-Owned and Family-Focused.
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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer. For specific technical or legal advice on the information provided and related topics, please contact the author.