Golden Living Center in Redding was the subject of a Class A citation from the Department of Public Health (DPH) earlier this year that hopefully represents a shift in enforcement of nursing home rules against the irresponsible use of psychotropic drugs in nursing homes.
In the case, a 78 year old male resident with a diagnosis of dementia and high risk of falls was receiving Ativan and Risperdal, two psychotropic drugs often used to sedate residents and that increase fall risks. On 9/18/12, the resident was given extra doses of Ativan to further chemically restrain him. That night, the resident fell and broke his arm. The resident’s one-to-one caregiver assigned in part to prevent falls, was not around. The facility was cited for failing to ensure the resident was free from excessive, inappropriate, and ineffective medication and for failing to provide the needed one-to-one supervision.
What made the citation noteworthy, aside from the $10,000 fine that was assessed, was DPH’s reporting that Ativan is supposed to be avoided for elderly patients – concluding that it is inappropriate for treating insomnia, agitation, or delirium and that it increases risk factors and symptoms often associated with dementia: impaired cognition and risk of falls and fractures. While the citation did not explore possible chemical restraint or non-pharmacologic options in addressing resident behavior, it is nonetheless laudable for contradicting the common reasons nursing homes use Ativan.
Nursing homes should consider the Golden Living Redding citation a warning against using expensive, ineffective, and sometimes deadly drugs to control residents who are communicating distress, discomfort, or unmet needs. It looks like DPH investigators are beginning to get the message: there is a better way.