by Anthony Chicotel, CANHR Staff Attorney
State and federal law define a nursing home chemical restraint as any drug used to control behavior and not required or necessary to treat the resident’s medical symptoms. Thus, if the resident’s symptoms could be ameliorated using any other treatment, the administration of a psychotropic medication is unnecessary and violates regulatory standards.
In any case where a facility or doctor is considering a psychotropic drug to “treat dementia,” it should first rule out any physiological or psychological causes of the target symptoms. Psych drugs are often used to mask – instead of to resolve – root causes of cognitive declines or problematic behavior.
On my way from the bus stop to my office this morning (yeah that’s right), I thought of ten simple root causes that should be ruled out before even considering a psych drug:
- PAIN – Elderly people often have conditions associated with significant pain. Modest prophylactic pain medication has proven more effective in reducing symptoms of dementia than antipsychotic drugs.
- DISCOMFORT – Lying in bed all day, bad positioning in a wheelchair, too hot or cold, constant noise, foul smells, or unchanged diapers could cause the best of us to act out.
- MALNUTRITION – With some residents entirely dependent on a hurried, overworked staff member for feeding assistance, it’s no wonder many residents lose weight and suffer shortages of vital nutrients that enhance cognitive functioning.
- DEHYDRATION – Dehydrated people show cognitive impairments similar to dementia. People in nursing homes are often unable to pour and drink water on their own and rely on others to make it happen.
- INFECTION – If I had a nickel for every urinary tract infection in a California nursing home this year, I could buy a pharmaceutical company.
- B12 DEFICIENCY – Often not considered. I would much rather take a Flinstone vitamin than Seroquel.
- THYROID – Thyroid? Is that a gland or something?
- ISOLATION – Long-term care facilities with 150 residents and 30 staff members can still be amazingly lonely places.
- DISPLACEMENT – You raised a family, had a career, followed your guiding lights. Now you’re stuck in a bed, staring at a wall, surrounded by strangers who poke, prod, lift, and wash you. Disoriented? You bet.
- MEDICATION – Look at those side effects. Sometimes they are transformed into “symptoms” used to justify even more medication.
If a long-term care resident is drugged to “treat dementia” without someone having seriously considered the ten issues above, that resident is being chemically restrained.