Articles Posted in Chemical Restraints

It’s one of the certainties of dementia: creating a calm environment for those suffering with the disease can help ease symptoms. Here in the U.S., however, the tradition has been to medicate nursing home residents with the disease, a confusing tactic given that limited activity and isolation have been shown to contribute to the advancement of dementia and Alzheimer’s. Nursing homes in the Netherlands have been taking an alternative approach to treating dementia patients, using visual and sensory stimulation, as well as social interactions, to relax and lift the moods of their residents.

Bars, Beach Rooms, Bus Stops and Shared Experiences: Alternative Dementia Treatment

According to the New York Times, researchers began considering alternative treatments to treating dementia patients when they realized the growing number of Dutch senior citizens suffering from the disease. Nearly 8.5% of the country’s residents over 64 have dementia, with that number expected to double within 7 years.

A recent review of nursing home data reveals that despite initiatives to reduce their use, the number of nursing home residents on antipsychotic drugs remains high in 2018. The Long-Term Care Community Coalition found that 20% of residents are taking an antipsychotic medication, even though the conditions the drugs are intended to treat are present in only 2% of these residents.

A Decades Old Argument 

Antipsychotic drugs are sometimes given to patients off-label to calm behaviors associated with dementia and Alzheimer’s. These medications make patients easier to handle, and have been known to be used without the patient’s physician or family’s knowledge or consent, a dangerous tactic given that off-label use of these drugs have been known to cause sudden death. This practice, officially known as chemical restraint, is not new. Since at least the mid-80s, consumer interest groups have pushed to curtail the use of antipsychotic drugs in nursing home residents with dementia.

Last fall, a CNN investigative report uncovered the misuse of a drug called Nuedexta, intended to control spontaneous crying, laughing, and other emotional reactions in those suffering from PBA (pseudobulbular affect). PBA is extremely rare and is most commonly seen in those suffering from ALS (Lou Gehrig’s Disease) or MS (multiple sclerosis).

Experts estimate that occurrence of PBA in the elderly is less than 5%. If that’s the case, then why are so many elderly nursing home residents with Alzheimer’s and dementia taking Nuedexta?

Off-Label Nuedexta Use Carries Significant Risks

LP-nursing-home-drug-abuse-blog-300x262Researchers with the advocate group Human Rights Watch interviewed 323 people and visited 109 nursing homes in six U.S. states between October 2016 and March 2017. The goal was to discuss the overuse and misuse of antipsychotic drugs given to dementia patients in their care. Those states included California, Florida, Kansas, New York, Texas and several facilities right here in Illinois. The interviews were conducted with nursing home residents, caregivers, and staff, ombudsmen, advocacy organizations, and disability experts.

The group used information collected in those interviews as well as federal data to estimate the percentage of dementia patients who are inappropriately given drugs in order to restrain them. The nursing home abuse and neglect attorneys at Levin & Perconti found these conclusions to be more than alarming. According to the 157-page report, titled, They Want Docile:

  • Each week, approximately 179,000 nursing home residents with dementia are inappropriately medicated and categorized as being chemically restrained.

The daughter of a Greeneville, TN man has settled a lawsuit against her father’s nursing home after he was given several powerful psychotropic medications that were not clinically warranted for a patient with Alzheimer’s and dementia, both from which he was suffering at the time of his death. Mr. Bobby Glenn Tweed died at age 79 due to complications from the unneeded drugs given to him by staff at Life Care Center of Greeneville. All 3 of the medications, Depakote, Seroquel, and Geodon, are contraindicated for use in treating elderly patients with dementia.  In fact, the Food & Drug Administration requires a ‘black box warning’ on both Seroquel and Geodon notifying prescribers that the medications are harmful to patients suffering from dementia and increase their risk of death.

While the terms of the settlement are confidential, the attorneys for the family reminded the press that any time psychotropic meds are used, prior consent must be given. In this case, Mr. Tweed’s daughter should have been notified that the facility needed to use such meds and allowed her to approve or deny their use on her father. According to the suit, these drugs were given over an “extended period of time” and “such medications were being given not because Mr. Tweed needed the medication to treat his illness or to improve his quality of life but to make him a more docile, compliant and passive patient.”

Unauthorized Use of Antipsychotics Due to Multiple Factors

Not all nursing home neglect is a simple matter of unintended mistakes or oversights that cause harm to residents. At times there are far more organized, repeat efforts that place dozens (or even hundreds) of residents at risk of serious harm and death. In those more far-reaching cases, the consequences may be severe for those who engage in the conduct, including nursing home staff members, nurses, doctors, and administrators. While family members of those harmed can file civil lawsuits seeking accountability, criminal charges can also be filed (by the state) if criminal laws are violated.

Three Year Prison Sentence

That is what happened in a unique case which just ended in a Director of Nursing at a long-term care facility being sentenced to three years in prison for conduct related to medication of facility residents. The defendant in the case pled no contest to state criminal charges alleging elder abuse which led to the death of a resident. Interestingly, she also faced “assault with a deadly weapon” charges–with the weapon being the drug Risperdal.

MedPage Today reported on a national analysis that revealed more than one in five U.S. nursing home residents are given antipsychotic medications.

Becky A. Briesacher, PhD and colleagues from the University of Massachusetts in Worcester conducted a study of more than 1 million patients in nursing homes in the U.S. The study revealed that 22% of the residents were given at least one prescription for an antipsychotic agent. The researchers analyzed data provided by Omnicare, a long-term care pharmacy which provides medication services across the country to many nursing facilities. The researchers found that nursing homes kept sparse records on the dispensation of antipsychotic medications so the most accurate way of measuring the use of antipsychotic medication was by examining Omnicare’s records.

Omnicare’s records contained extensive patient information including age, sex and location of residence for reimbursement purposes. The researchers noted this data was “complete and accurate.”

Our Chicago nursing home neglect attorneys work on civil lawsuits. The civil justice system is distinct from the criminal justice system. In a civil lawsuit the private individual harmed by misconduct (either a resident or their family) seeks accountability from the wrongdoer. That accountability usually takes the form of monetary damages. Conversely, the criminal justice system is society’s way of punishing misconduct generally. When an actual crime is committed the perpetrator may face fines, jail time, and other sanctions.

In the vast majority of cases related to nursing home neglect, civil lawsuits are all that are filed. That is because negligence is generally an insufficient mental state to be guilty of a crime in these settings. In other words, while it may be inappropriate to prevent something like a nursing home fall, the aide who does so did not necessarily intend for the resident to be hurt. In many cases, the individual must intentionally cause harm for a crime to be committed. There is more nuance to the issues of mental states as they relate to crimes, but for the most part, that difference between intentional misconduct and negligence is the main distinction.

Jail Time for Nursing Home Abuse

Yesterday we discussed the new book “Dementia Beyond Drugs: Changing the Culture of the Care” where a doctor argued for a new outlook on dementia care. The physician, who has decades of experience with patients experiencing cognitive disease as they age, argues that instead of focusing solely on the disease itself, the overall patient must be considered.

Admittedly, it is easier to grasp this general principle than it is to understand exactly what that means in terms of caregiving at nursing home and other assisted living facilities. Perhaps most obviously, the book is a call for less dependence on medications to control the symptoms of dementia. Instead, more individualized care plan need to be crafted which take the unique challenges of a resident with dementia into account.

Unique Nighttime Programs

Stories of tragic neglect and abuse fill the archives of this blog, because it is important to raise awareness of the plight faced by so many victims stuck in bad nursing homes. At the same time, some facilities (though still too few) are taking important steps to improve care for the residents whose lives are dictated by their decisions. Some facilities are reevaluating their approach to consider residents’ overall quality of life.

For example, the Chicago Tribune reported yesterday on Glenview’s Maryhaven Nursing and Rehabilitation Center. The facility has participated in a test-study examining ways to improve the lives of nursing home residents suffering with Alzheimer’s disease and dementia. The study tested new ways of providing care for these patients with a focus on simply improving the day to day living experience of the sufferers.

One general goal of the care is to get facilities to focus on comfort care rather than standard aggressive treatments that have found to offer little to no medical benefit. In addition, many family members of residents are encouraged to engage more fully in the new care programs. Pain medications are used in better ways under the new treatment programs as well. Care givers are encouraged to ensure that pain is prevented before it spikes, instead of only after the victim wallows for a time. Facilities using the new techniques actually saw a reduction in the need for psychotropic medications.
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