President Reagan signed The Federal Nursing Home Reform Act or OBRA '87 in 1987 which included a set of minimum standards for care and a Bill of Rights for people living in certified nursing facilities. Among other rights, OBRA '87 gave every patient the right to be free of unnecessary and inappropriate physical and chemical restraint. This body of laws defined the term “chemical restraint” to include “any drug that is used for discipline or convenience and not required to treat medical symptoms.” 42 C.F.R. § 483.13. Why would medications be used inappropriately in the first place?
Unfortunately, medications can and sometimes are used by nursing home staff to either punish or to make the staff's job of caring for your loved one easier. Sometimes they can be used to punish or abuse an unruly patient or they can be used to sedate a patient to lessen the time demands on the nursing home staff. This can be especially critical where the nursing home is already functioning with less staff than what may be necessary to care effectively for the number of residents under their charge.
In this way, medications can be used not to treat a sickness or disease, but can and are used inappropriately by nursing home staff resulting in the patient being “restrained.” Although these drugs can take many forms, they generally fall into one of five categories:
- Antidepressants Medications;
- Antipsychotic Medications;
- Mood stabilizers Medications;
- Anxiolytic Medications (diminish anxiety); and
- Sedative-Hypnotic Medications (sleep inducers)
Any misuse of medications increases risks to patients. Fundamentally, misuse adversely affects the patient's freedom or independence. Symptoms and effects include:
- A reduction in the patient's ability to think or speak clearly;
- Exhibiting less interest in self-care;
- Problems walking or other bodily movements;
- Increased fall risk;
- Orthostatic or Postural Hypotension (e.g., rapid drop in blood pressure upon standing from seated position)
- Memory problems;
- Withdrawal; and
- Decline in the overall ability to function
The nursing home is required by law to “care for its residents in a manner and in an environment that promotes maintenance or enhancement of resident's quality of life.” 42. C.F.R. § 483.15. This includes things like your loved ones dignity, self-determination and participation, participation in resident and family groups, participation in other activities, and others.
Along those lines, a patient “must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.” 42 C.F.R. § 483.25. This means the nursing home should evaluate a patient's needs based on the experience and training of various health care professionals including people like a physician, nurse, pharmacist, activities therapist, occupational and physical therapists, speech and language pathologist, or social worker. If the plan created by these professionals does not include the use of drugs, then none should be administered. Even if recommended, the patient must still give his or her informed consent to the use of such drugs. Then even after the required informed consent is obtained, except in the case of a temporary emergency, a physician must prepare a written order that specifies the amount, duration and circumstances of their use.
It would be good to know that Federal law prohibits the use of any unnecessary drugs. A drug is ‘unnecessary' when it is used:
- In excessive dose (including duplicate drug therapy); or
- For excessive duration; or
- Without adequate monitoring; or
- Without adequate indications for its use; or
- In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or
- Any combination of the reasons above.
There are many resources available to help you determine and monitor whether your loved one is receiving the appropriate level of care in a nursing home or whether they may be the victims of chemical restraint or some other form of neglect or abuse.
- 42 C.F.R. § 483.13; 42. C.F.R. § 483.15; 42 C.F.R. § 483.25