Articles Posted in Nursing Home Abuse & Neglect

The Boston Globe recently published a series on the overuse of antipsychotic medications in nursing homes. Those of us who represent victims of abuse and neglect in nursing homes refer to this as a form of “chemical restraint.” Many nursing homes use antipsychotic drugs to control combative behavior and agitation in nursing home residents who have not been diagnosed with a condition for which such drugs are recommended.

The Boston Globe’s investigation yielded a number of findings including:

(1) In 21% of U.S. nursing homes for the year 2010, at least one-fourth of the residents received antipsychotic medications despite the fact that they did not have illnesses or conditions for which such medications are prescribed.

(2) The use of antipsychotic medications was linked to staffing levels within the nursing homes. The facilities that used antipsychotic drugs for conditions not recommended by physicians had lower staffing levels than facilities who did not rely heavily on the use of antipsychotic medications.

(3) The use of antipsychotic medications by nursing homes tended to correlate with facilities whose residents were deemed by the nurses and staff to have behavioral problems, such as being verbally or physically abusive to staff, resisting care, or wandering.

Antipsychotic drugs are typically used to treat some of the most severe mental illnesses, such as schizophrenia. They are powerful sedatives with potentially harmful side effects. The U.S. Food & Drug Administration (FDA) has issued so-called “black box warnings” about the dangers of giving antipsychotic medications to patients with dementia or Alzheimer’s disease. These drugs can increase the risk of infections and cardiovascular complications in elderly individuals. Additionally, they can cause a sudden drop in blood pressure, dizziness, and blurred vision, any of which can lead to falls and serious, fall-related injuries.

Antipsychotic drugs are overprescribed in nursing homes because the nurses and staff either don’t have the time to deal with a resident’s behavioral problem, or they don’t take the time to investigate the underlying cause of a resident’s combative behavior. A resident with Alzheimer’s or dementia, for example, can become confused, frightened or anxious simply because of a change in their environment. By redirecting these residents to an area or environment that is more familiar or comforting to them, the anxiety or combative behavior can often be lessened or eliminated. However, it can take longer to redirect the resident than it takes to administer a sedative or antipsychotic drug that will knock the resident out for hours at a time.

Efforts are underway to encourage nursing homes to care for residents with Alzheimer’s or dementia without resorting to the use of antipsychotic medications. Nursing homes are encouraged to have lots of activities and try various types of interventions rather than using the quick fix of prescribing an antipsychotic. Federal regulations that govern nursing homes provide inspectors the authority to issue citations, known as “deficiencies,” if nursing homes are found to have engaged in “unnecessary medication use.” Additionally, federal regulations require nursing homes to try to gradually reduce the resident’s dose of antipsychotic drugs at least once a year, but facilities sometimes neglect to do so.

If you believe that a loved one in a nursing home is being given unnecessary antipsychotic medications or is being overmedicated, you should ask for a list of all medications that are being administered to the resident and the doses. A simple internet search or a review of sources commonly found in public libraries, such as the Physician’s Desk Reference, will provide you with the information you need regarding the medication, including what it is used for, the recommended dose, and potential side-effects. If you believe that the administration of antipsychotic drugs is causing or contributing to a decline in the resident’s condition, report your concerns to the nursing home administrator and ask to speak with the nursing home’s medical director.
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As our population continues to age, most of us will eventually face the prospect of placing a loved one into institutional care. Traditionally that has meant a nursing home. In the last ten to fifteen years, however, the growth of the assisted living industry has created an alternative to nursing home placement. So which is right for you and your family?

First, I would like to point out that, at least officially, Georgia does not license “assisted living facilities”. Georgia law, and the applicable regulations, use the term “personal care home” instead. While the terms are, for all practical purposes, synonymous, I mention the difference so anyone wishing to perform research on this issue will have the most accurate search terms possible.

A nursing home is a skilled nursing facility that is licensed to provide nursing care to its residents. They can administer medications, provide nursing assessments and order interventions to prevent injury. Nursing homes can provide physical, occupational and speech therapy. They can care for residents with feeding tubes and they can provide wound care. None of these services can be provided by an assisted living facility.

The decision to place a loved one in a nursing home is a gut-wrenching, emotionally draining experience. Most likely, the decision has been forced on you by an unexpected serious illness or major injury. Unfortunately, the decision must usually be made in a matter of hours, not days. You are placing the fate of a loved one in the hands of a facility, you likely know very little about. To make matters worse, the process is often accompanied by regret and guilt. To alleviate the guilt, many people need to trust in the nursing home. Most nursing homes understand this and they emphasize their trustworthiness during the admission process and through their marketing.

During the admission process, the nursing home hits you with countless forms. More than one client has told me they feel it is easier to buy a house than to place someone in a nursing home. Given the emotions involved and the strong desire to trust the facility, it’s no surprise most people will sign anything the nursing home puts in front of them without even reading it. The nursing home knows this and takes advantage of this trust.

Most nursing homes include an arbitration agreements as part of the admission process. Having placed their trust in the nursing home, the vast majority of people will sign the arbitration agreement without a second thought. Before your loved one is even through the front door, the nursing home has already violated your trust!

Because of our experience in representing victims of abuse and neglect in Georgia and South Carolina nursing homes, we are often asked which facilities provide better care. Our response has been that locally owned and operated nursing homes seem to provide better care for their residents. Our opinion has been based primarily upon the fact that we receive fewer calls from families complaining about locally owned and operated nursing homes than we receive from families complaining about facilities which are owned and operated by large corporations. Our opinion about the difference in quality of care can be traced back to the late 1990s. Beginning around 1998, there was a movement by corporations to purchase locally owned and operated nursing homes (so-called “mom and pop facilities”) in an effort to increase corporate profits. This resulted in the formation of several large nursing home chains that owned and operated approximately two thousand nursing homes across the United States. Around the same time, Congress reduced the level of benefits paid to nursing homes for some services, which cut into corporate profits. Rather than cutting back on administrative expenses and corporate perks, these large nursing home chains began to cut staff in an effort to boost profits. Consequently, we observed a corresponding decrease in the quality of care being rendered to nursing home residents.

Until recently, there were no significant studies to substantiate our opinion that locally owned and operating nursing homes provided better care than that provided by larger corporate chains. Now, an important study by the University of California San Francisco (UCSF) has confirmed what we observed and suspected all along. The largest for-profit chains provide worse care in their nursing homes than that which is provided by non-profit and government-owned nursing homes. The fact that reduced staffing was cited by the study as the reason for the decreased quality of care came as no surprise to those of us who have been fighting nursing homes on behalf of victims of abuse and neglect. According to the author of the report, Charlene Harrington, a Professor at the UCSF School of Nursing, the ten largest nursing home chains strategically attempt to boost profits by reducing labor costs (i.e. staffing).

There are Federal and State regulations which govern the provision of services in nursing homes. When facilities fail to follow these regulations, they are cited for deficiencies. The UCSF study found that the largest nursing home chains received citations for up to 41% more deficiencies than the best non-profit and government-owned facilities. The cited deficiencies included failure to prevent pressure sores, falls, weight loss, infections, and other conditions that can result in serious harm to nursing home residents. Regrettably, until these large nursing home chains stop putting profits ahead of people, the lower quality of care will likely continue.