‘Chemical Restraints’: Report Finds Nursing Homes Misuse Antipsychotics

Nursing homes in the U.S. are inappropriately prescribing antipsychotic drugs to an estimated 179,000 patients per week, according to a 157-page report by the Human Rights Watch.

The report, called “They Want Docile,” said that the misuse of antipsychotic drugs for dementia patients, which are not meant to treat dementia, is the equivalent of “chemical restraints.”

Most of the patients receiving the drugs have Alzheimer’s or another form of dementia, which does sometimes come with symptoms that are uncomfortable for both the patient and caregivers—outbursts and disruptive behavior. But the report reveals that nursing homes often misinterpret what may be signs of pain that needs to be addressed as unruly behavior. The report found that nursing home staff use antipsychotics to sedate patients in order to make them easier to manage, especially when they needed to engage them in activities like showering.

“People come in here [a hospital] for behaviors, but then we don’t see the behaviors when they’re here,” a social worker at a behavioral hospital in Texas told report authors. “Sometimes we change their meds. But they don’t usually exhibit horrible behaviors. Maybe they just need attention. But the nursing homes don’t want behaviors. They want docile. They want people with no cognitive deficits who can take care of themselves. I’ve worked in nursing homes. They’d say, ‘Send them to [the psychiatric hospital] to get medicated and let them come back.’”

The report found that patients were given antipsychotics without their knowledge or consent—a dangerous practice when you consider that studies show the risk of death almost doubles for older people once they go on antipsychotics. The drugs carry what’s known as a “black box” warning because of the associated increase in mortality. Antipsychotics were originally created to treat conditions like schizophrenia, but only 4.7 percent of claims processed by Medicaid in a 2012 investigation were used for people without dementia and not off-label. “In other words, they were used for someone with schizophrenia or another psychiatric or neurological condition for which the drugs are approved,” wrote the report authors.

Ruth, a 62-year-old woman who told the Human Rights Watch she was given Seroquel, an antipsychotic, without her knowledge or consent in a nursing facility in Texas said: “[It] knocks you out. It’s a powerful, powerful drug. I sleep all the time. I have to ask people what the day is,” she said in the report. “They crush it so you don’t know what you’re getting fed.”

The report is based on publicly available information, visits to 109 nursing homes in six states, and 323 interviews with patients, staff, caregivers and experts. Of their visits to care homes, the authors wrote: “It was not uncommon for facilities to have stenches of urine, in particular on locked dementia units.” They experienced conditions that they described as “disturbingly grim” and found that patients were left in positions that they could not move from, akin to placing them in restraints. “People were often heard screaming or calling for help. Call light alarms—buttons residents can press that produces sound and light up at a nursing station to alert staff—would often make noise unceasingly,” said the report.

The report comes after a change in policy that eases punishments for nursing home violations, even when the situation has resulted in the patient’s death, which was requested by the nursing home industry.

Read the full report here.