Chemical Restraints in Long-Term Care Facilities, Research Paper Example

The use of psychotropic drugs as a means of controlling a patient’s behavior, or “chemical restraints,” has been on the increase since 1995; their use constitutes up to 34% of psychotropic rug use in long-term care facilities (Agens, 2010.) Nevertheless, the practice has been widely regarded as controversial, and is legally permissible only in matters in which the safety of individuals or other residents is in jeopardy. This paper will discuss the use of chemical restraints, the advisability of its use in elderly patients, and the rights of patients regarding application of such methods.

Because the use of chemical restraints can have serious consequences, including death, utilizing these methods must be supported by documentation of the need for these measures, should be time-limited, and should also include regular assessments of their need, effectiveness and side effects for each patient for whom they are prescribed. In all too many cases, chemical restraints are utilized because of staff shortages that only increase the difficulties of providing proper care to nursing home residents. In addition, because state budgets increasingly have less funding for mental health programs, the number of patients with psychiatric patients who end up in long term care facilities is on the rise (Kisken, 2011.) In addition, many of the physicians associated with such facilities have a tendency to turn to medications immediately in order to manage patients’ behaviors, without necessarily considering alternatives to chemical restraint.

It should be noted that there are laws in place that are designed to protect patients that includes a prohibition on the use of medication for the sake of convenience or for discipline (Kisken, 2011.) However, enforcement of such laws is not a high priority for law enforcement officials, and psychotropic drugs are frequently prescribed without securing informed consent of the patient or his or her guardian. Medicaid and Medicare have developed specific guidelines about the use of antipsychotic medication for purposes other than to treat a diagnosed medical condition that has been documented. These guidelines include the ability for health officials to make unannounced on-site visits or to conduct telephone surveys in order to establish whether the institution is following the necessary regulations, including those pertaining to medication use (Health and Human Services, 2001.)

A study conducted by The Department Of Health And Human Services focusing on the use or misuse of psychotropic drugs in nursing homes concluded that 85% of nursing home residents who take or are given such medications had a medically appropriate treatment plan that require such medications. The use of medications as chemical restraints was not widespread, according to that study. However, more recently, there has been concern expressed that nearly one third of patients in nursing homes are being given powerful antipsychotic medications, whether or not they have medical diagnoses that require such treatment; these drugs are “used to calm demented patients, some with Alzheimer’s disease, and to assist with maintaining order in the facilities (Mantone, 2007.) Since staff members are often reluctant to use physical restraints, they may turn to using medications to help control the environment, both for themselves and for the other residence.

The use of chemical restraints in long-term care facilities is problematic on many levels. Since most elderly patients are already on a variety of medications to treat various conditions, adding another medication that is not designed to treat an illness runs the risk of drug interactions with the patient’s treatment regime. The polypharmaceutical status of such patients makes chemical restraints an added risk, medically. In addition, it is a very convenient and easy response to a patient who may need extra care and attention, but the staff is unwilling or unable to provide that because of shortages, cutbacks and staffing difficulties. There are other ways to calm down or soothe a nursing home resident who is agitated or tends to wander; these remedies require staff to be trained in how to defuse such a situation by gently but firmly embracing and holding the patient from behind until he or she is able to relax and be released and can remain safe. In addition, the financial issue, i.e., lack of staff available to manage patients is a genuine problem, but the need for adequate staffing is essential to being able to avoid using physical or chemical restraints in nursing homes except as a last resort.

Certainly, in extreme situations, if all other recourses have been considered and dismissed, chemical restraint may be inevitable for certain patients in order to keep them, the other residents and staff from being harmed. In a situation where my grandmother, stricken with Alzheimer’s, tended to wander off, she had to be watched constantly by staff, and at times, I imagine that when she became impossible to monitor 24 hours a day, seven days a week, the staff may have utilized some form of restraint. One would hope that this was considered an option only after all other alternatives had been ruled out. Certainly, if the patient has the capacity to understand an explanation about his or her ability to accept or reject treatments, that person should be given the opportunity to give or deny informed consent immediately following admission to the facility. That consent should include giving the staff the ability to prescribe medication in the event of an urgent situation. If the patient is not mentally capable of understanding such a document, the family member or friend who has the power of attorney should be presented with that information in order to give, or deny, their informed consent to allow the staff to take appropriate measures to ensure the patient’s safety.

Bibliography:

Agens, J. E. (2010, March). Chemical and Physical Restraint Use in the Older Person. Retrieved January 25, 2012, from British Journal of Medical Practitioners: http://www.bjmp.org/content/chemical-and-physical-restraint-use-older-person

Department Of Health And Human Services. (2001). Psychotropic Drugs Used in Nursing Homes. Washington, DC: U. S. Government.

Kisken, T. (2011, March 24). Use of Chemical Restraints in Nursing Homes Called an Epidemic. Retrieved January 25, 2012, from Vstar.com: http://www.vcstar.com/news/2011/mar/24/use-of-chemical-restraints-in-nursing-homes-an/

Mantone, J. (2007, December 4). Antipsychotic Drugs Abused As Chemical Restraints for Elderly. Retrieved January 25, 2012, from The Wall Street Journal: http://blogs.wsj.com/health/2007/12/04/antipsychotic-drugs-abused-as-chemical-restraints-for-elderly/