The use of physical and chemical restraints in California nursing homes is sometimes a necessary way of protecting patients from injuring themselves and others. When used excessively and, more importantly, without consent, the practice becomes outright abusive. Often this method is used not simply to protect the patient, but rather to make a staff member's job easier. Overuse of restraints is exacerbated by the growing number of understaffed nursing facilities. Physical restraints are used to keep patients from wandering around the facility, a potential hazard for the patient and others. A nursing home is required by law to have the resident's consent before using a physical restraint. Symptoms of physical restraints include sores or bruising on the arms and legs, usually on the ankles and wrists. Chemical restraints involve the administering of powerful psychotropic drugs to sedate and confine the patient by taking away his or her cognitive abilities. These drugs are not permitted under any circumstances unless the nursing care facility outlines a legitimate medical reason for their use and further provides the frequency and dosage. Because most people are not familiar with the side effects of psychotropic drugs, it can be more difficult to identify chemical restraints than physical restraints. Psychotropic drugs are administered to nearly 60% of all California nursing home patients, a 30% increase since 2000, according to a report by California Advocates for Nursing Home Reform (CANHR). "As of 2016, over 270,000 nursing home residents are still being drugged with antipsychotics, despite over ten years of black box labels warning of increased mortality and four years of a national campaign to end misuse,: according to CANHR. Some common psychoactive drugs are:
- Anti-Psychotics: These drugs are prescribed for psychosis, schizophrenia, and bipolar disorder. Nursing homes often prescribe anti-psychotics to dementia patients despite the FDA's strong warnings that they can be fatal to residents with dementia. Haldol, Seroquel, and Zyprexa are common antipsychotics.
- Anti-Depressants: Common brands are Prozac and Zoloft. Nursing homes have been known to over-prescribe these medications. They can have dangerous side effects such as impaired motor skills, which increase the risk of a patient falling while under a nursing home care.
- Anti-Anxiety drugs: These drugs also tend to be over-prescribed, and lead to impaired motor skills. Ativan and Valium are popular anti anxiety drugs.
- Sedatives/hypnotics: Restoril and halcyon are brands commonly administered to patients.
- What is the medical condition that necessitates the use of this psychoactive drug?
- What is the frequency with which the drug will be used?
- Over what period of time will the drug be used?
- What are the possible side-effects?
- Are there any reasonable alternative treatments?
- What are the interactions with other drugs being used?