Antipsychotic medications have been used as a form of chemical restraint in many nursing homes, with some reporting as high as 37% of residents. These drugs are often used in nursing homes to make residents more calm and easier to handle. This type of chemical restraint is often the result of understaffing and not enough training. When prescribed to patients that don’t need them, they can have a long list of side effects, which include agitation, fatigue, and loss of awareness and speech.
An alternative to chemical restraint is redirection, but critics say it can be time consuming. When a patient becomes agitated, instead of giving that patient a drug which will make them become drooling, incontinent, or out of it, the nurse or aide can redirect the patient. This involves finding out about the patient, what they liked, what they used to do. In many cases, a patient becomes agitated because they are in unfamiliar surroundings and cannot do things that they have done all their lives, like take walks, or sleep in. It can be helpful to learn more about a patient than simply their medical history because it can allow caregivers to form a bond with the patient which can help them feel familiar. Utilizing permanent staff for residents is a key part of building trust with that resident. Unfortunately, permanent staff requires that staff stay at a facility, and many homes have high turnover rates because of their working and operating conditions.
Critics say that in addition to being time consuming and sometimes impossible, taking time to redirect residents and forge bonds with them is simply not feasible or practical. In an industry where costs are constantly being cut, with Medicare and Medicaid being reduced at every turn, staff are decreasing, budgets for activities are decreasing, and there’s been a direct connection to federal cuts and the increase of these medications.
Overmedication of residents is a common occurrence because the systems don’t encourage caregivers to take time with residents. To have a nursing home where chemical restraints aren’t used unless necessary requires a timely, if not necessarily costly, overhaul of the entire home. The system that’s in place isn’t friendly to these changes, and until caregivers have the time to spend with residents, chemical restraint is going to be an accepted if hushed practice in nursing homes across the globe.
See articles here and here.