Chemical Restraint in Nursing Homes

Nursing homes are meant to be safe havens for elderly individuals with medical needs. Residents have the right to receive necessary medical services to improve their quality of life in a comfortable setting. 

One issue that occurs frequently in nursing homes is the use of chemical restraints to subdue residents or alter their behavior without medical necessity. Typically targeting those with dementia, it often uses antipsychotics or sedatives, potentially harming residents’ health and quality of life while exposing facilities to legal and regulatory risks.

The use of physical restraints or drugs to restrict a person’s normal access and freedom is against federal law and most state regulations, though there are some exceptions. If your loved one has suffered nursing home abuse, including wrongful use of chemical restraints, contact our team today to discuss your rights and legal options.

Definition of Chemical Restraint

Chemical restraint is the use of any type of medication to limit a person’s free body movement. Although chemical restraints are often used to restrict dangerous and uncontrollable behavior, nursing staff often use medication in inappropriate circumstances for convenience, discipline, or non-medical reasons. Chemical restraint is illegal in these situations.  

However, if there is a concern for the person’s safety or the health of other staff and residents, certain types of chemical restraints can be used in nursing homes. Additionally, staff can administer chemical restraints with a written order from a licensed physician or if the resident or their representative has given legal permission. 

Antipsychotic drugs, benzodiazepines, and, less frequently, dissociative anesthetics are typically used as chemical restraints for controlling acute psychosis or agitation.

Ethical and Legal Concerns of Chemical Restraints

Nursing home residents have the right to ethical and fair treatment. The use of chemical restraints, such as antipsychotic drugs, may violate this right. This practice raises ethical concerns regarding dignity and consent and carries legal implications if misused.

Ethical Considerations

In most circumstances, using a chemical restraint to limit a patient’s freedom of movement is highly unethical, especially when done to make life easier for the staff. Convenience or punishment are not ethical reasons to use chemical restraints. Here are some of the implications of using antipsychotic drugs or other means as restraints in nursing homes. 

Autonomy and Dignity

Elderly patients have the right to personal autonomy and dignity during their stay in a nursing home. That autonomy is violated when they receive drugs without their permission, especially to produce rapid sedation. Additionally, their dignity is violated because they are not being treated up to the professional standard of a nursing home.  

Alternative Approaches

There are many ways to manage an agitated patient without resorting to the typical antipsychotics used for chemical restraint. Staff can undergo de-escalation training to learn how to deal with challenging behaviors. Learning to remove triggers from the patient’s environment will also lower the risk of behavioral episodes. 

Staff should give space to patients acting out if their safety is not at risk or they can divert the resident’s attention with other structured activities. Sometimes, listening and reaffirming the patient’s concerns is enough to calm an acutely agitated patient. 

Informed Consent

Informed consent is required before administering sedative drugs or antipsychotics as chemical restraints. This consent must come from the resident or their legal representative if they lack capacity. However, informed consent alone does not guarantee legal compliance. 

Healthcare providers must ensure the use is medically justified, follow all relevant regulations, and consider less restrictive alternatives. Even with initial consent, the need for chemical restraints must be regularly reassessed.

Legal Implications

The legal implications for using chemical restraints to control or punish patients are severe. The nursing home facility or staff could easily face lawsuits from the victims or their family members because of the treatment. 

Federal Regulations

Federal laws currently prohibit the use of chemical restraints for staff convenience or patient punishment. Chemical restraints can only be used in medically necessary situations, requiring physician documentation, informed consent, regular review, and exploration of alternatives.

Anything that is not part of treating the patient’s condition can be considered illegal. When these drugs are used as chemical restraints, there is an increased risk of adverse effects like withdrawal symptoms, substance intoxication, and reduced cognitive function. 

In extreme circumstances, extrapyramidal symptoms from psychoactive drugs can lead to acute dystonia or extreme somnolence. Because of these potential effects and the violation of the patient’s right to professional medical treatment, chemical restraints in nursing homes are generally considered illegal. 

State Laws

Many states align with federal laws regarding chemical restraint usage. If antipsychotic drugs or other medications are used for staff convenience or punishment and are not included in the patient’s treatment plan, then they are illegal. Exceptions are granted if the patient poses a danger to themselves or others or the resident or their representative gives permission. 

Some states have more specific regulations on dealing with an agitated patient. In Illinois, chemical restraint is only legal if necessary to maintain the patient’s well-being and only with the resident’s knowledge. Connecticut, Colorado, Illinois, Massachusetts, Maine, Tennessee, and New Hampshire all ban chemical restraints outright. Twenty-three states do not have meaningful laws against these practices, only policy guidelines. 

Potential Liability

A nursing home that allows chemical restraints to control or punish patients opens itself up to lawsuits. Chances are high that there will be mental and physical health effects because of the chemical restraint method employed. If the use of atypical antipsychotics or other drugs violates state laws or federal regulations, the facility and its staff may face serious legal consequences. 

Liability will play a significant role in a potential lawsuit if the victim decides to pursue a claim against the nursing home and its staff. To protect patient health and avoid lawsuits, these facilities should adhere to ethical and legal standards regarding chemical restraint. 

Best Practices for Using Chemical Restraint

In states where chemical restraints are allowed to a certain degree, there are safe ways to use them. Here are a few guidelines to help avoid the adverse effects of chemical restraint. 

Last Resort

Chemical restraints should only be used if the person poses a serious threat to themself or others. Slightly agitated patients should not be given any intramuscular injections or oral medication to control their movement or mood. This strategy should only be considered once all other options are exhausted, such as affirming the patient’s concerns, giving them space, diverting their attention, and practicing de-escalation. 

If medical staff are too quick to use medications on an acutely agitated patient, then they could be legally liable for side effects or other medical symptoms like a known psychiatric disorder. 

Individualized Assessment

Every patient is different, which means their needs vary. An individualized assessment of each resident will prevent staff from using blanket methods to control similar behaviors. For example, one patient’s challenging behavior could quickly be de-escalated through other non-pharmaceutical interventions, making immediate emergency medicine unnecessary. 

Meanwhile, another patient may be quick to turn violent or pose an immediate threat, so if they give consent, using chemical restraints makes sense. Though it may be the best way to manage dangerous behaviors, it depends on the individual assessment. 

Monitoring and Evaluation

A person who has received chemical restraint should never be left alone afterward. These methods can cause numerous side effects, from respiratory depression to high blood pressure. Medical staff should monitor the patient to determine if certain medications have the desired effect and are not causing other medical issues. 

A process for evaluating the patient should also be in place to ensure that their health and safety are prioritized after they receive emergency medicine. 

Alternatives to Chemical Restraint for Nursing Home Residents

Non-pharmacological interventions should always be prioritized over chemical restraints when managing challenging behaviors. If staff can avoid invasive options, there will be fewer liability issues. Here are some methods of de-escalation and behavior management that may be more effective. 

Behavioral therapy

Many nursing homes offer behavioral therapy services. These techniques help teach elderly patients to manage their emotions and actions. Preventing a patient’s violent behavior starts with meeting their needs, so these methods could reduce the likelihood of violent episodes that may require chemical restraint. The benefits of this therapy include reduced depression rates, happier residents, improved quality of life, and easier care for nursing home staff. 

Environmental modifications

In many cases, nursing homes can avert violence by controlling the environment surrounding a patient. Challenging behaviors often occur due to environmental triggers. Once staff discovers these triggers, modifications to that patient’s room or living area could remove potential triggers and limit the risk of a violent outburst.

For example, an efficient call system can improve staff response times, reducing patient frustration and agitation. Additionally, identifying and removing environmental triggers that complicate a resident’s daily routine can help prevent aggressive behavior and minimize the need for more drastic restraint measures.

Activities and socialization

Patients’ behavioral outbursts are often caused by poor mental health or dissatisfaction with their lifestyle. If a person feels isolated or bored in a nursing home, they are less likely to make rational decisions. Providing outlets for socialization and mental engagement can reduce the chances of agitation and control violence. Plan more social activities within the nursing home so that residents can engage with others. Excursions outside the facility can also improve the quality of life for those residents, so consider planning more of these events in the community. 

Anything that makes patients happier will reduce the chances of behavioral outbursts and the need for atypical antipsychotics being used as chemical restraints. 

The Role of a Care Home Lawyer

Since the use of atypical antipsychotics and other drugs for chemical restraint is typically illegal, victims of these practices have the right to sue the nursing home or staff responsible. If you or a family member have been the victim of improper chemical restraints, you could file a lawsuit if you suffered legal damages. These damages may include medical bills, loss of enjoyment of life, emotional suffering, physical pain, or loss of companionship if the loved one dies as a result of the intervention. 

Your best chance of winning a lawsuit against the nursing home or staff is with the assistance of a nursing home lawyer. At Nursing Home Law Center, we will investigate your case, gather evidence, assess all damages, and provide legal guidance throughout the claims process to ensure you or your loved one receive adequate compensation to cover legal damages. Our team has the experience to build a solid case and negotiate a fair settlement. Together, we can pursue justice and hold the at-fault parties accountable for their actions when using chemical restraints. 

Conclusion

Residents and families concerned about chemical restraint use should consider seeking legal advice. An attorney experienced in elder law or healthcare can help interpret relevant regulations, assess whether proper protocols were followed, and advise on potential courses of action if violations occured.

If you or a loved one has experienced adverse effects due to chemical restraint, you must file your lawsuit quickly and seek compensation for legal damages. If the drugs used are not typically prescribed for the patient’s condition, you likely have a case. At the Nursing Home Law Center, we offer a free consultation so you can ask questions about your case and determine the best path forward. 

Contact us today to receive a free case review with an experienced nursing home lawyer.