Nursing Home Abuse Restraints: Physical & Chemical
When an elderly or disabled patient enters a nursing home, they should never be expected to give up their basic human right to decide how their bodies are treated throughout their stay. Unfortunately, many long-term care facilities seem to ignore this. The ongoing issue of coercive restraints used in California nursing homes and assisted living facilities is not only ethically irresponsible but is a violation of a person’s legal right to autonomy, dignity, and freedom.
What Is Wrongful Restraint?
An unlawful restraint is generally classified as anything that controls a person’s behavior or freedom of movement for the sole purpose of forcing them into submission. Generally speaking, there are two types of restraints found in nursing homes: physical and chemical.
Federal and California state laws forbid the use of physical and/or chemical restraints such as tethering a patient to a bed or giving them psychoactive drugs in skilled nursing facilities unless it’s a matter of medical necessity, in which case the patient’s consent and a detailed order from a doctor is required. However, many long-term care facilities, even smaller ones, apply these restraints liberally, irresponsibly, and without consent. This is harmful to a patient’s health and wellbeing and is legally considered a form of elder abuse.
What Are the Causes of Wrongful Restraint?
It has become a common misconception that the use of physical or chemical restraints helps promote safety and well-being in a nursing home. While this may be true in some cases – such as in an emergency or when preventing a patient from harming themselves or others – the truth is that they are more often used excessively in order to keep patients immobilized, sedated, and easier to care for.
In poorly run or mismanaged nursing homes, understaffing is the primary cause of these abusive practices. Facilities with too many patients and not enough caregivers will often find it much easier to simply restrain or sedate an elderly patient, rather than providing the requisite attention and physical assistance they need. A matter of medical necessity is too easily replaced by a matter of convenience, and these practices can have dangerous consequences if left unchecked.
Physical Restraints
A physical restraint in a nursing home setting is any physical or mechanical device or material attached or adjacent to a patient’s body that the patient cannot remove easily, which has the effect of restricting the patient’s freedom of movement.
Types of Physical Restraints
Some common examples of these restraints can include using straps to tether a patient’s arms, legs, or waist, using high bedrails so that the patient is unable to get out of bed, or tucking in bed sheets excessively tight so that a patient cannot move. The way some items are used can also be considered a method of restraint – such as positioning lap trays, tables, or furniture to restrict a person’s movement, or moving a wheelchair against a wall so that a resident cannot move. Other types of materials and devices typically used can include:
- Wrist and ankle cuffs
- Hand mitts
- Vests
- Cloth ties
- Belts
- Special chairs with straps and bars
- Lap cushions
Caregivers often argue that the use of physical restraints promotes patient safety and reduces the risk of falls, but the reality is that physical restraints are more often used to pacify patients and make them easier to handle. Sadly, there are also instances in which physical restraints are used as a form of punishment or retaliation, which not only amplifies a patient’s subordination and dependency on caregivers for mobility but can also take a severe physical and psychological toll over time.
Risks Caused By Physical Restraint
Aside from hindering a patient’s chance of regaining physical mobility, inordinate and neglectful methods of physical restraint can have much more dangerous long-term health problems. Since physically restrained patients are forced to remain stationary over extended periods of time, they can easily develop severe health issues such as pressure sores, incontinence, and constipation. Extended periods of immobility also affects elderly adults psychologically by causing shame, loss of dignity, depression, isolation, and agitation.
Chemical Restraints
Types of Chemical Restraints
Chemical restraints in nursing homes – often in the form of psychoactive drugs – can be another type of elder abuse when used exclusively to sedate, subdue, or control a person’s behavior. Some common types of psychotherapeutic drugs include:
- Antipsychotic Medication (i.e Haldol, Mellaril, Navane, Risperdal)
- Antidepressants (i.e Prozac, Zoloft, Aventyl / Pamelor, Desyrel)
- Anti-anxiety Medication (i.e. Xanax, Valium, Ativan, Serax)
- Sedative and Hypnotic Medication (i.e. Benadryl, Dalmane, Restoril, Vistaril)
- Mood Stabilizing Drugs (i.e. Depakene, Eskalith, Lithane / Lithium)
Although these drugs are not considered chemical restraints when used to treat diagnosed depression, schizophrenia, or bipolar disorder, they are commonly used off-label to chemically subdue patients for the sake of convenience, discipline, coercion, or retaliation. In a nursing home setting, they are also oftentimes used to sedate elders who suffer from dementia-related agitation, discomfort, or distress.
Studies have shown that the mis-use of antipsychotics to restrain dementia patients can actually increase their level of aggravation, since delirium is often triggered by polypharmacy (too many drugs in the system). A well-staffed nursing home should have enough employees to supervise patients and practice behavioral therapies – not pharmacological ones – as the main form of treatment for dementia.
Negative Effects of Chemical Restraints
Even when used properly, powerful psychoactive drugs can have adverse side effects on all types of patients – including young and physically strong ones. Since the elderly have a significantly reduced drug metabolism due to decreased liver function, their ability to biologically transform these medications and facilitate their elimination from the body is naturally lower. This makes it all the more crucial to use these drugs as sparingly as possible on older adults.
When elderly patients are indiscriminately “drugged” for behavioral control, the effects can be extremely harmful or even deadly. Although risks vary by drug, common side effects can include:
- Agitation, aggression, hallucinations, nightmares, and insomnia
- Sedation, unresponsiveness, impaired consciousness, and excessive sleepiness
- Disordered thinking, memory loss
- Decreased appetite, constipation
- Blood pressure disturbances, including low blood pressure and hypertension
- Muscle and neurological impairments
The extreme sedation associated with psychoactive drugs can also lead to a decline in a person’s ability to perform daily tasks, such as walk, eat, dress, use the restroom, and bathe. Reduced mobility from drugs inadvertently leads to the same negative effects and injuries caused by physical restraints, including pressure ulcers, incontinence, muscle contractures, balance impairment and increased risk of falls.
Take Action: Excessive Restraints Are Against the Law
Patient restraint laws state that nursing home residents have a legal right to accept or refuse any type of care or treatment, including physical or chemical restraints. Aside from the health risks, misusing restraints is an assault on a person’s dignity and quality of life. No one should have to see a loved one tied up against their will or slouching in a wheelchair after a drug-induced coma. Unless it’s an emergency, the only excuse for resorting to these types of measures legally require a patient’s consent and a doctor’s order – anything else is an abuse of power.
If you feel that you or your loved one has been wrongfully restrained, don’t hesitate to contact one of our nursing home and assisted living abuse lawyers today. Call us today at (818) 572-9759, or complete a contact form to schedule a free consultation about your nursing home abuse case.