A recent New York Times investigation may be a revelation to some, but not to family caregivers who have loved ones in nursing homes, especially memory care centers. The investigation found that at least 21 percent of nursing home residents are on antipsychotic drugs. “Chemical restraints” have become a convenient method to reduce the hands-on care needed for those with dementia in nursing homes which are chronically understaffed. Savvy (and/or devious) nursing home operators and doctors have found workarounds to circumvent the weak government regulations that attempt to curb this dangerous practice.
This is an issue near and dear to my heart. I’ve written about my father’s experience in a memory care center during the last year of his life. He was given Risperidone, a drug typically given to adolescents with schizophrenia. It turned my father into a zombie and made him unsteady, causing several falls which resulted in ER visits. To add insult to injury, my family was left with owing thousands of dollars for medications used to inappropriately sedate my father.
Here is what I wrote about my dad’s experience with the drug:
I remember the indifferent attitude the doctor at the local hospital had when I questioned the use of Risperdal, which was already controversial even while my dad was still alive. The doctor just shrugged his shoulders and said they had to continue prescribing what the doctor from the nursing home had ordered. He asked me if I knew what it was for and I responded “to make patients like zombies so they’re easier for the nursing home staff to deal with” and the doctor agreed with a laugh. I did not find it funny at all.
Johnson & Johnson paid over $2 billion in fines to settle charges levied by the government that they promoted off-label use of the drug to elderly patients with dementia and even provided kickbacks to doctors and nursing home operators. The massive fine didn’t hinder the practice. The drugs of choice are now Haldol and Depakote, according to the New York Times investigation. Doctors are adding a diagnosis of schizophrenia to nursing home residents with dementia to get around government regulations. Haldol is used to treat schizophrenia and therefore doesn’t have to be included in the mandatory reporting of antipsychotic use that nursing homes must provide to the government.
The underlying problem to the overmedicating of nursing home residents with dementia is staffing shortages. If facilities were adequately staffed and had special training in how to care for those with dementia, the need to sedate residents would be alleviated. Families aren’t going bankrupt just so there loved ones can be turned into zombies through chemical restraints. Nursing home operators get access to medications that a family doctor would likely balk out if a family caregiver asked for it to manage their loved one at home. The government’s response continues to be insufficient.
My advice is that if you have a loved one in a memory care center, review their medication list on a monthly basis. If you are not comfortable with your loved one being on a particular medication or you witness alarming changes in your loved one’s physical or mental state, speak up. If you are looking to move your loved one with dementia into a memory care center, ask about their use of off-label medications. Ask that they seek your permission before prescribing such drugs. We must advocate for our loved ones to be treated humanely and not as an experiment to sedate into submission.
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The Memories Project 
Amen this is a much needed discussion that many more people need to hear. It doesn’t touch home until it is our family or loved ones who are impacted.
I worked as an aide in a nursing home during the summer between HS and college in the 1960s – not out of choice, but as it was the only job I could get at the time. My family did not take any medications, so what I saw was all new (and appalling) to me. When we handed out trays of food, we were instructed to ensure that all meds were taken, but not to worry if they didn’t eat. Pills were crushed and added to a portion of the applesauce so that the one spoonful we fed them contained the drug(s). Some took one pill, others a handful. And yes, the easiest patients were either ones that were there because they had no family left and enjoyed the company of others, and those that were zonked out. One woman was turned into a zombie because she wanted a hot drink in the morning to ‘get her pipes moving’ and they prevented her from getting water from the hot tap in the bathroom as if their lives depended on it. Then they fed her laxatives!
The wealthy had rooms in the front, and wore pretty clothes. They had visitors each Sunday who joined them in a glass of wine and cheerfully made their rooms look like home. But if you ventured further, past the semi-private rooms to the wards and the locked rooms, It was depressing and alarming. Patients were moved to these areas based on their ability to pay. Falls out of railed beds were commonplace despite restraints, and few, if any, returned from the hospital. Calls to doctors and male ‘orderlies’ to assist with troublesome patients happened several times when I was there (I had the 3-10 shift), and has left me with unpleasant memories. I worked there for about three months, and was never so happy as the day I left.
Yes, things have improved in the fifty years since then, but it doesn’t mean we can let down our guard – and not just about the medications. These dear elders need advocates to watch over them! It’s also why I did everything in my power to keep my mother in my home until she passed.
Thank you for sharing your experience Hillary. It’s so true that our elders have been vulnerable to a variety of abuses for decades and family members must be vigilant when overseeing their care.
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