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Nursing Home Abuse | Chemical restraints

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President Reagan signed The Federal Nursing Home Reform Act or OBRA '87 in 1987 which included a set of minimum standards for care and a Bill of Rights for people living in certified nursing facilities.  Among other rights, OBRA '87 gave every patient the right to be free of unnecessary and inappropriate physical and chemical restraint.  This body of laws defined the term "chemical restraint" to include "any drug that is used for discipline or convenience and not required to treat medical symptoms." 42 C.F.R. § 483.13.  Why would medications be used inappropriately in the first place?



patients_IV_alert.jpgUnfortunately, medications can and sometimes are used by nursing home staff to either punish or to make the staff's job of caring for your loved one easier.  Sometimes they can be used to punish or abuse an unruly patient or they can be used to sedate a patient to lessen the time demands on the nursing home staff.  This can be especially critical where the nursing home is already functioning with less staff than what may be necessary to care effectively for the number of residents under their charge.


In this way, medications can be used not to treat a sickness or disease, but can and are used inappropriately by nursing home staff resulting in the patient being "restrained."  Although these drugs can take many forms, they generally fall into one of five categories:

  1. Antidepressants Medications;
  2. Antipsychotic Medications;
  3. Mood stabilizers Medications;
  4. Anxiolytic Medications (diminish anxiety); and
  5. Sedative-Hypnotic Medications (sleep inducers)

Any misuse of medications increases risks to patients.  Fundamentally, misuse adversely affects the patient's freedom or independence.  Symptoms and effects include:

  1. A reduction in the patient's ability to think or speak clearly;
  2. Exhibiting less interest in self-care;
  3. Agitation;
  4. Problems walking or other bodily movements;
  5. Increased fall risk;
  6. Orthostatic or Postural Hypotension (e.g., rapid drop in blood pressure upon standing from seated position)
  7. Memory problems;
  8. Sedation;
  9. Withdrawal; and
  10. Decline in the overall ability to function

The nursing home is required by law to "care for its residents in a manner and in an environment that promotes maintenance or enhancement of resident's quality of life."  42. C.F.R. § 483.15.  This includes things like your loved ones dignity, self-determination and participation, participation in resident and family groups, participation in other activities, and others.


patient_receiving_meds.jpgAlong those lines, a patient "must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care."  42 C.F.R. § 483.25.   This means the nursing home should evaluate a patient's needs based on the experience and training of various health care professionals including people like a physician, nurse, pharmacist, activities therapist, occupational and physical therapists, speech and language pathologist, or social worker.  If the plan created by these professionals does not include the use of drugs, then none should be administered.  Even if recommended, the patient must still give his or her informed consent to the use of such drugs.  Then even after the required informed consent is obtained, except in the case of a temporary emergency, a physician must prepare a written order that specifies the amount, duration and circumstances of their use.


It would be good to know that Federal law prohibits the use of any unnecessary drugs.  A drug is 'unnecessary' when it is used:

  1. In excessive dose (including duplicate drug therapy); or
  2. For excessive duration; or
  3. Without adequate monitoring; or
  4. Without adequate indications for its use; or
  5. In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or
  6. Any combination of the reasons above.

There are many resources available to help you determine and monitor whether your loved one is receiving the appropriate level of care in a nursing home or whether they may be the victims of chemical restraint or some other form of neglect or abuse.  If you have questions, we invite you to contact us for a free initial consultation regarding your loved one's situation.

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References:

  1. http://www.skillednursingfacilities.org/blog/life-in-nursing-homes/restraints-nursing-homes/
  2. http://scholarship.law.marquette.edu/cgi/viewcontent.cgi?article=1232&context=elders
  3. http://nursinghomeabuseguide.com/legal-action/nursing-home-regulations/georgia-nursing-home-laws/
  4. 42 C.F.R. § 483.13; 42. C.F.R. § 483.15; 42 C.F.R. § 483.25
  5. http://oig.hhs.gov/oei/reports/oei-01-91-00840.pdf
  6. http://www.medicare.gov/what-medicare-covers/part-a/rights-in-snf.html
  7. http://www.ncmust.com/doclib/OBRA87summary.pdf

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Sam has a long history of local ties to middle Georgia. He was born and reared in Marshallville, Macon County, Georgia, in a family associated with theorigin of today’s Peach industry. Sam earned his B.S. degree in Ocean Engineering at the United States Naval Academy and was commissioned in the U.S. Navy in 1993. After completing the Navy’s nuclear power training program, he served aboard a fast attack nuclear submarine as a naval Submarine Warfare Officer and was certified by the Naval Reactors Division of the U.S. Department of Energy as a Nuclear Engineer. In the Navy, Sam maintained a Top Secret – SCI security clearance and circumnavigated theworld during his tour of duty, successfully completing missions vital to U.S. national security, before beginning his legal career in 2002. Sam holds his Juris Doctor from theNorman Adrian Wiggins School of Lawat Campbell University in Raleigh, North Carolina. Sam’s practice is now devoted to representing the rights of the injured, the families of deceased victims, and a select number of other clients in litigation. He has repeatedly served as lead counsel in jury trials resulting in six and seven figure verdicts, numerous bench trials, hearings, and motions. He has been recognized as one of the top young lawyers in Georgia and named a Georgia Rising Star by Atlanta Magazine and the Super Lawyers™ publication in 2009 and 2010 (only 2.5% of the total lawyers in Georgia are listed as a Rising Star). Sam has also received the "AV" Preeminant Rating by Martindale Hubble, the highest attorney rating for demonstrated skill, professionalism and ethics. Sam is married and has three children. He is one of the founding members of the practice.

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Guest Thursday, 18 January 2018