The Dangers of Chemical and Physical Restraints
The use of chemical and physical restraints in long-term care facilities is a contentious issue — particularly when they are used without proper justification. Inappropriate use of restraints can violate a resident’s legal right to autonomy and mobility, often resulting in significant physical and psychological harm. Federal and state laws impose strict limitations to protect residents from elder abuse, neglect, and undue restriction of freedom.
Both chemical and physical restraints pose serious health risks to residents:
- Physical Restraints can cause pressure ulcers, muscle atrophy, or injury if the resident attempts to resist or escape.
- Chemical Restraints can result in over-sedation, increased risk of falls, aspiration pneumonia, dehydration, and long-term cognitive impairment. Overuse of psychotropic medications can cause cognitive decline and a severely diminished quality of life.
Let’s look at what physical and chemical restraints are, how their use is regulated by federal and state laws, and what facilities should do to prevent their misuse.
Physical Restraints
Physical restraints are devices or methods used to restrict a resident’s movement. Common examples include bed rails, lap belts, vests, or wrist restraints.
Physical restraints are only permitted when a resident poses an immediate risk to themselves or others. Even then, restraints should be regarded as a last resort, applied only after all less restrictive interventions have been attempted. They absolutely can not be used for staff convenience or as a form of punishment.
Under federal regulations and California state law, nursing homes must demonstrate a) that restraint use is medically necessary, and b) that the least restrictive measures possible were attempted first. Use of restraints must be continually monitored by the facility, and their necessity reassessed with a view to removing them as soon as possible.
Chemical Restraints
Chemical restraints are used for behavioral management. The term refers to the use of medications — most commonly psychotropic drugs — to control or suppress aggression, agitation, or restlessness.
Common medications used as chemical restraints include:
- Antipsychotics (e.g. Haloperidol, Risperidone). Often prescribed for aggression or psychosis in dementia patients, antipsychotics come with serious risks, including an increased mortality risk among patients with dementia.
- Antidepressants (e.g. Trazodone). Sometimes used off-label for sedation, they are associated with increased fall risk and confusion.
- Benzodiazepines (e.g. Lorazepam, Diazepam). Used to treat anxiety or restlessness, these drugs may cause sedation, confusion, and an increased fall risk.
- Sedatives (e.g. Zolpidem). Used to calm residents; prolonged use can lead to dependence, cognitive decline, and impaired mobility.
Sadly, many facilities misuse medications — especially psychotropic drugs — as a form of behavioral control, rather than addressing the root causes of the resident’s distress. This practice can lead to over-sedation, adverse side effects, and a significant decline in the resident’s overall health and functional capacity.
Federal law strictly prohibits the use of psychotropic drugs, including antipsychotics, without a clear medical necessity. Nursing homes must regularly evaluate the continued use of chemical restraints and obtain informed consent from the resident or their legal representative.
As with many other forms of elder abuse, chronic understaffing is a major contributor to the misuse of chemical restraints. Understaffed facilities are unable to provide proper supervision. As a result, overwhelmed staff may rely on sedating medications to manage difficult behaviors, prioritizing their own convenience over resident well-being.
Alternative Interventions
As we’ve seen, restraints should only be used after all other options have been exhausted. Alternative interventions may include:
- Implementing behavior modification programs
- Increasing staff supervision and staffing ratios
- Using non-pharmacological approaches, such as individualized care plans targeting the root causes of distress
- Transferring the resident to a facility better equipped to manage their needs
If your loved one has been victimized by unjustified chemical or physical restraints in a nursing home or assisted living facility, a dedicated elder abuse attorney can help you determine whether or not elder abuse has occurred. For a free consultation with a San Francisco/Bay Area or Los Angeles elder abuse attorney, contact Dudensing Law here.
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