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Social myth of over-medication in nursing homes begs clarification

by Isabel Fawcett

Bad news sells big time. There is a perception among the general public that nursing homes over-medicate residents. This may have been true at one time, or limited to some nursing homes. However, most nursing homes administer and supervise medications judiciously. There are recurring and similar circumstances in nursing homes where anti-anxiety prescriptions or anti-psychotics may be the best alternative for certain residents.

Increasingly, nursing homes are glibly accused of over-sedation as an elder management strategy. Like other socially glib statements, there is sometimes a shred of truth. It likely does happen in a some nursing homes. Like anything else, there is always more than one side to any story.

Broken Eldercare Record

I cringed when a stand-up comedian made fun of his grandmother and other chronically ill elders who are prescribed multiple medications for chronic diseases. The punch-line of the joke is that elder prescriptions presumably appeal to types like the comedian, whatever the comedian's social profile may be.

The comedian would welcome access to his elder's prescriptions? That's his problem. Such humor is insensitive of elders who are chronically ill, not to mention an affront to ethical treating physicians, whom I believe to be in the medical majority.

It would be nice if the latest eldercare bashing were limited to tasteless stand-up comedy. Some law firms and experts of other types, use the 'o-word' on their websites with impunity to target and stir a segment of the general public into looking for over-sedation and over-medication of their elders as a possible sign of elder neglect and abuse in nursing homes. What a tragic oversimplification of a complex eldercare social issue. Chronically ill elders don't need to be nickel-and-dimed to death.

I would hope that the vast majority of the general public is able to objectively weigh the larger picture of eldercare issues in nursing homes, including how and why elders who are chronically ill may require, and be prescribed, sedatives such as anti-anxiety and anti-depressant medications.

Management of Chronic Diseases is an Ongoing Juggling Act

My own lens on this eldercare social debate comes from 10 plus years as an unpaid caregiver, both full and part-time. Add to that the fact that I was a former management professional in large acute care hospitals, as well as a management professional background for a (for-profit) provider of long-term care with locations across the US and in Japan.

Eldercare Reality

For various reasons not limited to chronic diseases, some elders become easily disoriented, whether at home or in healthcare institutional settings. Sudden-onset illnesses of limited duration also may contribute to, or escalate, an elder's cognitive confusion.

It is not uncommon for some elders to demonstrate defiant independence toward family members, fellow nursing home residents and/or direct care workers. It is a reality of eldercare that some chronically ill elders may pose a direct threat to themselves, other residents, patients and healthcare staff.

Have you ever witnessed uncontrollable sobbing by a distraught elder who is crying for a loved one long-since deceased? Sometimes the crying lasts for hours in spite of multiple caring reassurances from others. In a nursing home, chronic bouts of crying and loud rants by any resident can be heard easily in corridors by staff and visitors. Other elders who are residents in the same nursing home reasonably may become alarmed, agitated, or (further) confused by unexplained noises.

Although I do not have a loved one in a nursing home, I have seen such situations more than I care to recall. I have also visited nursing homes where my arm or other parts of my body have been grabbed by more than one resident. That can be a frightening experience for a visitor and, I would imagine, even more so for a fellow resident. One elder's uncontrolled, acted-out behaviors will affect other nursing home residents, visitors and staff in the same nursing home.

After long days filled with steady, competing and confusing distractions, some elders become increasingly agitated. I have seen and helped search for missing nursing home residents, later found wandering aimlessly outdoors in the middle of the night. Elders sometimes wander in search of their former home, a familiar face, or anything that may alleviate the elder's feeling of being lost, abandoned and confused.

One of my relatives was placed in a nursing home for his own safety after he became lost. He was found the following day wandering far away from his own home in the wee hours of the morning. Some elders are oblivious to rules of pedestrian or vehicular traffic. Mobility impairment issues don't preclude some elders from going on such unsafe excursions.

Nursing Home Staff Cannot Be All Things to All People

Generally, nursing home staff is doing its best to repeatedly re-direct and manage dangerous, unsafe, and sometimes compulsive behaviors in elders.

When nursing home staff is doing everything possible:

  • Is it ethical, reasonable, practical, or safe for an agitated, sometimes violent, elder to be allowed to continue unchecked on a collision course to disaster? In a recent tragic news headline, a nursing home resident physically attacked and mortally wounded another resident in the same nursing home. Dollars-to-donuts that the elder-attacker was not over-medicated. I may be wrong on that, but that's my educated guess. Thankfully, such situations are the exception and not the norm for the industry. Yet resident, staff and visitor safety risks should never be ignored by responsible directors of nursing and/or nursing home administrators.
  • Nurses are required to timely identify, document and report eldercare health concerns to treating physicians to ensure prompt, safe and effective remedial action.
  • Failing all other reasonable (recurring) nursing interventions, the treating physician's responsibility is to prescribe the most effective sedative or anti-anxiety medication that may help the elder calm down, rest, and eventually re-join nursing home or acute care socialization, when possible. Sadly, in some instances that may not be a realistic medical outcome.

Temporary, medically supervised 'time-out' may be the lesser evil in some eldercare circumstances. Ask a doctor or a nurse. Ask a direct care worker in any nursing home. Ask caregivers, even. Any one of us, I believe, will share true stories that will make your head spin.

In eldercare, as with most things, society needs to avoid throwing out the baby with the bathwater. The mission of nursing homes is larger than the needs of any single individual. Safety and common sense must prevail for the common good. Like caregivers, nursing home staff must make the best judgment calls for elders in their care based on the totality of circumstances.

Until all social critics of eldercare walk a mile in the shoes of nursing home personnel, it is prudent to ask well-qualified doctors experienced in long-term care, overworked nurses and direct care staff about the realities of eldercare rather than tarnishing an entire industry with the oversimplified 'o-word.'